I was 12 years old when I got diagnosed with major depressive disorder. And when I was about 17, my psychiatrist told my mother that I would have to continue taking antidepressants if I wanted to live a “stable life." But I didn't heed my doctor's warnings. I got off the medication—successfully—at 22.
For many, this is not the case. Depression is a seriously debilitating condition that affects an estimated 18.8 million Americans. The primary forms of treatment are a variety of therapies, such as cognitive and electroconvulsive therapies, antidepressants, or a combination of these. But unlike certain therapies, particularly cognitive therapy, that have proven to be as effective or even better than antidepressants, these drugs have left many with dangerous side effects including a worsening of symptoms and even in a numbing state where daily chores seem monumentally overwhelming. The continuous development of antidepressants, though full of promises, can leave someone wondering, “do antidepressants really work?” According to the Center for Disease Control, there has been a 400% increase in the use of antidepressants between 2005 and 2008. Yet, current research has failed to provide significant evidence of the efficacy and safeness of these drugs.
As the Hippocratic Oath stipulates: “first, do no harm,” medicine should not cause more pain than relief. Still, in recent years more and more studies have not only demonstrated a lack of effectiveness from antidepressants, but have led many to question their method of treatment. In fact, in a February 2012 interview with 60 Minutes, Dr. Irving Kirsch, an associate director of the Placebo Studies Program at Harvard Medical School, revealed that “the difference between the effect of a placebo and the effects of an antidepressant…would be clinically insignificant”. He explained that “people get better when they take the drug. But it’s not the chemical ingredients of the drug that are making them better. It’s largely the placebo effect.” Undoubtedly, Dr. Kirsch’s findings have proven the insignificant benefit antidepressants offer.
In defense of antidepressants, Dr. Michael Thase, a professor of psychiatry at the University of Pennsylvania School of Medicine, said that Dr. Kirsch’s statistical studies belittle the drug’s benefits for each individual. He adds that even though placebos have shown a significant positive effect, antidepressant benefits are more pronounced in moderately to severely depressed patients, especially in general practice. More importantly, what Dr. Thase asserted is that antidepressants are more effective in severe cases of depression. However, the answer as to how much more effective antidepressants can be for these patients may be hard to find.
Numerous pieces of evidence have identified that positive clinical trials were, for the most part, the only ones being published, and may reflect bias from the pharmaceutical companies. In an article published by The New England Journal of Medicine, 74 studies, registered by the Food and Drug Administration (FDA), were reviewed for bias publication of antidepressant trials that could alter their efficacy level. The analysis noted that positive clinical trials were frequently published more so than those showing poor results, which accounted for 31% of the studies. According to the observations made, the negative results that did reach publication were presented in a manner that conveyed a positive outcome. The greatest discovery is that because of the bias publication of these trials, the efficacy of antidepressants may turn out to be less impressive than what the public has been led to believe. It is clear that antidepressants have posed an unreliability in their level of efficacy for the millions who take them and, ultimately, its flaws could potentially prove more dangerous than helpful.
But their worth is subject to dispute. As, Dr. Thase explained, antidepressants can make a difference, especially in the lives of a chronically depressed patients. Some psychiatrists, on the other hand, believe that the benefit is not substantial enough. Dr. Gordon, a clinical psychiatrist and director of The Center for Mind-Body Medicine, described how “in many studies the improvement that was noted [in clinical trials] were only partial – according to the widely used Hamilton Depression Rating Scale, a ‘reduction’ in symptoms of 50 percent rather than a ‘ remission’ of most or all symptoms. Furthermore, the serious side effects these drugs pose can depreciate, not just their monetary worth, but their medical value.
Despite all the research and evidence people are continuing to be prescribed antidepressants, and in many cases its numbing effect is mistaken for efficacy. But perhaps two of the most disturbing side effects that antidepressants may pose are cognitive disabilities and suicidal tendencies. In an effort to alert the public of the potentially fatal side effects, on May 2, 2007 the FDA ordered the extension of the black box warning. This further questions the efficacy of these drugs and points to the threat they can represent to the patients in treatment.
Undoubtedly, antidepressants have not been proven to be the effective drugs they were intended to be. Even when for many, a reduction of symptoms is evident, a full remission is difficult to achieve. A reduction of symptoms does not necessarily represent a positive outcome, when side effects are present. In many instances the side effects are more debilitating and painful than the relief.
In my own struggle with depression, I found antidepressants not relieving at all, but numbing and as the cause of my passivity that ultimately affected me in all areas of my life, more noticeably in school. The question now is, “should antidepressants be considered the best method of treatment?” There is surely enough evidence out there that questions and challenges the inefficacy and potentially harmful effects of antidepressants.
So, the question is: should people question their psychiatrists before filling a prescription? I did.