Antidepressants Are Placebos

Do antidepressants actually work to treat depression? They do have some effect, although in most studies the effect is barely distinguishable from the placebo control.

Irving Kirsch, a psychiatry professor in the UK, first discovered this through his interest in the placebo effect. His recent article, Antidepressants and the Placebo Effect(1), explains. The following are the most important points:

  • clinical trials show little difference between placebo and drug
  • any difference at all could be due to an enhanced placebo effect, since almost always both patients and doctors become “unblinded” — they guess that they’re getting real medicine
  • in trials without placebo controls, antidepressants have greater efficacy, since patients know they’re getting a real drug — an enhanced placebo effect
  • whether the drug raises serotonin, lowers it, or doesn’t affect it at all, the antidepressant efficacy is always about the same
  • therefore, the serotonin theory of depression “is as close as any theory in the history of science to having been proved wrong”
  • it follows that doctors should quit prescribing antidepressants and use therapies with no side effects, don’t depend on the placebo effect, and have been shown to work, namely psychotherapy and exercise.

The reason why both patients and doctors become “unblinded”, that is, they guess that they’re getting medicine, is because antidepressants have side effects, like insomnia and sexual dysfunction.

Kirsch remarks, “In the data sent to us by the FDA, only 43% of the trials showed a statistically significant benefit of drug over placebo. The remaining 57% were failed or negative trials.”

The FDA requires two clinical trials showing benefit before drug approval. But pharmaceutical companies are allowed to keep trying until they get two good trials, hence the negative trial’s don’t count.

Furthermore, Kirsch carefully distinguishes between statistical benefit and clinical benefit, and he says that in almost all cases, the minute statistical benefit would not be enough for doctors to notice or for actual benefit to the patient.

As in so many other cases, this is now all about money. Big Pharma isn’t about to let go of its cash cows, and it has enablers in the FDA and among bought-and-paid doctors and scientists.

If serotonin “imbalance” doesn’t cause depression, what does? Depression is an inflammatory disease. Anything that fights inflammation will fight depression: exercise, weight loss, low-carbohydrate diet, curcumin, etc.

PS: This post is shorter than usual. I have such a backlog of things that I want to write about, but I’m too busy to write thousand-word articles about them, so I may try a few of these shorter pieces.

PPS: Slightly related: check out the list of side effects of another psychoactive drug, Aricept, used to treat dementia.

aricept

PPS: Check out my Supplements Buying Guide for Men.

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6 comments
David says June 3, 2016

Only thing I noticed from my admittedly very brief time on them was feeling very drowsy, almost ran off the road driving and had to let someone else take over

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Herman Rutner says June 3, 2016

As a retired industrial scientist with experience in analyzing clinical trial outcomes at 3 major Rx and medical device companies, I agree that placebo effects are often nearly as high as drug effects considered effective. A more meaningful new drug protocol would be testing against an existing approved drug or preferably an older established drug, in a direct A-B comparison, if available. Furthermore, testing of both drugs should be done on the same patient, sequentially with a sufficient washout interval, to eliminate often large patient specific differences in drug metabolism complicating differentiation of toxic from ineffective doses to get optimal dose ranges even with huge ph3 studies, the major cost in new drug development at high failure rates.

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Kavin says June 4, 2016

This doesn’t reflect my personal experience at all. For the many years while the medications worked, they worked well and I became a far more functional, effective human being. When they stopped working months ago I fell into and continue to have episodes of suicidal tendencies. All I can due is endure and pray during the worst of times. I agree that inflammation is probably an underlying cause but all attempts so far to address that theory have not yielded results, either before or after the meds quit working. My diet is CLEAN. It would be nice and I wish it was so simple a problem, it is not and for the 47% for whom medication is effective it can be the difference between quality of life and wishing for it to all end. There are still options out there for me to try, I can’t try them all at once and between episodes I’m researching and applying them one by one. I agree with most of your health advise and have applied it, this article however seems more of a blind pharma attack. As much as I dislike how pharma operates, it would be unfair to say these meds are nothing short of life savers for a percentage of us.

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Rick Darby says June 5, 2016

Statistical studies on experimental populations have their place, but I expect you would not claim they are the last word. I’d like to see a large-scale survey of patients who have used anti-depressants and see what they have to say, based on their experiences before and after use — before, or after, use being the control. My guess is that a significant number would say they derived some benefit from the meds.

Sure, that doesn’t completely eliminate the placebo factor — I can’t imagine any experiment that could — but results from those who know what depression feels like, in a large enough sample, seem to me as valid as an “objective” study by researchers who rely on standardized criteria instead of personal experiences of depression sufferers.

My own experience is that anti-depressants offer some benefit, though certainly not a cure. When I ditch anti-depressants entirely both I and my wife perceive a difference. (It matters little which anti-depressant is used — the effect is modest but real, sometimes strong for a brief period but then sinking to a baseline, which is still better than the no-meds condition.) This is the conclusion I have drawn from years of individual trials, and it sure doesn’t feel to me like a placebo effect.

I wouldn’t dispute that there may be inflammatory and other causal factors in depression, much less claim that meds are the only valid intervention. But for many people they offer some relief, which I think a major survey of those actually affected would confirm.

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FormerlyBigFatGuy says June 6, 2016

Aricept.

In the process of killing my mom, the doctors followed a lucrative protocol of unnecessary surgeries and worthless pharmaceutical offerings. The many surgeries slowly scrambled her brain — especially her knee replacement surgeries — so, having induced dementia, the wise doctors then prescribed Aricept to treat it. Aricept caused mom to talk in her sleep. She would gesture and point to things as if she were still awake.

Over time, more and more pills were prescribed. One was an iron supplement. (That’s right, Dennis, more iron.) I told her, “Mom, these pills aren’t helping you. Throw them away. You don’t need this.”

“Got to do what the doctor says,” was her only reply.

In the end, the doctors could not fix mom as there was nothing wrong with her in the first place aside from being too fat, but the medical-pharmaceutical complex sure made a lot of money off her, and I guess that was the point all along.

My sister, having learned nothing from mom’s experience, subscribes to the antidepressant, Lexapro. She put her kids on it. She wants me to take it too.

I confess I find myself in low spirits these days over the deliberate and calculated destruction of my country, still I would rather face reality than soften it. As Edmund Burke said, “Never despair, but if you do, work on in despair.”

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    P. D. Mangan says June 6, 2016

    FBFG: What a sad story, and I’m sorry to hear it. My own mother was recently prescribed Aricept, even though she has no dementia, she’s just very old. I had asked the doctor to consider prescribing Deprenyl, the Parkinson’s med that increases lifespan and prevents dopamine neuron loss, and she came back with a scrip for Aricept. She then proceeded to have nightmares so bad that she didn’t want to go to bed at night. The doc was informed, took her off the Aricept, and the nightmares stopped. Boy, was I pissed off.

    I agree with your other sentiments here. The medical system is in terrible shape. You can free yourself from its grip to a great extent by learning and putting into practice the proven methods to good health. But that will save only a few. The rest are following blindly.

    I love that Burke quote.

    Reply
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