Are conventional antidepressants simply placebos?
On Wednesday 6th October the Lincoln Academy hosted a talk by Irving Kirsch, professor of psychology at the University of Hull, in which he suggested exactly that. His meta-analyses of the published and unpublished trials of antidepressant drugs show only a small, clinically insignificant, difference between drug and placebo. And then even this small difference can be explained by patients ‘breaking blind’: the side-effects of the drugs are a giveaway that the patient is taking the ‘real drug’ and not placebo, causing an enhanced placebo response as compared to people who suspect they are only taking sugar pills.
For more information, see the Huffington post for an article by Professor Kirsch.
These findings have implications for our concept of what depression actually is. If depression is linked to imbalance of brain neurotransmitters, as is the conventional view, then manipulation of levels of these neurotransmitters should result in varying responses. But in fact, all the different classes of antidepressants studied by Professor Kirsch shared a similar response rate, i.e. equal to placebo.
However, depression is essentially a subjective state, characterised by feelings such as sadness and loss of hope. The attempt to convert these personal, subjective emotions into an objective pathophysiological state is symptomatic of a science that thinks something is only a real problem if you can find a ‘real’ defect. But why not look at what the patients are actually experiencing – sadness, loss of hope – and try to treat that directly? We call it placebo, but that’s just another name for hope. And surely that’s the most direct and logical treatment possible?