I'm not really trying to take either side of the debate here; but just giving some quotes that I found interesting on the subject, and which may perhaps have some truth in them. The quotes are mostly towards the pro-antidepressant side.
Quoting:
webmd.com/mental-health/new...
"...But in a statement, American Psychiatric Association President-elect Nada Stotland, MD, maintained that studies like those reviewed by Kirsch and colleagues, which compare a single drug to placebo, do not accurately reflect the way doctors prescribe antidepressants.
"We know that many people who are depressed do not respond to the first antidepressant they try," she says. "It can take up to an average of three different antidepressants until we find the one that works for a particular individual. Therefore, testing any single antidepressant on a group of depressed individuals will show that many of them do not improve.""
Quoting from a 2012 article:
psychiatrictimes.com/adhd/e...
ncbi.nlm.nih.gov/pubmed/222...
"In a recent interview on 60 Minutes, Harvard psychologist Irving Kirsch, PhD, commented, “the difference between the effect of a placebo and the effect of an antidepressant is minimal for most people.” However, a newly published “panoramic overview” of 127 meta-analyses challenges that assertion by demonstrating how psychiatric drugs, including antidepressants, are as efficacious as drugs used to treat general medical conditions.
“Our study puts the effectiveness of psychiatric drugs and general medical drugs into perspective,” lead author Stefan Leucht, MD, Assistant Professor in the Department of Psychiatry and Psychology at Munich Technical University in Germany, said in a press announcement. “There is a deep mistrust of psychiatry, fostered by reports suggesting that the efficacy of psychiatric drugs is very small. Psychiatrists, patients, carers, and the media are often unsettled by these findings, and some may think that psychiatric medication is not worth the bother.”
...
"The meta-analyses review, Davis said, is particularly important for primary care and other physicians who may “think that psychiatric drugs are not efficacious, may not prescribe them, and may discourage their patients from taking them. Such perceptions and actions,” he noted, “can cause great harm to patients.”
Davis added he has tried for years in his lectures to make psychiatrists aware that the effect sizes of the psychiatric drugs are in “the ballpark with most of the internal medicine drugs” and that “most medical drugs were not the breakthroughs they [psychiatrists] thought they were.”
“With this review,” he told Psychiatric Times, “we finally got it done.”"
...
"The authors also acknowledged that earlier meta-analyses in psychiatry yielded higher effect sizes than recent meta-analyses. In a paper published last year, Davis and coworkers wrote that the antidepressant drug-placebo difference is larger in the more severely depressed subgroups and in older studies. They explained that in the early double-blind studies involving antidepressants, for example, there were severely ill and drug-naive patients referred to clinical trials by their physicians.
Davis said that many severely ill and suicidal patients are excluded from recent drug trials because of ethical concerns, that a lack of “fresh” (drug-naive) patients exists, and that there is an increase in advertisements offering free medications to clinical trial participants—all of which can influence the placebo response."
Quoting:
psychologytoday.com/us/blog...
"While it is true that clinical trials of antidepressant medications over the past couple of decades show less efficacy than trials performed several decades ago, according to Nestler, this reflects the simple fact that, unlike several decades ago, the vast majority of individuals in the U.S. today with depression have access to medication. “The only people now seeking out clinical trials of new drugs are those who haven’t responded to existing medications.” he says, “It is therefore not surprising that trials today are showing less efficacy among the group of patients with so-called treatment-resistant depression.""
Quoting:
elemental.medium.com/are-an...
"If antidepressant drugs provide a benefit — even a small one — over placebos, that’s meaningful. “The unintended message from some of these placebo studies is that [antidepressant] medicines don’t work, but that’s really not true — they work really well,” Sanacora says. And even if a portion of a drug’s benefit does stem from placebo, it’s still true that you won’t get any of this benefit if you don’t take the drug, he says.
Another important point: There are very few clinical trials that compare antidepressants to no treatment at all. Depression can be a lethal disease, so it would be unethical to deny depressed people treatment for the purposes of drug-development research, says Charles Nemeroff, MD, a professor of psychiatry and behavioral sciences at the University of Miami and chief of psychiatry at the University of Miami Hospital. “So, even in the placebo group, patients are usually going from nothing and feeling awful to going to a clinic and being seen weekly by nurses and other people involved with the study,” he explains. This figurative “laying on of hands” is almost certain to provide some benefit, Nemeroff says."
Quoting:
newscientist.com/article/mg...
"Even most sceptics agree that antidepressants have psychological effects. These vary from person to person, but many describe a slight dampening of their emotions – a feeling of being chilled out. “It was just enough to take the edge away,” says Barber, who was prescribed an SSRI called citalopram. “That was what I needed at the time: everything to be a little bit flatter.”"
...
"A recent development suggested that the criticisms of antidepressants were misplaced after all. In April, The Lancet published the biggest analysis to date, led by psychiatrist Andrea Cipriani at the University of Oxford. It covered 21 of the commonest antidepressants and encompassed more than 500 international trials, both published and unpublished, with over 100,000 participants. For each drug, people were more likely to benefit from antidepressants than dummy pills. The size of the effect varied, but most medicines were about 50 per cent more likely to produce a response than placebos.
The results were widely reported as “putting to bed” the controversy. Far from it. Kirsch, for instance, says the authors used a misleading measure of the drugs’ efficacy. Depression is usually assessed using a questionnaire that gives a number on the Hamilton Depression Scale between 0 and 52, rising with severity. The antidepressants did indeed increase people’s chance of a positive response. Yet Kirsch points out that those who took the drugs showed an average reduction on the Hamilton scale that was only about two points greater than that of those taking the placebo tablets. “It’s an extremely small effect size,” he says.
But at least there is a measurable effect, counters John Ioannidis of Stanford University in California, one of those who carried out the Lancet analysis. “You can see that as the glass is half empty or half full.”
And the average effect hides great variation in responses, says James Warner, a psychiatrist at Imperial College London. “Looking at mean responses irons out those that don’t respond at all and those that respond quite well.”"
Quoting:
blogs.discovermagazine.com/...
"...The thing is, “effective but only modestly” has been the established view on antidepressants for at least 10 years. Just to mention one prior study, the Turner et al. (2008) meta-analysis found the overall effect size of antidepressants to be a modest SMD=0.31 – almost exactly the same as the new estimate.
Cipriani et al.’s estimate of the benefit of antidepressants is also very similar to the estimate found in the notorious Kirsch et al. (2008) “antidepressants don’t work” paper! Almost exactly a decade ago, Irving Kirsch et al. found the effect of antidepressants over placebo to be SMD=0.32, a finding which was, inaccurately, greeted by headlines such as “Anti-depressants ‘no better than dummy pills‘”.
The very same newspapers are now heralding Cipriani et al. as the savior of antidepressants for finding a smaller effect…
I’m not criticizing Cipriani et al.’s study, which is a huge achievement. It’s the largest antidepressant meta-analysis to date, including an unparalleled number of difficult-to-find unpublished studies (although both Turner et al. and Kirsch et al. did include some.) It includes a broader range of drugs than previous work, although it’s not quite comprehensive: there are no MAOis, for instance, and in general older drugs are under-represented....
It’s important to bear in mind however that the meta-analysis only included ‘acute’ trials of about 8 weeks duration. This is a big limitation because a lot of people take antidepressants for much longer than this (I’ve been on mine for about 10 years, ironically the age of the Kirsch et al. paper). The absence of long-term antidepressant trials isn’t Cipriani et al.’s fault: there just aren’t very many of them out there, unfortunately....
Overall, there’s no big surprises here. The new paper confirms what we already knew about antidepressants, and the media confirmed what we knew about the media."
Quoting:
aeon.co/essays/the-evidence...
"...Every trial on antidepressants uses a scale to measure the severity of depression of subjects before and after the trial. These scales are deeply flawed, and they bias the research toward overestimating the effectiveness of antidepressants. A typical scale that is often used is called the Hamilton Rating Scale for Depression. This scale has 17 questions, each of which has several possible answers. Each answer receives a particular score, and then the scores for all the questions are added together to give an overall measure of depression severity, for a maximum score of 52 points. The hope when testing a new antidepressant in a trial is that the depression-severity score of subjects in the drug group will decrease more than the depression-severity score of subjects in the placebo group. The scale was invented in 1960 by the psychiatrist Max Hamilton in the UK, and has been in use ever since (from here on, when I mention depression-severity scores, I am talking about this scale).
The problem with this scale is that large changes in a subject’s score can occur as a result of trivial changes in a subject’s real depression. For example, there are three questions about the quality of a subject’s sleep, with a total of six possible points, and there is a question about how much a subject is fidgeting, with up to four points. So a drug that simply made people sleep better and fidget less could lower one’s depression score by 10 points. To put this in context, recent clinical guidelines in the UK have required drugs to lower depression scores on this scale by an average of only three points...."
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