According to the U.S. Center for Disease Control and Prevention antidepressants were the most commonly prescribed medications in ’03-’04. The introduction of selective serotonin re-uptake inhibitors (SSRIs) was heralded as nothing less than groundbreaking. Last month a study was published in PLoS Medicine that threatens their impressive prevalence. Upon meta-analysis of studies (including unpublished ones) submitted to the FDA they found antidepressants and placebo similarly effective. It concludes:
Drug–placebo differences in antidepressant efficacy increase as a function of baseline severity, but are relatively small even for severely depressed patients. The relationship between initial severity and antidepressant efficacy is attributable to decreased responsiveness to placebo among very severely depressed patients, rather than to increased responsiveness to medication.
I remember reading a book on Abnormal Psychology that had interesting statistics about the effectiveness of different strategies of treating depression. Biological therapy alone was effective in 60% of patients with a high relapse rate, Beck’s Cognitive Behavioral Therapy alone in 60% with a low relapse rate, and Electro Convulsive Therapy in 60% of treatment resistant patients. Piggybacking medication and CBT, though, was only minimally more effective. If biological therapy is only as effective as placebo and other therapies are only as effective as biological therapy then are therapies really therapeutic?
Maybe time itself does the majority of the healing. Would you be so surprised? At times the mind can be as powerful as it is dynamic.