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Saturday, February 13th 2010

The Expanding Universe of Psychoactive Drugs

Newsweek ran a cover a few weeks ago bringing forward old, but hardly well publicized, research on antidepressants versus placebo to the public.

In just over half of the published and unpublished studies, he and colleagues reported in 2002, the drug alleviated depression no better than a placebo. “And the extra benefit of antidepressants was even less than we saw when we analyzed only published studies,” Kirsch recalls. About 82 percent of the response to antidepressants—not the 75 percent he had calculated from examining only published studies—had also been achieved by a dummy pill.

Here’s the 2002 paper Sharon Begley is referencing in her piece in Newsweek.

“Many have long been unimpressed by the magnitude of the differences observed between treatments and controls,” psychology researcher Steven Hollon of Vanderbilt University and colleagues wrote—”what some of our colleagues refer to as ‘the dirty little secret.’ “

Essentially except for those with severe depression, the vast vast majority of benefit seen with antidepressants can be attributed to a placebo effect.

The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial.

That’s the reality that is hardly well penetrated into primary care and the non-psychiatric medical community.

Yeah, Tom Cruise Is Still An Idiot

That raises serious questions about the potential overuse of anti-depressants. Drugs with serious side effects and potential consequences all for a placebo effect.

Don’t get me wrong I am all for the placebo effect. If it works, it works. And depression is a serious illness that needs something to work for it. But with the efficacy of therapy and perhaps other clinical options to draw out the placebo effect you have to question the rate at which anti-depressants are given out. The major problem may be how little the medical field realizes the lack of effectiveness of these drugs beyond the placebo effect.

And I think the treatment of depression is a paradigm for where we’re going with psychiatric diseases in general. Don’t get me wrong. On the margins of the bell curve, where irrefutable and severe psychiatric disease live, psychoactive drugs can do wonders. But with an ever growing list of psychiatric diseases to medicate and questionable effectiveness it’s not beyond questioning psychiatric pharma.

Pathologizing behavior and feelings and thoughts has always been dangerous. Even more dangerous is over medicating for such.