(3 minute read)
There is no question that many people who take antidepressants feel better. The real question is: are they feeling better because of the drug itself, or because they’re taking something that has been prescribed by an authority figure in a white coat that they believe is going to make them better. In other words, is it the drug, or is it placebo? This is an issue that has been getting more attention recently — even 60 Minutes has looked at the question.
And it's an important question, because antidepressants aren’t like vitamins: they have side effects which can be mild — like dry mouth, blurred vision and constipation — or severe, such as loss of sexual desire, nausea, weight gain and (in children and adolescents) increased suicidal ideation and attempts. There are even suggestions that long term use of antidepressants can actually increase depressive symptoms, although the research on this is far from conclusive.
If you’re on these drugs, or considering going on them, here are some facts you should know.
The Research Is Tainted
There is a large body of research over many years that shows that antidepressants are significantly better than placebos. Unfortunately, that research is entirely misleading for a number of reasons. Three of the most important are:
Pharmaceutical companies publish only the studies they like. Much of the research on these drugs is sponsored by the pharma industry, and there’s no law that says they have to publish the results. So they sponsor lots of trials, and when things don’t go so well they simply file the results in the bin. How do we know? Well, in the United States, pharma companies asking the Federal Drug Administration (FDA) to approve a drug have to report all their trials to the FDA. Dr. Irving Kirsch found this out and sued the FDA to get the results of all the trials, not just those that were published. It was no surprise that the unpublished trials showed the drug was no better than the placebo. When all the data was combined, on average, the antidepressants were only slightly more useful than a sugar pill.
Trials are manipulated. Here are just two ways the pharma companies (which either conduct, or fund much of the research) twist the results. First, they sometimes study the effect of antidepressants across multiple clinics or hospitals, but only publish the sites where it seems the drug was more effective than the placebo. So a five site study showing no effect suddenly becomes a two site study showing a strong effect, and the other three sites are ignored. Second, they will publish the same data sliced and diced in a different way with different authors. So a single study showing their drug is effective suddenly becomes three studies. By sheer volume, they drown out the studies showing that the antidepressant is no better than a placebo.
Double blind is broken. To test an antidepressant against a placebo, good science requires that neither the depressed subject, nor the experimenter know which subject is getting the active drug and which is getting the placebo. That’s called a ‘double blind’ study and it’s the only way to know if someone’s getting better because of the placebo effect, or because the drug really works. Unfortunately, in many studies, both subject and experimenter are able to figure out who’s getting the real drug, and who’s getting a sugar pill. How do they figure this out? Well, only the real drug has side effects like impaired sexual function, nausea, dry mouth, etc. So when the subject mentions (or fails to mention) any side effects to the experimenter, both parties can figure out who’s getting the real drug. If you know you’re getting a sugar pill, you’re not likely to feel better, while if you know you’re getting a powerful drug with significant side effects, you’re much more likely to feel better. In studies where the placebo is laced with a chemical that gives similar side effects to antidepressants, lo and behold, whatever edge the drug had over placebo suddenly disappears.
So if a psychiatrist or medical doctor wants to put you on antidepressants and tells you that the research showing their effectiveness is solid, ask them to answer the points above.
Stopping Antidepressants Can Cause Withdrawal Symptoms
These meds are taken so widely that many of us are lulled into a false sense of security, feeling that other than a few side effects, these drugs aren’t harmful. But people do suffer from withdrawal — that’s well documented. What’s worse, withdrawal symptoms include depression and anxiety, disturbed sleep, crying spells, poor concentration and memory…probably the very symptoms that make many people start taking the drugs in the first place. And the immediate conclusion is “My depression has returned” which leads to starting up on the meds again. It’s now standard practice to taper patients off the drugs over several months, although that’s no guarantee that some individuals won’t react badly anyway.
What this means though, is that people going off antidepressants can be fooled into thinking that they need the drug to combat their depression.
The Serotonin Deficiency Theory Is False
We’ve long been told that depression is caused by an imbalance of chemicals in the brain, specifically serotonin. (By the way, 90% of the serotonin in the body isn’t found in the brain — it’s in the digestive tract.) There are even catchy TV commercials that demonstrate this imbalance for consumers.
There’s actually no evidence for depression being caused by a chemical imbalance. Perhaps one day we’ll find what causes depression, and perhaps one day it will turn out to be too much or too little of this or that chemical. But the belief that low levels of serotonin are responsible for depression is at best, too simple, and at worst, flat out wrong.
The Placebo Effect is Stronger Than We Believe
A lot of people do get better when they take antidepressants. But pretty much the same number of people get better when an authority figure in a white coat gives them a sugar pill. Most of us don’t believe we are fooled by the placebo effect, but the evidence says otherwise. Even if you’re fully aware of the possibility that the placebo effect may affect you, it still has its effect. Placebos don’t help you get better from cancer or heart disease, but they have a big impact on psychological problems.
What Should You Do?
So if you come to the conclusion that antidepressants are not for you or a loved one, does that mean you just give up and resign yourself to the situation? Absolutely not: There are two treatments that don’t involve chemicals, have no withdrawal symptoms and no side effects, and have been proven to work very well: psychotherapy and exercise. If neither of those work, then by all means, try antidepressants -- perhaps the placebo effect will work wonders on you.