By Robert Whitaker
August 13, 2022
Source: Mad in America
Photo / Image Source: Unsplash,
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Do Antidepressants Work?
When the public is told that a drug “works,” they are being led to believe that most people who take the drug can expect to receive a benefit. An antibiotic, for instance, is a drug that can be said to “work.” When penicillin and other antibiotics were introduced in the 1940s, they cured bacterial infections and any number of bacterial illnesses: pneumonia, scarlet fever, diphtheria, and tuberculosis, to name a few. But an antidepressant cannot be said to work in this way.
What can be said is that there are clinical studies that provide information about the possible risks and benefits of antidepressants, both over the short-term and long-term. The relevant information can be grouped into three types.
Placebo-controlled trials
When psychiatrists state that antidepressants “work,” they are mostly citing findings from industry-funded trials of the drugs. Meta-analyses of these short-term trials have found that the difference in the reduction of symptoms between the drug-treated and placebo groups is about two points on the 52-point Hamilton Depression Rating Scale. While this difference may be statistically significant, it is of questionable clinical significance.
The best way to understand this difference is to look at its effect size. At an individual level, responses fall along a bell curve, and a visualization of the effect size reveals how the bell curves for the placebo and drug-treated groups differ. Researchers have concluded that the “effect size” in the industry trials is 0.3 (effect sizes can range from 0 to 3.0).
As the graphic below reveals, when a treatment has an effect size of 0.3, there is an 88% overlap in the bell curves of the two groups. That means you need to treat eight people with an antidepressant to produce one additional person who benefits from the treatment. Seven of eight treated with the drug will be exposed to the adverse effects of the drug without any additional benefit beyond placebo.
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