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Do Antidepressants Work?

Antidepressants have been hailed as miracle drug rock stars and vilified as brain-changing happy pills.  All promotion aside—good or bad—are they effective?  The Savvy Psychologist Dr. Ellen Hendriksen digs though the data.

By
Ellen Hendriksen, PhD,
February 28, 2014
Episode #008

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According to the Mayo Clinic, about 13% of Americans—more than 1 in 10—take an antidepressant. 

Of women between the ages of 50 and 64, nearly 1 in 4 take an antidepressant.  Second only to antibiotics, antidepressants are the most commonly prescribed class of medication.  

To clarify, when I say antidepressant, I mean the most common of many classes of antidepressants—the selective serotonin reuptake inhibitors, or SSRIs, like Prozac, Celexa, Lexapro, Paxil, or Zoloft.  They’re safer and cause fewer side effects than other, older types of antidepressants.

So, do they work? Or do they not work?  The answer to both questions seems to be yes.

I know that’s a frustrating answer.  So let’s look at each side.  We’ll start with the claim that they don’t work.

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Antidepressants Don't Work

A 2008 study led by Dr. Irving Kirsch of Harvard Medical School started a big ruckus in the mental health world.  He and his colleagues re-analyzed 35 different antidepressant drug trials submitted to the FDA for the licensing of Prozac, Effexor, Serzone, and Paxil.   He used the Freedom of Information Act to get access not only to the studies that showed the drugs worked, but also to the studies that didn’t show an effect, which were, unfortunately, most of them. 

For individuals with mild-to-moderate depression, they found that treatment with an antidepressant was almost no different from placebo. 

The placebo effect, to review, is improvement due to expectations, not to actual treatment.  The placebo effect is powerful, and leads to real relief through sugar pills, fake acupuncture, and even mock surgeries.

Those with severe depression felt better with antidepressants, but only a little.  Only patients who were among the most depressed of all reported a noticeable improvement.  Overall, placebos were 82% as effective as the antidepressants - not that much of a difference.

Two years later, in 2010, a paper in the prestigious Journal of the American Medical Association found pretty much the same thing.  In sum, the benefit from taking an antidepressant increased as the severity of the depression increased.  In other words, for patients with mild to moderate depression, antidepressants did almost nothing.  But for patients with severe depression, the benefit was considerable.

Considering that most antidepressants are prescribed to people with mild to moderate depression, this is bad news indeed. 

But now, let’s hear from the side that says they do work.....

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