On the Efficacy of Psychiatric Drugs
On the Efficacy of Psychiatric Drugs
In a recent interview on 60 Minutes, Harvard psychologist Irving Kirsch, PhD, commented, “the difference between the effect of a placebo and the effect of an antidepressant is minimal for most people.” 1 However, a newly published “panoramic overview” of 127 meta-analyses challenges that asser-tion by demonstrating how psychiatric drugs, including antidepressants, are as efficacious as drugs used to treat general medical conditions.2
“Our study puts the effectiveness of psychiatric drugs and general medical drugs into perspective,” lead author Stefan Leucht, MD, Assistant Professor in the Department of Psychiatry and Psychology at Munich Technical University in Germany, said in a press announcement. “There is a deep mistrust of psychiatry, fostered by reports suggesting that the efficacy of psychiatric drugs is very small. Psychiatrists, patients, carers, and the media are often unsettled by these findings, and some may think that psychiatric medication is not worth the bother.”
In CBS’s 60 Minutes segment, Kirsch, Associate Director of the Harvard-wide Program in Placebo Studies and the Therapeutic Encounter and Lecturer on Medicine at Beth Israel/Deaconess Medical Center, said his research, which analyzed both published and unpublished trials of antidepressants, challenges the effectiveness claims for antidepressants.
“If they [patients on antidepressants] were mildly or moderately depressed, you don’t see any real difference at all. The only place where you get a clinically meaningful difference is at these very extreme levels of depression,” Kirsch said.
He went on to explain that the reason most people who are taking antidepressants get better relates to the placebo effect and “not because of the chemicals in the drug.”
Later, in a 60 Minutes Overtime show, interviewer Lesley Stahl acknowledged that her husband has taken antidepressants for years, and she noted, “we know they work.” She found the placebo-effect discussion very “confusing” and worried about Americans discontinuing their antidepressants without consulting their physician.
John Davis, MD, a coauthor of the meta-analyses review and Research Professor in the Department of Psychiatry at the University of Illinois at Chicago, urged health care professionals, journalists, and others to “do their homework” before mak-ing pronouncements about placebo effects and efficacy of psychiatric drugs, because the consequences can be deadly.
“I personally know of patients who have quit taking their medications and ended up back in the hospital,” he said. “And I know of others who went off their meds, had a recurrence of depression and committed suicide.”
Davis likened the controversy over the efficacy of psychiatric medications to the widespread scare linking the vaccine for measles, mumps, and rubella to autism. There is, he said, a similar anatomy—lack of credible evidence tying the vaccine to autism; extreme opinions; sensationalism in the press; and health professionals and patients seeking fame by promoting the link as a cause clbre. All of this has led to children not being immunized, unnecessary mortality and morbidity, and possible loss of herd immunity in some countries.
Hope is the best medicine. Whether "hope"comes as a form of soothing words from the health care professionals and/or as a form of an antidepressant, it is the essential ingredient for the recovery of the depressed people. It is true that we are taking the infant steps in the mazes of serotonin, neuroepinephrine, dopamine and other neurotransmitters. Hope one day we can take a firm step and declare "this will cure you." Until then let the research continue and keep the hope alive.
The New York Times magazine section from April 22, 2012 has a great article discussing this issue as well as mechanism of actions. It pointed out the flaws of Kirshes work, including flawed studies and excluding good ones. It also pointed out the evidence for neurogenesis with antidepressants.
Excellent article and News coverage about antidepressant efficacy and the placebo effect.
I believe Great Britain's approach is the best, and that is to not prescribe so many medications and use other forms of treatment for the mild to moderately depressed patients. All clinical trials need to be included in published results, not just the ones that make the drug companies $$$.
All medicine and specifically behavioral health medicine needs to be totally revamped to include multiple disciplines (counseling, exercise, spiritual principles) rather then relying on "pills" to be the great panacea for all ills! What it comes down to is, our beliefs and hopes really do go a long way towards improving our health. We can't get a lot of that motivating faith if we take a pill and sit in front of the T.V. watching Jerry Springer.

Excellent article--thanks, Arline and Dr. Davis. Taken along with recent observational data showing that antidepressants actually reduce suicide risk [Leon et al, J Clin Psychiatry. 2011 May;72(5):580-6. ], it is time to put an end to the "antidepressant as sugar pill" canard. --Ron Pies MD