I’ve just been reading James Davies book, “cracked” which starts by looking at how we categorise mental illnesses and psychiatric disorders- scary reading in itself, but even more worryingly, examines in damning detail the evidence base for how effective anti-depressant medications are. Davies tell us that drug trials unequivocally demonstrate that anti-depressants are no more effective than placebos, or psychotherapy. At one level I accepted this, but at another, I thought that it couldn’t really be true- after all we’ve all known people who have really seemed to get better with anti-depressant drugs, so they must work. Right?
However, I had not pondered the next question Davies raises, which is that if sugar pills (placebo) are effective if people believe they are receiving an anti-depressant, then is it possible that the actual anti-depressants are only effective because people believe they will be rather than from any particular effect that the chemicals in the medications actually have?
You might argue that it doesn’t really matter- if they help people, then why not? But this doesn’t take into account the very many and sometimes serious side effects these drugs have- nausea, loss of appetite, loss of sex drive, erectile dysfunction, weight gain, insomnia, dizziness and in some cases they can cause internal bleeding and suicidal thoughts. Almost 50% of people experience at least one side effect.
Chris Kresser (chriskresser.com) cites a chilling litany of well referenced side effects one of which rather scarily, suggests that anti-depressants may actually cause depression to worsen in the long term for some people.
On a positive note, the meta analysis (collection of all of the analysis that existed about effectiveness of anti-depressant treatment) shows that psycho therapy (talking therapy) is as effective in helping people get better from depression as drugs, or placebos. I conclude from this is that if we therapists avoid getting sucked into the hype about anti-depressants, and make sure we let our clients/patients know that talking to us can help them just as much, if not more than drugs and without the nasty side effects, then together with our clients we can really make a difference.