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Antidepressants: An Emperor with No Clothes?

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On rare occasion, I have reported startling findings that challenge current wisdom: Brain training games do NOT boost intelligence. Traumatic experiences are NOT often repressed. Seasonal affective disorder (wintertime blues) is NOT widespread.

 

The just-arrived lectures from the 2016 Bial Symposium on Placebo Effects, Healing and Meditation, offers another shocker: In an update on his meta-analyses, Irving Kirsch concludes that antidepressant drug effects are close to nil.

 

Here’s Kirsch’s gist: Many, many studies, including unpublished drug trials made available by the FDA, consistently show that

  1. Antidepressants work. They produce clinically significant benefits (using a standard depression scale).
  2. Placebos work, too. In two large meta-analyses, placebos produced 82 percent of the antidepressant effect. Moreover, “the difference between drug and placebo is . . . so small that clinicians cannot detect it.”
  3. Side effects can “unblind” a drug. The statistically (but not clinically) detectable drug effect may be attributable to antidepressants’ detectable side effects.
  4. The FDA only counts “successful trials.” Kirsch reports that despite meager evidence of antidepressant efficacy, the drugs gain approval because of a stunning FDA policy—which ignores trials that find no drug effect and reports only successful trials.
  5. “All antidepressant drugs seem to be equally effective.” As one would expect from a placebo effect, the benefits of various antidepressant drugs are “exactly the same regardless of type of drug.” Various serotonin-increasing drugs relieve depression, but so does a drug that decreases serotonin! “What do you call pills, the effects of which are independent of their chemical composition?,” asks Kirsch. “I call them ‘placebos.’”

 

Given that antidepressants work, even if they are hardly more than active placebos, what’s a clinician to recommend? Kirsch notes three considerations:

  1. Antidepressants have side effects, which can include sexual dysfunction, weight gain, insomnia, and diarrhea.
  2. Antidepressant use increases the risk of relapse after recovery.
  3. Cognitive behavioral therapy, acupuncture, and physical exercise also effectively treat depression.

Ergo, “When different treatments are equally effective, choice should be based on risk and harm, and of all of these treatments, antidepressant drugs are the riskiest and most harmful. If they are to be used at all, it should be as a last resort.”

But surely this is not the last word. Stay tuned for more findings and debate.

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About the Author
David Myers received his psychology Ph.D. from the University of Iowa. He has spent his career at Hope College, Michigan, where he has taught dozens of introductory psychology sections. Hope College students have invited him to be their commencement speaker and voted him "outstanding professor." His research and writings have been recognized by the Gordon Allport Intergroup Relations Prize, by a 2010 Honored Scientist award from the Federation of Associations in Behavioral & Brain Sciences, by a 2010 Award for Service on Behalf of Personality and Social Psychology, by a 2013 Presidential Citation from APA Division 2, and by three dozen honorary doctorates. With support from National Science Foundation grants, Myers' scientific articles have appeared in three dozen scientific periodicals, including Science, American Scientist, Psychological Science, and the American Psychologist. In addition to his scholarly writing and his textbooks for introductory and social psychology, he also digests psychological science for the general public. His writings have appeared in four dozen magazines, from Today's Education to Scientific American. He also has authored five general audience books, including The Pursuit of Happiness and Intuition: Its Powers and Perils. David Myers has chaired his city's Human Relations Commission, helped found a thriving assistance center for families in poverty, and spoken to hundreds of college and community groups. Drawing on his experience, he also has written articles and a book (A Quiet World) about hearing loss, and he is advocating a transformation in American assistive listening technology (see www.hearingloop.org). For his leadership, he received an American Academy of Audiology Presidential Award in 2011, and the Hearing Loss Association of America Walter T. Ridder Award in 2012. He bikes to work year-round and plays daily pick-up basketball. David and Carol Myers have raised two sons and a daughter, and have one granddaughter to whom he dedicates the Third Edition of Psychology in Everyday Life.