Antidepressants: do the drugs work?

“It’s official,” said Mark Rice-oxley in The Guardian: antidepressants work. This was the conclusion of a groundbreaking study led by the University of Oxford and published last week in The Lancet. Researchers examined 522 trials involving more than 100,000 people over almost four decades, and found that all 21 widely-used antidepressants they studied were more effective than placebos in treating both moderate and severe depression. The study should, at last, put paid to many of the suspicions that have dogged these drugs. “They are not a multibillion-dollar conspiracy dreamt up by Big Pharma. They are not a snake oil distilled in secret laboratories, designed to stupefy us all. They are not a futile cop-out from overextended family doctors.” Thanks to this study, “millions of people who take them can continue to do so without feeling shame or doubt about the course of treatment”.

Hang on a minute, said John Naish in the Daily Mail. “Let’s imagine that a pharmaceutical company unveils a new drug to treat cancer and makes the startling claim that it’s ‘just a bit more effective than a placebo’.” How impressed would you be? It seems a remarkably modest assertion, particularly when you consider that nearly 80% of the trials examined by the study were funded by pharmaceutical companies, and since the researchers only looked at the effects over eight weeks, they can tell us nothing about longer-term effects. It has been known for years that antidepressants can be helpful. But for mild depression – and even for many more severe forms of the condition – talking therapies are known to work equally well, and without antidepressants’ sometimes debilitating side effects and withdrawal symptoms.

Discussion of antidepressants always attracts “insteaders”, said Mark Brown in the New Statesman. Why, these people ask, are we prescribing drugs when we could be doing something that they prefer instead – offering talking cures, or healthier diets, or more exercise. But depressed people often find themselves incapable of making even small changes in their lives. The point is that drug treatment is one of a range of tools that can make life with depression manageable – and a very useful one at that. For many people, the real question is not, “Do antidepressants work?”, but, “Which one will work for me?”, said Judith Woods in The Daily Telegraph. The science of the chemical treatment of depression remains vague and there are a lot of products on the market, so prescription remains “hit and miss”. Different drugs work for different people. Given that side effects are sometimes very severe, taking antidepressants can be a scary “clinical lottery”.