At first glance, SSRI antidepressants appear relatively effective, seeming to help anywhere from 30% to 50% of their patients. Tens of millions of people around the world take these drugs, believing they will help them get better. Yet independent research casts serious questions about how effective these drugs are at actually treating depression.
In 2002, Harvard psychologist Irving Kirsch and his colleague Thomas Moore used the Freedom of Information Act to get data on the 6 most commonly prescribed antidepressants between 1987 and 1999; Prozac, Paxil, Zoloft, Celexa, Serzone, and Effexor (the first 4 of which are SSRIs). This gave them access to ALL the studies the drug companies were required to submit to the FDA, not just the published ones. The resulting meta-analysis combined data from these widely prescribed antidepressants. What he and his colleagues found is that 82% of the improvement in mood could be duplicated by giving patients a placebo pill instead of an antidepressant. A 2008 study by Kirsch and colleagues produced similar results, showing that antidepressants had no effect whatsoever except in the most severe cases of depression. His conclusion: “Unless your patient is extremely depressed, you shouldn’t be prescribing an antidepressant.” (Gura, 2013)
The picture from other independent research isn’t as rosy. In fact, antidepressant drugs continually fail to show any significant effect over placebos in test results. One review of 29 published and 11 unpublished clinical trials conclude that placebo medications were just as effective as the antidepressant paroxetine, sold as Paxil, in treating moderate to severe depression. (Rubin, 12-11-2008) Another similar study found that antidepressants show only modest effects on the severely depressed, and do nothing for mild to moderate depression. “There is little evidence to suggest that (antidepressants) produce specific pharmacological benefit for the majority of patients with less severe acute depression,” researchers conclude. (Dooren, 1-6-2010)
A January 2010 study in JAMA found that the true drug effect was “nonexistent to negligible” in patients with mild, moderate, or severe depression. (Begley, 2010) Because most antidepressant trials last just 6 weeks (the basis on which drugs are approved), their effectiveness as a long-term solution has been completely unsubstantiated.
A recent study known as the Star*D trial monitored the effects of drug therapy in around 3,000 patients. Of those on antidepressants, only 37% of subjects went into remission (meaning their depression subsided), in an average of around 6.3 weeks. But among this group, 34% of patients became symptomatic again within 12 months. Fifty-one percent of people did not respond at all to the drug, and the rest improved somewhat but not completely. (Marantz-Henig, 2012) These underwhelming numbers show that most people DO NOT respond with antidepressants, and even among those who seem to, more than a third find only short-term relief lasting less than a year.
Overall, the sum of the evidence shows that antidepressant medications are only slightly better than sugar pills at treating depression. (Herper & Langreth, 2010) To give you an idea of how small their effect is, this difference between the placebo and the antidepressant amounted to a two point difference on a 62-point Hamilton Depression Scale, which is commonly used to assess depression. How big is this 2-point difference? It equates to a person being slightly less fidgety in the interviewer’s opinion during the examination. As Marcia Angell states, “While that is statistically significant, it is very unlikely to be of any clinical importance.” (2005, p. 113) In general, antidepressants seem to be little more than a multibillion dollar version of snake oil. (Kirsch, 2010)
As Irving Kirsch states, “The belief that antidepressants can cure depression chemically is simply wrong.” (Begley, 2010) Counselors Richard J. Hazler and Elizabeth A Mellin (2004, p. 23) write that “Psychiatrists typically only attempt psychopharmacological treatment for adolescent depression when other psychological interventions have failed because such treatments have not proved to be particularly efficacious (Moreau, 1996).” I only wish this were actually the case. In fact, most practitioners prescribe medications first, either because it’s written by a general practitioner or because medication is what the patient wants.
How antidepressant use has effected historical trends in depression
The data on larger population trends also paints a skeptical picture. If these drugs work so well at treating depression, then depression rates should be trending downwards since their introduction. After all, millions upon millions of people suffering from depression are using these drugs, so it should be treating their condition and leading to a decline in depression rates, in the same way that rates of a disease plummet once a vaccine or an effective drug is introduced.
Instead, precisely the opposite trend is occurring. Despite a drastic explosion in the use of antipsychotic medications, the rates of mental illness have vastly increased since the introduction of such drugs in 1954. (Fitzpatrick, 5-3-2010) Now it’s quite possible that modern living conditions are simply fueling rates of depression. Yet by 2005, 27 million Americans were taking an antidepressant–more than twice the number of 10 years earlier. (Bauldauf, 2009) In the midst of such widespread antidepressant use, rates of depression continue to climb rather than decline. Such statistics should illustrate that for whatever improvements SSRIs might be bringing, they are certainly not a miracle cure for what ails us.
“My view is that we really don’t have good enough evidence that antidepressants are effective, and we have increasing evidence that they can be harmful. So we need to stop this increasing trend of prescribing them.”
– Psychiatrist Joanna Moncrieff (Kwon, 2016)