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and Lecturer on Medicine at Beth Israel/Deaconess Medical Center, said his research, which analyzed both published and unpublished trials of antidepressants, challenges the effectiveness claims for antidepressants.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.
1. Treating depression: is there a placebo effect? [transcript]. 60 Minutes. CBS television. February 19, 2012. http://www.cbsnews.com/8301-18560_162-57380893/treating-depression-is-there-a-placebo-effect/?tag=contentMain;cbsCarousel. Accessed February 29, 2012.
2. Leucht S, Hierl S, Kissling W, et al. Putting the efficacy of psychiatric and general medicine medication into perspective: review of meta-analyses. Br J Psychiatry. 2012;200:97-106.
3. Seemuller F, Moller HJ, Dittmann S, Musil R. Is the efficacy of psychopharmacological drugs comparable to the efficacy of general medicine medication? BMC Med. 2012;10:17.
4. Davis JM. Overview: maintenance therapy in psychiatry: I. Schizophrenia. Am J Psychiatry. 1975;132:1237-1245.
5. Davis JM. Overview: maintenance therapy in psychiatry: II. Affective disorders. Am J Psychiatry. 1976;133:1-13.
6. Davis JM, Giakas WJ, Qu J, et al. Should we treat depression with drugs or psychological interventions? A reply to Ioannidis. Philos Ethics Humanit Med. 2011;6:8.
7. Gibbons RD, Brown CH, Hur K, et al. Suicidal thoughts and behavior with antidepressant treatment: reanalysis of the randomized placebo-controlled studies of fluoxetine and venlafaxine. Arch Gen Psychiatry. 2012 Feb 9; [Epub ahead of print]