Mood Disorders

Antidepressants

Do they really work?

Antidepressants are used to treat Major Depressive Disorder, and can be prescribed for various off-label uses – mostly notably, children are commonly put on antidepressants for bipolar disorder. Antidepressants can be diagnosed to someone who is not clinically depressed. They can be prescribed to treat pain, insomnia, relieve stress, etc. Poverty and unemployment are some of the most common risk factors for depression (along with virtually all mental disorders). 

In the DSM-V, grief and bereavement over the loss of a loved one is going to be pathologized into a “mental disorder”. In the DSM-III, the time-frame needed to be diagnosed with clinical depression over loss of loved one was about 12 months. In the DSM-IV, that number dropped to 2 months. Now in the DSM-V, that number is now 2 weeks. Can you imagine this audacity? I cannot even begin the fathom how the panel could even suggest something as hypocritical as this. I’m sure those people on the panel have children, and through shortening the time-frame from 12 months to 2 months to 2 weeks, they are saying that if they lose their children, they’ll be okay within 2 weeks and if they aren’t then they should be diagnosed with a mental disorder. 

Antidepressants are usually the first line of treatment. When an antidepressant doesn’t work, then the patient is usually switched to another one. If that one doesn’t work, then another one is prescribed. Then another, and another.  There is a wide variety of these “me-too” drugs for this not to be much of a problem. But if all antidepressants act exactly the same, then why have so many different kinds? Antidepressants in fact do act exactly the same. One is not more effective than the other. It doesn’t matter whether an SSRI, SNRI, MAOI, a tricyclic, or even if a placebo is prescribed. The clinical effect is almost the same. If no antidepressant works for you, a combo is usually created of multiple antidepressants – a drug cocktail. It is a common notion that different antidepressants have different effects on different people. A certain person needs their own specific dosage and kind of antidepressant in order for it to be the most effective. This process is called psychiatric drug tailoring. Meta-analysis of data has shown that switching a person from antidepressant to antidepressant is almost just as effective as keeping the person on the same antidepressant. It doesn’t matter which antidepressant you are switched to. How can this be? 

I believe most of the antidepressant effect is actually due to the placebo effect. People experience symptom improvement in depression from placebo almost as much as they do from antidepressants. The difference between the placebo effect and the chemical effect in depression is quite small.  Antidepressants can just be seen as active placebos -- that is, they have little therapeutic effect with powerful and very noticeable side effects.

Here is a clip with Irving Kirsch talking about the placebo effect:

 
If any of the following information stirs any interest for you, please check out Irving Kirsch’s book The Emperor's New Drugs.

DISCLAIMER: If you or anyone you know is taking a prescriptive psychiatric medication for stress, anxiety, depression, or any other reason deemed appropriate by the prescribing physician, alteration or discontinuation of the drug(s) is NOT recommended. Discontinuation or alteration of prescriptive medications can be life-threatening and can only be done under the authority and supervision of a licensed medical doctor!