http://www.thetimes.co.uk/tto/health/mental-health/article2562303.ece
Do antidepressants works?
Some interesting parts.
Do antidepressants works?
Some interesting parts.
The allegations about these medicines are many and varied: first, that nobody really knows how SSRIs work in the brain; second, that the drugs were licensed on the basis of flawed or unrepresentative clinical trials; third, that if they work at all it is mostly because of the placebo effect; and, finally, that they are marketed aggressively to people who don’t really need them.
His first finding was that about 40 per cent of studies were never published. That means they were never sent to a peerreviewed academic journal. Overwhelmingly, the unpublished studies showed the drugs to be marginally effective or useless. This is known as “publication bias”, when scientists publish work that backs up their theories but quietly bury studies that don’t. Companies will often run the trials again, say with specific patient groups (eg, under-40s, or those with only severe depression), or using different criteria to gauge improvement, until the data looks prettier. This is the (not entirely unfounded) basis for the allegation that drug companies get their products licensed on the grounds of unrepresentative data.
His view is not that they have no effect (in fact, he urges people to carry on taking them); it is, instead, that antidepressants pep up the psyche, rather than restore a chemical imbalance. The reason you feel better after taking antidepressants is mostly because you expect to feel better. He suggests that doctors should be trying other interventions to shoo away the “black dog”, such as counselling or cognitive behavioural therapy, which don’t have a long list of side-effects.
Dr Ted Kaptchuk from Harvard Medical School, who carried out the survey, said that self-reported conditions such as chronic fatigue, arthritis, headache, insomnia and depression are more responsive to placebo treatments than other conditions: “All illnesses have this [psychosocial] component to some extent, but [placebo] is more likely to change outcomes in an illness that is primarily about the patient’s experience.”
In modern medicine, prescribing a placebo does not square with the hallowed principle of fully informed consent, because only an uninformed or semi-informed patient will benefit from it. Placebo is essentially about deception, so it is a question of degree, says Dr David Shaw, lecturer in medical ethics at the University of Glasgow: “There might, under certain circumstances for some medical conditions, be a place for semiinformed consent.