Antidepressant Medications Miracle Drugs or PLACEBOS With A Buzz (YOU ARE PAYING FOR IT)

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Thursday, April 25, 2002 8:50 AM

Antidepressant Medications Miracle Drugs or

PLACEBOS With A Buzz (YOU ARE PAYING FOR IT)

 

 

- http://www.apa.org/releases/debate.html -

 

APA News Release

 

July 16, 1998

Contact: Doug Fizel

Public Affairs Office

Phone: (202) 336-5706

E-mail: public.affairs

 

 

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Antidepressant Medications: Miracle Drugs or Placebos With A Buzz?

Meta-Analysis of Drug Studies Spawns Lively Debate In Prevention & Treatment,

APA's New Online Journal

 

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WASHINGTON - They are widely prescribed, their effectiveness has been highly

praised and many people consider them to be nothing less than life-savers. But

is the effectiveness of drugs used to treat depression a product of their

chemistry or the patients' psychological reaction to them? The authors of a

meta-analysis of 19 drug studies involving 2,318 patients conclude that it may

be the latter: three-quarters of the beneficial effect of anti-depressant

medications, they contend, can be ascribed to the placebo effect - the patient's

belief and expectation that the pill they are taking will make them better.

Furthermore, the authors say, the remaining 25 percent of the positive effect of

anti-depressants may be attributable to the fact that the drugs have side

effects, which inert pills do not. The article, " Listening to Prozac but Hearing

Placebo: A Meta-Analysis of Antidepressant Medication " appears in the premiere

issue of APA's new online journal Prevention & Treatment, followed by

commentaries from other psychologists and a psychiatrist, and a response from

the lead author.

 

The authors, psychologists Irving Kirsch, Ph.D., of the University of

Connecticut, and Guy Sapirstein, Ph.D., of Westwood Lodge Hospital in Needham,

MA, pooled and analyzed the data from 19 randomized, placebo-controlled studies

assessing the efficacy of various medications in treating depression, including

some studies that involved drugs not considered anti-depressants. Looking across

all 19 studies, the authors calculated the extent to which the beneficial

effects of the various drugs could be attributed to the drugs themselves and the

degree of positive effects that could be attributed to the placebo effect.

 

They concluded that 75 percent of the response to the drugs was a placebo

response and that, at most, 25 percent might be a true drug effect. ''This does

not mean that only 25 percent of patients are likely to respond to the

pharmacological properties of the drug. Rather, it means that for a typical

patient, 75 percent of the benefit obtained from the active drug would also have

been obtained from an inactive placebo,'' the authors say. And it is possible,

they say, that the remaining benefit came not from anything the drugs did to

fight depression specifically, but from an enhancement of the placebo effect

caused by the fact that those who received medication (rather than a dummy pill)

could tell by the side effects that they had taken something.

 

This result was seen in all the studies in the meta-analysis, including those

involving drugs not considered to be anti-depressants, but which were as

effective as anti-depressants in treating depression.

 

 

 

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As the editors of Treatment & Prevention point out in an editor's note

accompanying this article, this is a controversial conclusion. The

all-electronic format of the journal made it possible to obtain rapid responses

to the article and to publish some of those responses along with it.

 

The most lengthy and vociferous response (''Listening to Meta-Analysis but

Hearing Bias'') came from Donald F. Klein, MD, of Columbia University who

criticizes the authors' choice of studies to analyze as ''a miniscule group of

unrepresentative, inconsistently and erroneously selected articles arbitrarily

analyzed by an obscure, misleading effect size.'' Dr. Klein found fault with

almost every aspect of the article, including the fact that it is a

meta-analysis, pointing to a recent study that compared meta-analyses with large

clinical trials and concluded that the meta-analyses ''would have led to

rejection of a useful treatment in four out of 12 cases.'' (In his response to

the commentaries Dr. Kirsch addresses Dr. Klein's complaints under the heading

''Klein's Laundry List.'')

 

Another critic of the article is psychologist Robyn M. Dawes, Ph.D., of Carnegie

Mellon University who argues that the authors' logic is seriously flawed and

their methodology oversimplified. ''Science (like art and life),''he says, ''is

not that easy.''

 

Psychologist Larry E. Beutler, Ph.D., of the University of California, Santa

Barbara is more supportive. In his commentary (''Prozac and Placebo: There's a

Pony in There Somewhere'') he notes that ''the poor showing of antidepressants,

both in this and other meta-analytic studies of these drugs, raise an

interesting question about why and how public enthusiasm and faith is maintained

in these treatments. This is a research question whose importance may even

exceed that of the specific effects of the drugs themselves.''

 

Article: ''Listening to Prozac but Hearing Placebo: A Meta-Analysis of

Antidepressant Medication,'' by Irving Kirsch, Ph.D., University of Connecticut,

Storrs, CT and Guy Sapirstein, Ph.D., Westwood Lodge Hospital, Needham, MA, in

the Treatment and Prevention, Vol. 1, Article 00002a.

 

(Full text available at

http://journals.apa.org/prevention/volume1/pre0010002a.html or by contacting the

APA Public Affairs Office.)

 

Treatment & Prevention is a peer-reviewed, archival, scholarly electronic

journal and is part of the regular APA journals program. Articles that appear in

it will be available online indefinitely (although they will be posted on the

APA website for two years). Journalists can access the journal through the APA

website (http://www.apa.org) and can register to be notified of new postings.

 

 

 

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The American Psychological Association (APA), in Washington, DC is the largest

scientific and professional organization representing psychology in the United

States and is the world's largest association of psychologists. APA's membership

includes more than 155,000 researchers, educators, clinicians, consultants and

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