In Consultation

In Consultation

It’s More Complicated Than That: Probing the complexities of the antidepressants debate

By John Preston

January/February 2012

Q: Recently there’s been a spate of studies and negative media stories raising questions about the effectiveness of antidepressants. As a practicing therapist, I’m not sure what clinical conclusions to draw from all this confusing information. Can you help?

A: In February 2010, the cover of Newsweek magazine declared: “Antidepressants Don’t Work.” Earlier that year, “Antidepressant Drug Effects and Depression Severity,” published by Jay Fournier and his colleagues in the Journal of the American Medical Association (JAMA), arrived at a similar conclusion: antidepressants’ effects are minimal to nonexistent in treating mild to moderate depression when compared to placebos. They corroborated the findings of Irving Kirsch and his colleagues published in “The Emperor’s New Drugs”—-the first metanalysis of data from pharmaceutical companies’ registration trials.

Registration trials are the studies pharmaceutical companies conduct to demonstrate the effectiveness of their drugs to garner FDA approval. In all cases, they must be double-blind, placebo controlled, randomized trials, with adequate sample sizes. For FDA approval, the medication must be shown to be superior to placebos to an extent that’s statistically significant.

The Kirsch metanalysis included outcomes from 38 studies, and all of the antidepressants surveyed had been approved by the FDA between 1987 and 1999. However, the conclusion from this metanalysis…

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1 Comment

Tuesday, January 17, 2012 4:02:42 PM | posted by Lorraine Baum
For those interested in reading in more detail the findings of the STAR*D trial I recommend Understanding Depression issue of the Special Health Report series published by Harvard Medical School. The contact for ordering this and others in the series is 877-649-9457 or online at