Antidepressants – and the Sensationalist Press

Newsweek has published  a really stunning  article  by its lead science writer,  titled The Depressing News About Antidepressants.  The sub-title is “Studies suggest that the popular drugs are no more effective than a placebo. In fact, they may be worse.” (Newsweek,  February 8th, 2010) The article will be a shock to the 27,000,000 Americans who take these drugs (as of 2005).

It will almost certainly to stir into high gear the  PR departments of  drug companies which sold us $9,600,000,00 worth of antidepressants in 2008 alone (that’s 9.6 billion dollars – I like to add the zeros, just so you compare it to your family budget.

The main source for the Newsweek piece was a article published in the January (2010) edition of  the prestigious Journal of the American Medical Association (JAMA)(1).  The JAMA article was a “meta-analysis” of previous studies. These included both published and unpublished studies submitted to the FDA by drug companies seeking approval for marketing anti-depressant medication.  These studies were financially  sponsored by the drug companies themselves.

Despite making shocking headlines in Newsweek, there are major limitations to the JAMA meta-analysis on which the Newsweek article was largely based. These limitations are too big to warrant the kind of sensationalist journalism published in Newsweek. For instance:

  1. The JAMA article found that while antidepressant medication didn’t work very well for mild-to-moderate depression, it is effective for more severe depression.  In fact, the more severe the depression, the more effective the medication.
  2. There have only been 22 studies of mild-to-moderate depression, and the JAMA meta-analysis only used the data of six (for quite valid reasons).
  3. These six studies studied only two classes of antidepressants: paroxetine and imipramine.  Granted, these antidepressants are among the most widely used, but there are many others also in use.  Paroxetine is a SSRI (with trade names Seroxat and Paxil.)  Imipramine was the first tri-cyclic antidepressant developed in the 1950s (with  trade names such as  Antideprin,  Deprimin,  Deprinol,  Depsonil,  Dynaprin,  Eupramin, Imipramil,  Irmin,  Janimine,  Melipramin,  Surplix,  and Tofranil).

So, really, the JAMA article found that two kinds of antidepressants were not effective for mild-to-moderate depression, NOT that all antidepressants are useless!

Still, mild-to-moderate depression accounts for only 13% of depression.  Also, these studies found that 82% of the effect of anti-depressants were “placebo effect.”  In other words, 82% of the effect of the effect of the (paroxetine and imipramine). antidepressants would  have been achieved if the patients had been given a sugar-pill instead of the drug.

The extra effect of real drugs wasn’t much to celebrate, either. It amounted to 1.8 points on the 54-point scale doctors use to gauge the severity of depression, through questions about mood, sleep habits, and the like (Newsweek).

Dr. Michael Yapko has provided an eloquent summary of the reasons why antidepressants are often ineffective.  Dr. Yapko is  a local psychologist who is a well respected expert on both Depression and Hypnosis. He is in demand world-wide as a teacher and lecturer.  I list two of his many helpful books on my resource page for depression. He has summarized the situation so well that I will just quote his correspondence on the Newsweek article rather than re-invent the wheel:

1) The marketing of these drugs has been intense and misleading, suggesting to anyone who will listen that depression is caused by a chemical imbalance in the brain the drug can presumably correct. There is still no evidence to support that notion, and quite a bit of evidence contradicts it;

2) The fact that the drug companies have hidden data contradicting their inflated claims, manipulated information and lied about the effectiveness of these drugs is only recently coming to light. In my new book, Depression is Contagious, I reviewed evidence presented in major medical journals affirming this shocking reality in the promotion of antidepressants;

3) The research is now accumulating quickly, and is reviewed thoroughly in the new Newsweek, that antidepressants perform little better than placebos and can be dangerous for some people;

4) The evidence is massive that depression arises from many contributing factors, some of which are cognitive, some of which are social, and some of which are behavioral. Antidepressants don’t work because they can’t work on these significant factors. No amount of medication can help you build social skills and relationships, teach you problem-solving skills or change your history. Psychotherapy matches and even exceeds medication in success rate and beats it hands down in reducing relapses.

I would add, and I think this is important:  this research does not mean that antidepressants are not helpful for some people.  Yes, they can be very helpful for some people.  But, they are over-prescribed and as I discuss elsewhere on this website, the need for them must be carefully assessed.

(1) Fournier JC, DeRubeis RJ, Hollon SD, et al. Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA. 2010;303:47-53. Abstract

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