BY PHILLIP MANNING
My daughter suffers from depression and has long relied on antidepressants to keep her straight. In this book, Irving Kirsch offers her alternatives that he believes are superior to her pills.
The first sentence spells out his position on the $11 billion a year business that supplies her. “Like most people,” he writes, “I used to think antidepressants worked.” The rest of the book explains why he changed his mind. He contends that the standard antidepressants – Prozac, Paxil, and Celexa, among others – used by millions of Americans are no more effective in treating depression than sugar pills.
This is an extraordinary claim, and as the renowned scientist Carl Sagan said, “Extraordinary claims require extraordinary evidence.” Kirsch, an emeritus professor of psychology at the University of Connecticut who now lives and works in the United Kingdom, uses clear no-nonsense prose to marshal the extraordinary and convincing evidence needed to support his position.
His arguments revolve around the placebo effect, the improvement in symptoms many people experience after sham medical treatments. Placebos can be enormously effective in treating a variety of ailments. They work, Kirsch tells us, because they “instill hope in patients by promising them relief from their distress.” The hope comes from the patients’ belief that they are getting real medicine.
He and a colleague collected and analyzed data from 38 clinical trials (later expanded to 47) involving 3,000 people. Those who took no treatment improved only slightly. Those who took drugs or underwent psychotherapy improved much more. However, patients taking placebos also improved markedly, about 75 percent as much as those getting real antidepressants. Kirsch argues that the difference between drug and placebo is not real but merely an artifact of the way clinical trials are run.
In double-blind trials such as those in Kirsch’s meta-analysis, neither the doctors administering the medication nor the patients are told whether they are getting the medicine or the placebo. However, because antidepressants cause side effects and placebos do not, many patients figure out which one they are getting. And if you know you are taking a placebo rather than real medicine, you eliminate the expectation of improvement – and the effect vanishes. “If this is the case,” he says, “then there is no real antidepressant drug effect.”
So, how should depressed people now on antidepressants go about finding relief? The answer is not simple. Changing medications is tricky. Kirsch issues a stern warning near the end of the book: “Antidepressant medication should not be discontinued without first discussing it with your doctor.” The sometimes serious withdrawal symptoms can fool patients into thinking that their depression has returned, in which case many climb back on the pill treadmill.
However, if you have been recently diagnosed or are dissatisfied with your
current medication, Kirsch recommends that you consider psychotherapy after
consulting with your doctor. His analysis showed that psychotherapy works just
as well as drugs – with no side effects. it's
On the other hand, if you are happy with your medications and if they are doing
the job, stay with them. The first rule in treating depression, according to
my daughter, is "If it ain’t broke, don't fix it."