Antidepressants and Placebos: Secrets, Revelations, and Unanswered Questions

@article{Kirsch2002AntidepressantsAP,
  title={Antidepressants and Placebos: Secrets, Revelations, and Unanswered Questions},
  author={Irving Kirsch and Alan Scoboria and Thomas J. Moore},
  journal={Prevention \& Treatment},
  year={2002},
  volume={5}
}
George Washington University We are very heartened by the thoughtful responses to our article. Unlike some of the responses to aprevious meta-analysis of antidepressant drug effects ( Kirsch & Sapirstein, 1998), there is now unanimous agreement among commentators that the mean difference between response to antidepressant drugs and response to inert placebo is very small. It is so small that, despite sample sizes involving hundreds of participants, 57% of the trials funded by the pharmaceutical… 

Figures from this paper

The antidepressant debate and ethically defensible placebo-controlled trials.
TLDR
A plausible argument can be made that clinical equipoise would permit the use of active placebo controls in the clinical trials that test them, and one can conclude that placebo controls for antidepressant trials are ethically defensible and sci entifically justified.
The antidepressant debate and the balanced placebo trial design: an ethical analysis.
  • D. Waring
  • Psychology
    International journal of law and psychiatry
  • 2008
Deception as treatment: the case of depression
  • C. Blease
  • Psychology, Medicine
    Journal of Medical Ethics
  • 2010
TLDR
This paper examines the case of depression as an entry point for understanding the complexities of the prescription of placebos and suggests that there may be a limited unavoidable role for deception in medicine.
Relabeling the Medications We Call Antidepressants
TLDR
It may be time to stop calling these medications antidepressants because the negative effects on libido and sexual functioning are so common and consumers deserve a label that more accurately reflects the data on the largest effects and helps them understand the range of effects from these medications.
The relativity of ‘placebos’: defending a modified version of Grünbaum’s definition
TLDR
It is shown that with four modifications, Grünbaum’s definition provides a defensible account of placebos for the purpose of constructing placebo controls within clinical trials.
Efficacy and Effectiveness of Antidepressants: Current Status of Research
TLDR
The STAR*D analysis found that the effectiveness of antidepressant therapies was probably even lower than the modest one reported by the study authors with an apparent progressively increasing dropout rate across each study phase.
Treatment of depression with antidepressants is primarily a psychological treatment.
TLDR
It is argued that available empirical evidence indicates that depression treatment with antidepressants is primarily a psychological treatment, and this conclusion has far-reaching consequences for the scientific status of contemporary treatments for depression.
Antidepressants Should ��er a �is��Bene�t Balance
is paper raises the question about whether the data on the medications we call antidepressants justify the label of antidepressant. e authors argue that a true antidepressant should be clearly
The Other Side of Psychopharmacology: A Review of the Literature
TLDR
Recent developments in psychopharmacology research are examined, focusing on the safety, efficacy, side-effects, and theoretical assumptions of various classes of psychotropic medications.
The "Chemical Imbalance" Explanation for Depression: Origins, Lay Endorsement, and Clinical Implications
When a client asks whether her or his depression is caused by a chemical imbalance, how do you respond? Depression is regularly depicted in popular media as resulting from a “chemical imbalance” and
...
...

References

SHOWING 1-10 OF 43 REFERENCES
Listening to Prozac but Hearing Placebo: A Meta-Analysis of Antidepressant Medication
TLDR
Examination of pre–post effect sizes among depressed individuals assigned to no-treatment or wait-list control groups suggest that approximately one quarter of the drug response is due to the administration of an active medication, one half is a placebo effect, and the remaining quarter isdue to other nonspecific factors.
Placebo response in studies of major depression: variable, substantial, and growing.
TLDR
The response to placebo in published trials of antidepressant medication for MDD is highly variable and often substantial and has increased significantly in recent years, as has the response to medication.
Antidepressants using active placebos.
TLDR
The more conservative estimates from the present analysis found that differences between antidepressants and active placebos were small, which suggests that unblinding effects may inflate the efficacy of antidepressants in trials using inert placebos.
How should efficacy be evaluated in randomized clinical trials of treatments for depression?
  • M. Thase
  • Psychology
    The Journal of clinical psychiatry
  • 1999
TLDR
The process of conducting the clinical trials that support a New Drug Application is described, issues in evaluating efficacy are discussed, and suggestions for modifying and improving the drug development process are offered so that clinicians can better judge new drugs.
Raising Questions about Antidepressants
TLDR
The evidence suggests that psychological interventions are at least as effective as pharmacotherapy in treating depression, even if severe, especially when patient-rated measures are used and long-term follow-up is considered.
The Placebo Effect: An Interdisciplinary Exploration
The placebo effect - is it much ado about nothing?, Arthur K. Shapiro and Elaine Shapiro clinical reflections on the placebo phenomenon, Howard Spiro the nocebo phenomenon - scope and foundations,
Changes in brain function of depressed subjects during treatment with placebo.
TLDR
It is suggested that "effective" placebo treatment induces changes in brain function that are distinct from those associated with antidepressant medication, and cordance may be useful for differentiating between medication and placebo responders.
Effect of Hypericum perforatum (St John's wort) in major depressive disorder: a randomized controlled trial.
TLDR
This study fails to support the efficacy of H perforatum in moderately severe major depression; the result may be due to low assay sensitivity of the trial, but the complete absence of trends suggestive of efficacy is noteworthy.
Evidence report on: Treatment of depression - Newer pharmacotherapies
TLDR
A comprehensive evaluation of the benefits and adverse effects of newer pharmacotherapies and herbal treatments for depressive disorders in adults and children with major depression finds no significant differences in efficacy among individual newer agents or between newer and older agents.
...
...