Antidepressants Don't Work
Apologies if the title startled you, but last week, some headlines that shared this or similar sentiments, were splashed over newspapers and the information super-highway. ‘No better than a sugarpill’, declared some. The one consistent feature of most reporting was that it was high in scare tactics and low in fact & detail.
So-called ‘selective reporting’ has long been associated with certain elements of the media. This particular pearl of misinformation must have made millions of people draw breath and ponder what was happening. Hopefully, people currently on antidepressants didn’t decide to throw in the towel and discontinue them?
For those who are uncertain about the origins of this particular media drama, let me fill in the details. Professor Irving Kirsch, from the University of Hull in the UK, wanted to know how well the latest generation of antidepressant drugs stood up to clinical scrutiny. These ‘new generation’ drugs include fluoxetine (Prozac), venlafaxine (Effexor), nefazodone (Serzone) and paroxetine (Seroxat/Paxil). The research team pulled together all published and unpublished data they could find and they analysed the findings. They found that when compared to placebo, the benefits fell below accepted criteria for clinical significance. However, Kirsch stressed that the effectiveness of antidepressants also appeared to depend upon the severity of depression at the outset.
As a psychologist I have to confess a certain lack of surprise, or maybe a passing ‘thought as much’. Psychologists after all, do tend to think of depression as a disorder of thinking more than a disorder of mood, although we generally accept an association between biology and psychology. Coupled with this, cognitive behavioral therapy has a very good track record of success.
So, don’t throw away your antidepressant medication. Antidepressants do still have a positive effect and it can be unwise to simply stop in the middle of treatment. The report itself states:
“there is little reason to prescribe new generation antidepressant medication to any but the most severely depressed patients unless alternative treatments have been ineffective” (p.2).
And here’s the catch. The alternative treatments suggested refer to the ‘talking therapies’ such as counseling and psychotherapy. Exactly where these therapists are supposed to be found eludes me. Most therapists I know struggle as it is to manage their existing case loads. Incidentally, by therapists I mean properly qualified individuals accredited by their professional bodies, not the 12 week trained ‘therapist’.
So, whilst the original source of my gripe is with shoddy reporting, I can’t help feeling equally irritated that viable alternatives to medication are known, tested, but sparse because of the lack of appropriately trained therapists. It seems to me that it is time for a far higher investment in talking therapies. The report is another issue, and there is clearly more scope to investigate the antidepressant/placebo relationship.