

Do Antidepressant Drugs Really Work? (A: As well as sugar pills) - jdnier
http://nutritionfacts.org/video/do-antidepressant-drugs-really-work

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dalke
The basis of this link is the 2008 New England Journal of Medicine article by
Kirsch at
[http://www.nejm.org/doi/full/10.1056/NEJMsa065779](http://www.nejm.org/doi/full/10.1056/NEJMsa065779)
.

Quoting from a more recent (2014) scientific article on the issue, "Are
antidepressants clinically useful? Conclusion of a decade of debate" at
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4102296/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4102296/)
(the key paragraph is at the end, but I provide the first few paragraphs for
context):

> During the last decade, a number of meta-analyses have questioned the
> clinical usefulness of antidepressants, and exposed a significant
> publication bias and low effect size in comparison to placebo 1–9. The most
> important implication has been that antidepressants might not have any
> effect at all in mildly depressed patients 1,4,5. Several authors and
> agencies, such as the National Institute for Health and Clinical Excellence
> (NICE), have suggested the utilization of “alternative” treatment options
> (e.g., exercise and psychotherapy) in mildly depressed patients, and
> pharmacotherapy only for the most severe cases. An immediate consequence of
> this is that patients suffering from mild depression may be deprived from
> receiving antidepressants.

> The Kirsch hypothesis concerning depression 10,11 is that there is a
> response which lies on a continuum from no intervention at all (e.g.,
> waiting lists) to neutral placebo, then to active and augmented placebo
> including psychotherapy, and finally to antidepressants, which exert a
> slightly higher efficacy probably because blinding is imperfect due to side
> effects (enhanced placebo). This hypothesis has triggered much interest from
> the mass media and from intellects outside the mental health area, often
> with a biased and ideologically loaded approach 12.

> Two early efforts to re-analyze the Kirsch data set using different
> methodological approaches 15,16 independently reported results quite similar
> between them but different from those published by Kirsch. A recent multi-
> meta-analysis 17 utilized the Kirsch et al dataset and concluded that the
> most probable effect size of antidepressants relative to placebo is 0.34
> (0.27-0.42) and that there is no significant effect of the initial severity
> of depression.

...

> The series of meta-analyses performed during the last decade made
> antidepressants perhaps the best meta-analytically studied class of drugs in
> the whole of medicine. The results of the recent multi-meta-analysis is
> likely to close the debate, _suggesting that antidepressants are clearly
> superior to placebo and that their efficacy is unrelated to the initial
> severity of depression. Thus, there seems to be no scientific ground not to
> use antidepressants in mildly depressed patients._

(Emphasis mine.)

