Antidepressants: Society duped?

Has our society has been duped about antidepressant medication?

It’s estimated that around 10% of the American population is taking an antidepressant. However, a growing body of research seems to indicate that antidepressant medication isn’t much better in the treatment of depression than placebo (sugar pills). The treatment effects of antidepressants may be statistically significant when compared to placebo, but not clinically significant. In other words, if you ask people treated with antidepressants enough of the right kinds of questions, you can find differences between them and people treated with placebo. However, these differences don’t affect their lives or how they feel in any meaningful way.

So why is there such widespread acceptance — indeed, embrace — of antidepressant medication for treatment of depression?

I think there are several reasons. The pharmaceutical manufacturers were able to get their medications approved by the FDA, which lends an aura of legitimacy to them. However, data now made public shows that they obtained that approval by withholding data from studies that showed that their products were less than effective. So the manufacturers sponsored lots of studies, then picked only the ones with favorable results to publish and submit to the FDA. They didn’t publish the studies that showed the medications were ineffective. GlaxoSmithKline was recently required to disclose the data from all of the company-sponsored clinical trials of the antidepressant Paxil; when the complete data set from all of the trials, published and unpublished, was analyzed, it demonstrated that there was very little difference between those taking the antidepressant and the placebo, and that what difference there was probably wasn’t clinically significant. Internal documents from Pfizer (referenced here) regarding its antidepressant Zoloft contain statements like, “… but now we need some help in dealing with the most important issue … i.e the huge placebo response in the continuation phase which wiped out the significant superiority of Zoloft at six weeks,” and “Table III must certainly be deleted.” The manufacturers dealt with this “most important issue” (that is, that there’s no difference between their drug and placebo) by suppressing data and employing ghostwriters and “thought leaders” to carry their message to the prescribers and the patients.

But another reason for the widespread embrace of antidepressants is that there is a wide audience that wants a simple, technical answer to depression, that is comforted to believe that depression is caused by a chemical imbalance, that is relieved that the cure for depression is as straightforward as taking a pill. In fact, it may be that the primary reason antidepressants work at all is simply because we expect them to work — which is to say, they work by the placebo effect more than by any purported adjusting of supposed chemical imbalances.

So what’s so bad about that? As long as people are being helped with their depression, what does it matter if it’s mainly via a placebo effect? It matters in at least two significant ways. First, because we as a society have been duped by the drugmakers, our medical system is set up to pay for throwing pills at people and money into the drug company coffers, rather than paying for the hard, time-consuming, but possibly more effective treatments that involve counseling. Second, these placebos are not benign sugar pills; they cause many serious side effects, including suicidal tendencies, that are responsible for thousands of emergency room visits annually; and some people suffer severe withdrawal symptoms when they try to stop the medications.

So yes, it appears we have been duped, individually and as a society, by the hawkers of antidepressants; and we may find, as with so many other treatments once in fashion but now looked upon with disdain (hormone replacement therapy and bloodletting are two that come to mind), that we have done much more harm than good by our liberal use of antidepressants.

 

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Robin DiSilvestro
Robin DiSilvestro
6 years ago

In response to some of your research, there are several research reports that contradict each other, but the estimate is the effectiveness of anti depressants is somewhere between 10 – 30%. Another fact that is reported in research but often glazed over by reporting venues, is that antidepressants are most effective with CBT or DBT/MBT therapy models. Unfortunately both medical doctors and insurance companies do NOT recommend psychological care consistently to patients and therefore reduce the efficacy of depression treatment by 30-40%. A great deal of overcoming depression is dependent on a dual therapy of increasing the mood pharmacologically and then learning to reframe unhealthy thoughts and behavior patterns. So in part it is unfair to say that antidepressants are ineffectual overall when, for the most part, the treatment plan is at fault. That is a bit like saying Philips head screws are useless when you simply failed to buy a Philips heads screwdriver as part of the needed tools.
Robin DiSilvestro
Mental Health Counselor, Intern

Susan Haack
Susan Haack
6 years ago

Your observations are enlightening; but two other issues come to mind as I read your blog. One is our societal belief that life is supposed to be easy, and our disposition to seek the “easy way out” when it is not: we want NO pain. And for physicians, it is far easier to “push a pill” for ordinary reactive depression (say, for example, due to grief) than to do the harder and more time consuming work of listening. That makes us all easy targets for pharmaceutical slights of hand. Secondly, there has been a significant alteration in the stigma of anti-depressant use. Years ago, when I was much younger, there was a stigma associated with anti-depressant usage; now they are commonly referred to as “happy pills”–not unlike “Soma.” And antidepressants are not alone: I wonder what the approach will be to statins a decade from now? At present they seem to be the fruit of the Tree of Life! We’ve “been there, done that” with HRT as you mentioned. We just never learn…

Scarlet Anna
5 years ago

I’m not a professional one but I often try to cure my or others’ mental problem by psychology treatment (I name it that way- ie: it can be done by listening to some kind of song fit the mood of the patient. Have a walk where they can be calm or feel release. a talk, etc). I have done this because I also have the same thought as this article. I’m not sure that those pills can help. Or in other word, I only use pill when I want to fix something quickly. For long term treatment, I often try to do it naturally (I meant by changing some hobby, eat something naturally that might help or practice something that it helps). Anyway, because I’m not a professional so that I don’t know which statistic is true.

Great article!

I have the same idea with reasons you listed out about “What’s so bad about that?”.

Thanks!

Todd Kramer
Todd Kramer
5 years ago

I’m on citalopram. It doesn’t make life better, but it does make it manageable. I still have issues like everyone, but when I stop taking my medication those problems seem overwhelming and sad. On the medication I don’t give as much thought to things, so I think there is something to be said about SSRIs.

Serotonin is a very important chemical for the central nervous system in all creatures so it’s important that it’s balanced.

So far research suggests that vitamin D is probably the best thing a person can take. It’s by far in my opinion the most powerful of supplements.

The other thing is that society is starting to figure out that seasonal affective disorder is a real thing and that many people become depressed during the winter. As a result, light therapy as talked about at http://www.sadlamps.org has proven to be one of the most successful methods of treatment. This makes sense considering that the D vitamin is also linked to sunlight.