There is a wide range of medications indicated for depression. These drugs are supposed to be effective in alleviating depressive symptoms. Recent studies, however, question whether is it really effectiveness or simply placebo effect?
Antidepressants are currently among the bestselling drugs. A few years ago, during the panic about avian flu, the pharma industry was urged to step up on developing a vaccine against the pandemic flu. Some big guys in the industry at first did not express any interest. From their point of view, there is more money to be made from antidepressants that from vaccines. After all, depression is a chronic condition with long-term treatments whereas vaccines are once in a lifetime or at most once in a season drug. Of course, that was before the vaccine stockpiling began. It remains a fact, though, that antidepressants bring in billions of revenues each year. In 2005, an estimated 27 million Americans are taking antidepressants, up from just half of that number a decade before.
A rather controversial study on this topic was a 1998 paper by Irving Kirsch and Guy Sapirstein of the University of Connecticut entitled Listening to Prozac but Hearing Placebo; A Meta-Analysis of Antidepressant Medication. The study analysed data from 19 double-blind clinical trials which involved a toal of 2,318 patients. The main findings of the analysis are that there is virtually no difference between drug effect and placebo effect. In particular, the effect from a xxx.
Due to strong criticism of the metaanalysis, Kirsch and colleagues did another meta-analysis, this time on studies in the US FDA database, which of course included unpublished trial data. The results indicate that antidepressant have a small yet statistically significant advantage (18%) over placebo. Furthermore, this benefit is more evident in patients with severe depressive symptoms than those with low to moderate symptoms. The study led to further debate whether this difference, although statistically significant, is clinically relevant.
The controversy was of course picked up by the media, which critics dubbed as media hype. One such article, for example, was entitled Against Depression, a Sugar Pill Is Hard to Beat and went:
“After thousands of studies, hundreds of millions of prescriptions and tens of billions of dollars in sales, two things are certain about pills that treat depression: Antidepressants like Prozac, Paxil and Zoloft work. And so do sugar pills.”
That was years ago, but the issue remains unresolved. Readers, patients and doctor alike did not really get clarifications. What is clear is that both antidepressants and placebo seem to work against depression, the active drug better among those with severe symptoms. Antidepressants, however, come with certain side effects. In the end, the patient and the doctor should probably weigh the pros and cons about pharmacotherapy for depression. In addition, concomitant therapies such as counselling, behavioural therapy and lifestyle changes need also to be considered.