Do Antidepressants Really Work?

Three recent books and a series of commentaries and reviews in the press raise the question whether widely used antidepressants are really effective in most of the individuals who take them.  In an especially high-profile article, Marcia Angell, former editor in chief of The New England Journal of Medicine provided a stinging rebuke of psychiatric drugs in general and of course the drug companies that manufacture them. Writing in The New York Review of Books Angell seemed to seriously consider the possibility that “psychoactive drugs are useless”. There were also highly visible pieces in USA Today and Newsweek, the first on a study done by the psychologist Robert DeRubeis headlined “Antidepressant lift may be all in your head,” and the other a cover article on a retrospective “meta-analysis” by the psychologist Irving Kirsch and colleagues of clinical trial data provided to the FDA by pharmaceutical companies and interpreted as evidence that antidepressants were no more effective than placebo in most patients.
Mainstream scientists, however, have and continue to understand the same data as showing that antidepressants work well for at least 20 percent of patients on an initial trial. The scientific dilemma is to separate patients who really need a drug from those who will respond to placebo. In the future this should be possible as the field develops better laboratory tests for measuring relevant brain function. In the meantime, the challenge for doctor and patient is the same as for the scientist – to make as good a decision as possible about whether or not to use an antidepressant in each situation without a laboratory test for guidance.