The rise and fall of antidepressants

Newsweek has an excellent article that charts the rise and fall of antidepressants from their status as a wonder drug that made people ‘better than well’ to the recent evidence that suggests for many people, they’re not much better than placebo.

The piece particularly follows the work of psychologist Irving Kirsch who was the first to conduct a meta-analysis of the effects of anti-depressants back in 1998.

Titled “Listening to Prozac but hearing placebo” it suggested that the drugs were hardly more effective than placebo and, for many, marked Kirsch out as a biased and dangerous ‘anti-psychiatrist’.

However, later studies in a similar vein by both Kirsch and others have supported his original findings and many countries have now changed their treatment recommendations as a result.

The Newsweek article tracks this story but also picks up on many important subtitles in the story, notably that the research doesn’t suggest that antidepressants are useless – quite the opposite – just that their effect is only in part due to their direct chemical effect; and that many patients in trials work out that they’re not taking placebo because of the side-effects and this realisation can trigger a stronger placebo effect.

It also integrates evidence from the recent STAR*D study, one of the most complete on the best methods to treat depression.

If you want a good overview of the debate on the effectiveness of these iconic drugs, this is a good place to start.

Additionally, if you’re interested in a good analysis of the most recent study in this area, just published in the Journal of the American Medical Association, the Neuroskeptic blog has a great write-up and analysis of what this means for the concept of depression itself.

Link to Newsweek piece on antidepressants (via @DrDavidBallard).
Link to write-up of JAMA study at Neuroskeptic.

2 Comments

  1. Posted February 3, 2010 at 9:52 pm | Permalink

    Found you via Times Online top 30 list, congrats! Looks good in general, I’ll come back and read more later, but I had to comment about this post.
    I understand the underlying research has very valid points about anti-depressants and placebos, but this Newsweek article is certainly not excellent.
    1. “antidepressants are basically expensive Tic Tacs.” Great quotable, but lousy science journalism. The tic tacs don’t work anywhere near as well as antidepressants for severe depression.
    2. Almost only authors of studies with similar findings are quoted in the story. The one exception: “Even defenders of antidepressants agreed that the drugs have ‘relatively small’ effects.” And the drug company quotes, but they are easily disregarded as biased. There is not one neutral source to evaluate the claims. I’d say this the definition of a puff piece.
    3. “the difference was minuscule” One-third better is minuscule?
    4. “the editors of the journal Prevention & Treatment ran a warning with his paper, saying it used meta-analysis ‘controversially.'” Hid this rare rebuke in smarmy paragraph.
    5. “emperor had no clothes” Quote sources, otherwise don’t bother.
    6. “Why that should be remains a mystery, admits coauthor” Maybe because antidepressants work for severe depression?
    Bad Science wrote up some problems with the main study here: http://www.badscience.net/2008/02/619/
    See “One more thing” after the pictures.
    Anyway, sorry to rag on here, my issue is with the article, not you. I still look forward to more reading.

  2. Posted February 4, 2010 at 9:56 pm | Permalink

    Science Based Medicine has a write-up on the new JAMA article.

    http://www.sciencebasedmedicine.org/?p=3722


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