Antidepressants don't work
“The drugs don’t work…”
Researchers at the University of Hull have carried out an extensive analysis of data for clinical trials of antidepressants. This study is a meta-analysis: that is a statistical review of many trials combining all the results into one overall conclusion. They were trying to discover whether there were any trends in response to anti-depressant drugs that did not show up from individual studies alone.
In February 2008, Kirsch and his team released their results. The findings appeared in many of the major newspapers with headlines such as:
"Antidepressants do not work"
Their results showed a statistically significant benefit when compared to a placebo from the use of antidepressant medications called Selective Serotonin Reuptake Inhibitors (SSRIs). However, for all but the most depressed patients, the statistical difference was so small that it did not reach a level of 'clinical significance'. This is an official level set down by the UK's National Institute for Clinical Excellence (NICE).
In fact, it was only because those most severely depressed patients showed a very low response to the placebo that the drug response in this group of patients became “clinically significant”. In other words, the drug out-performed the placebo because the placebo produced a low level of responses.
I believe that there are two important points to consider, following on from this research.
It is particularly significant that this analysis included that data from a number of previously unpublished studies into particular SSRIs, which the team was able to obtain under the Freedom of Information Act.
Pharmaceutical companies can cherry-pick the trials that they send to the US Food & Drink Administration (FDA) to get approval for their new drug. Therefore research data from pharmaceutical companies is likely only to include successful trials in the submission to the FDA. The randomised controlled trial (RCT) is the current 'Gold Standard' of evidence-based medicine, but it is easy to see how results from these trials could be distorted simply by omitting to send in unsuccessful trial results.
When previously excluded trials were included in the analysis, the strong positive results that had been shown for the effectiveness of SSRIs became almost negligible for many patients. Given the powerful side effects seen with these drugs, you have to wonder if they are worth the risk.
The second important point is the response to placebo. The analysis showed that patients had a strong response to taking the placebo across all the trials that were included in the analysis. This can be taken as an indication of the incredible complexity of depression as an illness. For me, it also shows the power of the mind to heal itself. There is more to the mind/body/spirit connection than we will ever understand.
If this study shows that for most people with depression, “the drugs don’t work”, I believe that it also shows that alternative and complementary therapies can, and should, play a positive role in the alleviation of depression. Whether it be through nourishing the body well in Nutritional Therapy, by treating the body well through Reflexology, or providing respite for the mind through Aromatherapy, to mention but a few of many, many possibilities.
1 in 6 British adults experiences at least one diagnosable mental health problem at any given time. This is somewhere around 8 million people. We should take this opportunity to think about how our own therapy can help depression, and how we offer our services to people who are silently suffering from it.
The research is freely available on line at PLoS Journals
Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration
Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, et al.
PLoS Medicine Vol. 5, No. 2, e45