Treating Depression: Is there a placebo effect?

Summary

Irving Kirsch, a Harvard psychologist, challenges the effectiveness of anti-depressants, suggesting their impact is largely due to the placebo effect rather than the drug's chemical properties. Through extensive research, Kirsch discovered minimal differences between anti-depressants and placebos, even when analyzing both published and unpublished data. This controversial stance has sparked debates within the medical community, with some defending the drugs' effectiveness, especially for severe depression. Meanwhile, the UK has revamped its approach to treating mild to moderate depression, focusing more on therapy and lifestyle changes than medication, questioning the overwhelming reliance on pharmaceutical solutions.

Takeaways

• 😀 Irving Kersh, a psychologist at Harvard, challenges the effectiveness of antidepressants, suggesting their impact is minimal and comparable to placebos for most patients.
• 😀 Kersh's research suggests that the placebo effect, which involves taking a dummy pill, can be powerful enough to alleviate symptoms of various conditions like depression.
• 😀 A placebo can result in real physical changes in the body, such as decreased pain or lower blood pressure, challenging the idea that the effects are purely psychological.
• 😀 In clinical trials, Kersh found that the difference between antidepressants and placebos is often clinically insignificant, especially for those with mild to moderate depression.
• 😀 Psychiatrist Dr. Michael Fahey defends antidepressants, claiming they are effective for many patients, particularly those with severe depression.
• 😀 Kersh's findings have sparked debate, with some defending the widespread use of antidepressants, while others argue that they may be overprescribed, especially for mild depression.
• 😀 Studies show that antidepressant prescriptions have soared, with a significant increase in prescriptions for mild depression, despite these patients benefiting little from the drugs.
• 😀 The National Health Service in the UK has reassessed the effectiveness of antidepressants, recommending them only for severe depression and promoting talk therapies and physical exercise as alternatives for mild depression.
• 😀 The FDA's approval process for antidepressants is questioned, as it only requires two positive trials out of several to approve a drug, even if other trials show no benefit over placebos.
• 😀 Kersh and others argue that drug companies may manipulate the publication of clinical trial data to present antidepressants more favorably, withholding negative results.
• 😀 Despite ongoing controversy, Kersh advocates for non-drug treatments for depression, such as therapy and exercise, which have shown comparable or better results for mild to moderate cases of depression.

Q & A

What is the central claim of Irving Kersh's research regarding antidepressants?

Irving Kersh claims that antidepressants are largely ineffective and that the improvement seen in patients is primarily due to the placebo effect, with minimal or no benefit from the chemical ingredients in the drugs.

What does Kersh say about the effect of placebos compared to antidepressants?

Kersh argues that the difference between the effect of a placebo and an antidepressant is minimal for most people, and for those with mild to moderate depression, there is almost no clinically significant difference.

Why does Kersh believe his findings challenge the conventional view of antidepressants?

Kersh believes that his findings challenge the conventional view because they show that antidepressants may not be much more effective than a placebo, which goes against the widespread belief in their chemical effectiveness in treating depression.

What is the placebo effect, and how does it relate to the treatment of depression?

The placebo effect occurs when a patient experiences improvement due to the belief that they are receiving treatment, even if the treatment has no active ingredients. In depression treatment, Kersh suggests that many patients improve due to the placebo effect rather than the antidepressants themselves.

What were the findings of Kersh's second study on antidepressants?

Kersh's second study, which included unpublished data obtained through the Freedom of Information Act, found that antidepressants were no more effective than a placebo for most patients. Only those with severe depression showed any significant difference.

How do psychiatrists like Dr. Michael Fazio respond to Kersh's findings?

Dr. Michael Fazio and other psychiatrists defend antidepressants, stating that Kersh's analysis overlooks the benefits they provide to individual patients. Fazio argues that while placebos work for some, antidepressants help a significant number of patients, especially those who are severely depressed.

What is the role of the FDA in approving antidepressants, and what is Kersh's criticism?

The FDA approves antidepressants based on two successful clinical trials, even if other trials fail. Kersh criticizes this approach, suggesting that the approval process might allow drugs with only marginal benefits to be marketed.

How have antidepressant prescriptions changed over time, and why is this concerning?

Antidepressant prescriptions have increased by 400% since the 1980s, with a significant rise in prescriptions for mild depression. Experts, like Dr. Walter Brown, are concerned that many people with mild depression are being prescribed drugs that provide little benefit.

What alternative treatments are being recommended for mild to moderate depression?

For mild to moderate depression, treatments like physical exercise and talk therapy are being recommended as effective alternatives. In the UK, the government is investing in training talk therapists to address depression without relying on medications.

What does Dr. Tim Kendall's research reveal about antidepressants and mild depression?

Dr. Tim Kendall's research reveals that for mild to moderate depression, antidepressants offer little to no benefit. His review found that the effectiveness of antidepressants is significantly overstated in published studies and that side effects are often underestimated.