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clinical trials of the antidepressant Paxil; when the complete data set from all of the trials, published and unpublished, was analyzed, it demonstrated that there was very little difference between those taking the antidepressant and the placebo, and that what difference there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.