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The Truth About SSRIs

Published: August 5, 2011

Placebos work. They have, in fact, guaranteed over the centuries that many treatments offered by physicians were regarded as effective, even if they were not. We now know that some of them could not possibly do most patients a bit of good. Bleeding the patient comes to mind, as does the use of tobacco. As recently as the 1940s cigarettes were recommended – yes, recommended by doctors! – to “calm peoples nerves”.

For years there have been doubts about the efficacy of antidepressant pills. Because they were much less toxic than prior medications – which were fine pills with which to commit suicide – the SSRI class of drugs (selective serotonin inhibitors) have been widely prescribed for decades. How widely? No fewer than 10% of Americans are on some form of SSRI. With 30 million people taking SSRIs on a daily basis, an annual sales of an incredible 10 billion dollars is generated from their use.

In its July 22, 2011 issue, The Week magazine’s Briefing section addressed the controversy and echoed remarks we have made previously. We know that SSRIs can alter brain chemistry, We know that some studies reported patient improvement with their depression. Unfortunately, the pharmaceutical industry has never presented convincing data that the drugs are actually working better than a placebo.

Worse, they have presented the world with the dubious theory that people’s depression results from a “deficiency” in serotonin which (lucky for the patient) is fixable with these wonder drugs that……. drum roll please…… raise people’s too-low serotonin levels. There is no definitive evidence to supports this widely believed notion. In fact the levels of neurotransmitters in the depressed are no different than levels found in the non-depressed.

Psychologist Irwin Kirsch studied the clinical trials done on behalf of the SSRIs between 1987 and 1999, and guess what – more than half showed results no better than placebo. In January 2010 JAMA published a study showing that for mild to moderate depression the difference between placebo and SSRIs was “nonexistent to negligible”. FDA rules allow companies to do as many studies as they like with negative results just so that they can arrive at two positive trials, which then leads to the drugs approval.

The SSRIs are doing something to the brains of 30 million Americans. Side effects range from reducing people’s sex drives, to agitation, to thoughts of suicide. It is just that the best evidence fails to show that they fix depression in most people. It seems to this correspondent that the best explanation for their popularity is the 10 billion dollars they generate for the companies that manufacture them. To fully document the weak case made for SSRIs, Irwin Kirsch had to resort to the Freedom of Information Act. Using this tool Kirsch was able to uncover numerous studies performed, but not published, which showed antidepressants failing to perform better than placebo.

Do SSRIs have a role to play in treating depression? Surely they do.

Are 10% of American’s “depressed” and/or benefiting from their use. I doubt it, as the evidence for this is dubious. This topic needs a re-think. If you are on SSRIs you need to talk to your doctor about stopping them. Exercise has been proven to help with depression. Substituting an exercise program for a daily pill is definitely something to think about. This is a topic we will visit again.