The Emperor's New Drugs: Exploding the Antidepressant MythPublisher: Basic Books
Author: Irving Kirsch, Ph.D.
US Publication Date: 2010-02
What if antidepressants were not just too easily available and overly prescribed by doctors -- as has been argued in many venues for years now, though to no discernible effect -- but didn't even work? That's the takeaway premise of psychology professor Irving Kirsch, Ph.D., in his new book, The Emperor's New Drugs: Exploding the Antidepressant Myth.
By examining a broad spectrum of research, using both the published drug studies and the deep well of unpublished research which many drug companies would prefer stay hidden, Kirsch presents the all-too-plausible theory that there is essentially no positive effect from taking antidepressants. In fact, comparing test results between patients taking antidepressants and those taking active placebos (a drug that isn't an antidepressant but has other, noticeable side effects, so that the patient can tell something is working on them), Kirsch found no statistically significant difference. Actually, he found that it didn't seem to matter what drug patients were taking, as long as they knew they had ingested some kind of active drug, they improved by about the same degree. So much for the last few decades' great advances in pharmacology, it would seem.
If what Kirsch is saying is true, then not only are untold millions being wasted on essentially worthless drugs, but an entire school of psychological thought is utterly wrong. Kirsch spends an entire chapter of his tightly argued book tearing down the oft-recited belief that depression is frequently or always caused by a chemical imbalance in the brain. After relating several studies which purport to show that drugs which increase, decrease, or have no effect on the serotonin levels in patients brains (something long described as crucial to pharmacological therapy) all have about the same effect, Kirsch concludes very simply that "the data just do not fit the theory".
Problematically, this doesn't seem to be news to anybody outside the industry. Kirsch writes of how drug-industry researchers have long referred to the often negligible difference in results between antidepressants as the "dirty little secret". He even presents evidence that the Food and Drug Administration cautioned drug companies in 2004 to not publicize their findings that antidepressants were no better than placebos for depressed children. Their reasoning was that doing so would discourage doctors from prescribing those drugs. For those readers now wondering why the FDA would want doctors to push ineffective medications, there doesn't seem to be a logical answer.
Proving or disproving Kirsch's hypothesis (based as it is on massive amounts of crunching data not available to the average person) will be beyond the abilities of most lay readers, which is his book's greatest downside, apart from the cardboard-stiff prose. (Kirsch is a great synthesizer of data, but no artist when it comes to relating his findings to a general audience.) But given how resolutely the treatment of mental disease has shifted from therapy- to drug-based regimens, just about any good-faith effort to turn the focus of treatment back on actual human interaction seems well worth it.