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Do antidepressants benefit from the placebo effect?

February 21, 2012
by Nick Zubko, Associate Editor
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If you didn’t see "60 Minutes" this past Sunday, you missed an interesting piece. Correspondent Lesley Stahl interviewed Harvard scientist Irving Kirsch, a psychologist whose research is raising questions about how effective antidepressants really are.

In the segment, called “Treating Depression," Kirsch, who is the associate director of the placebo studies program at Harvard, made his case for why the difference between the effects of placebos and the effects of antidepressants is “minimal for most people.”

In addition to data from clinical trials published in medical journals, his research used unpublished data that had been submitted to the FDA. That data, according to Kirsch, was from unsuccessful studies that never saw the light of day.

With all the data in front of him, he now concludes that antidepressants provide “no benefit” over a placebo.

“If [a patient was] mildly or moderately depressed, you don't see any real difference at all,” Kirsch explained. “The only place where you get a clinically meaningful difference is at these very extreme levels of depression.”

Of course, the claims are generating plenty of opposition. For example, Dr. Michael Thase, a professor of psychiatry at the University of Pennsylvania School of Medicine, said the statistical analysis “overlooks the benefits to individual patients.”

Thase’s research shows that antidepressants help 14% of those moderately depressed, but offers more for those who are “severely" depressed. While the number seems surprisingly low, he pointed out that it represents “hundreds of thousands of people who are happier and less likely to take their life.”

"60 Minutes" interviewed more experts during the segment, who offered their insights on prevailing issues with overprescribing, the FDA’s approval standards, and how well the field really understands brain chemistry. Put together, the entire picture does raise some concern.

Given the 17 million Americans currently taking some form of antidepressant, is the field monitoring this issue closely enough? Should more questions be asked when clinical trials are completed, especially when so much seems to be left out of the final data?

If you did happen to catch this piece on 60 Minutes, did anything resonate with the experiences you may have had with your own clients? For those who didn’t see it, take a few minutes to read the transcript (or watch it online) and let us know what you think.

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The unaddressed issue is that both placebos and antidepressants do help,so if the antidepressant is discontinued, and the placebo is discontinued, we could expect a worsening in symptoms.

Nick Zubko

Associate Editor

Nick Zubko

@BH_Zubko

www.behavioral.net

Nick Zubko is associate editor of Behavioral Healthcare.