It’s the dirty little secret at the heart of a multi-billion dollar industry: double-blind trials, considered the gold standard of medical research, have repeatedly shown that antidepressant drugs barely work at all, with some studies even finding that placebos are more likely to cheer people up than antidepressants.
In 1993, psychiatrist Peter D. Kramer published a book that was to have a profound effect on society. The book was called Listening to Prozac, and it purported to represent a balanced view of the effects of an antidepressant drug, Prozac, and its reputed ability to transform the lives of some people for the better. Kramer described how some of his patients appeared to transform under the influence of Prozac, developing the outgoing, go-getting type of personality that Kramer believes we need to have in order to thrive in modern society.
Listening to Prozac, together with a massive marketing campaign by the pharameutical giant, Eli Lilly, helped to convince much of the Western world that Prozac and other anti-depressant drugs were the answer to many of life’s problems.
Before long, an estimated almost one in ten Americans were taking Prozac. In 2001, Eli Lilly reported Prozac sales of $2.8 billion. In the UK the Environment Agency reported in 2004 that traces of Prozac were found in the water supply; so many people were taking and excreting the drug that it had become impossible to keep it from getting into drinking water.
Scarcely ever has a drug achieved such stupendous popularity in such a short space of time. And yet while Prozac had become cemented in the popular mind as a drug of astonishing effectiveness, carefully-controlled studies carried out by drug companies themselves were showing that Prozac and other antidepressants were bordering on being completely ineffective.
Freedom of Information
One small problem prevented the public from finding out that they had been sold the modern equivalent of snake oil. In 2008, Dr. Erick H. Turner and his colleagues published a paper that might have shaken Eli Lilly to its very boots, had the patent on Prozac not expired in 2001. Turner had used the Freedom of Information Act to request all double-blind studies on antidepressants submitted to the FDA. By law, all drug studies carried out in the USA have to be submitted to the FDA, but not all such studies have to be published. The truth that emerged was shocking. Out of all the studies on antidepressants submitted to the FDA, most of the ones showing positive results had been published; most of the ones showing negative results had not.
In fact when all the studies were taken into account, it emerged that the effects of antidepressants were at the very border of clinical effectiveness. In some studies, subjects given sugar pills had experienced greater relief of their depressive symptoms than those assigned drugs.
Antidepressants, it seems, often have powerful effects on people who know they’re taking them; the same can be said about homoeopathic remedies, and the power of religion to change people’s lives is widely vaunted. Yet we had expected something different from antidepressants; we believed that their effects were not due simply to the hope given by the difficult decision to take the drugs in the first place or to the effects of a vast advertising campaign, but due to sophisticated chemical effects upon the brain itself. These effects, it seems, are for the most part non-existent.
Indeed, it seems that had Prozac been a treatment for cancer instead of depression, it is unlikely that the FDA would have approved it for use.
The selective publication of antidepressant research appears to be part of a much wider problem, with both drug researchers and medical journals in general tending to shout about positive studies while quietly discarding negative ones. It’s a problem that the prestigious British Medical Journal has promised to devote an special themed issue to in 2011. The problem of selective bias has become a rallying cry for evidence-based medicine, an increasingly important field, the existence of which sort of makes us wonder what the rest of medicine is based on, if not evidence.
While Prozac has entered the consciousness of the Western world as synonymous with nearly-instant chemical happiness, studies show that the drug scarcely lifts depression better than placebos, while many depressed subjects attest to feeling much less depressed when given pills that are entirely inactive. Perhaps this is not surprising; since the human race began, human beings have been overcoming incredible odds in all sorts of appalling situations, learning to survive on little more than hope. Is it any wonder that the belief that one is taking a powerful modern drug, developed at the cutting edge of modern science, is sometimes enough to lift a person out of a state of severe melancholy?
And after all, thoughts themselves affect the brain’s chemistry. How is a depressed person to know, without taking a detailed chemical inventory of their own brain, whether they have become more cheerful due to taking a drug, or because some new thought pattern has somehow altered some unhelpful aspect of their own brain chemistry?
Time for a Non-Chemical Revolution?
Some suggest that the antidepressant revolution, while being perpetuated by biased research publication, is really part of an even deeper problem in our society. Fifty years ago, depression as an illness was an idea that was virtually unheard of. Yet like neurasthenia more than a century ago, ‘depression’ has come to symbolise a state of mind that a large percentage of us find ourselves in, if continuing antidepressant sales are anything to go by. Perhaps we have become a society that, like an alcoholic in the depths of a binge, refuses to ask itself hard questions about our lifestyles and the expectations we place upon ourselves.
Instead of taking the dangerous (but possibly productive) route of contemplating radical changes to our views about education, work and our lifestyle choices, we allow ourselves to sink into a passive and wretched state of mind from which we believe only drugs can save us. Our malaise, we believe, is too deep to be treated by mere changes to lifestyle, however radical; we must alter the very chemistry of our brains in order to feel OK in the society that we have created.
Perhaps there lies somewhere in all of this a truth that’s just too disturbing to face.
If you want a balanced review of the antidepressant phenomenon and the history of antidepressants — also including a look at how mental illnesses become assigned to categories in general, and the role that economics plays in the process — I heartily recommend the following book:
You can buy it using the above link if you’re in the US (click the image), or of course you can go to Amazon or your local bookshop and maybe find a better deal. The author of this book clearly believes that antidepressants “work” (and I sort of agree with him, it’s just that I’m inclined to think that the degree to which they work is so minimal and so at odds with our expectations that antidepressants may fairly be called a “scam”, especially when you take into account the nasty side effects that they can have), but he also has a balanced appreciation of the pros and cons of antidepressants and a fantastic understanding of the way in which our views of mental illness have been colored by many interesting factors, not least the need to sell drugs.