Are antidepressant drugs better than placebo for depression?

by James Baker, MD

Clinical psychologist Irving Kirsch is selling a new book in which he argues that anti-depressants aren’t much better than placebo.  He bases his claim on sophisticated statistical studies he has done that combine the results of antidepressant research trials from over the years.

The scary part is that he had to use the freedom of information act to get a hold of some of the studies.

His analysis shows that for all but very depressed patients, the impact of using antidepressants wasn’t any better than using placebo.

This turns out to be very similar to the results of a recent study published in JAMA — antidepressants didn’t really help mild depressions.

So, what to do if you are depressed?

First – most research says to do both medications and psychotherapy.  The outcomes are much better than with either one alone.

Second – if your medication is working, don’t worry about Dr. Kirsch’s opinion.   And if your medication doesn’t seem to be working, change it.  Some critics of Dr. Kirsch say his analysis just shows that the first drug used by most people isn’t the best one for them.

And if you need to change drugs, think about this.

My anecdotal experience has been that the newer generation of antidepressants, the SSRI’s, are just not as powerful as the older generation, the tricyclics.  But the older medicines have been so demonized and marginalized through powerful marketing of the newer ones, they are seldom used today.

James Baker is a child and adolescent psychiatrist with Metrocare Services who blogs at Mental Notes.

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