The Emperor’s New Drugs: Exploding the Antidepressant Myth
By Irving Kirsch, PhD
Random House, 2009
Dr. Irving Kirsch originally set out innocently enough to investigate the placebo effect of antidepressant drugs. During the course of his investigations, however, a series of surprising discoveries led him to the conclusion that the actual “antidepressant effects” of the drugs ranged from ineffective to downright dangerous, including both minor and truly harmful and often fatal side effects such as diabetes, increased risk of heart attacks, severe weight gain, nausea and insomnia to name a few. Dr. Kirsch doesn’t claim that antidepressants don’t work any better than placebos. In the reverse, he claims that placebos work about as well as antidepressants but with none of the harmful side effects. Thus, placebos are actually powerful medicine.
How do you measure depression? This is important to know for those individuals who might visit a doctor at some point in their lives complaining of depression. A doctor determines a patient’s level of depression based upon a numerical scoring method called the Hamilton Scale. This Hamilton Rating Scale for Depression, or HRSD, is a summation of scores compiled by doctors based on interviews and observations of patients. As Dr. Kirsch explains, “The doctor rates the patient’s mood, thoughts about suicide, sleep disturbances and other symptoms of depression. For example one point is given if the patient feels that life is not worth living, and four points are given if the person has made a serious suicide attempt. The result is a numerical score that can range from zero to fifty-one.
Dr. Kirsch has systematically stripped the antidepressant efficacy claims by dint of largescale meta-analyses that indicate 75 percent of an antidepressant’s efficacy comes from its placebo effect, a mere 25 percent from the drug itself. Worse, for severely depressed patients who are given ever larger doses of antidepressants, any improvements in levels of depression are likely due to the “enhanced placebo effect.” How do we know this? Because patients who took increased amounts of placebos showed just the same sorts of improvements as those who took increased amounts of antidepressants! This means that a sugar pill would have worked just as well as the prescription drug. The problem with high doses of antidepressants as opposed to placebos is not merely that they don’t work, but that at higher doses, they do much, much more harm, as their side effects become seriously magnified, and often fatal.
Dr. Kirsch further suggests that patients given antidepressants as opposed to placebos in supposedly blind trials “improve” because they frequently “break blind,” which means that they develop terrible side effects from the drug and deduce—accurately—that they got the “real deal” as opposed to the placebo. This psychological trick actually produces an “enhanced placebo effect” because patients feel better as a result of knowing that they got the drug and not the placebo.
Dr. Kirsch analyzed thirty-eight clinical trials of major antidepressants, involving thousands of depressed patients, and as a result presents a shattering and methodically analyzed indictment of antidepressant efficacy, Big Pharma data-doctoring, and FDA collusion and complicity—all of which come at a large cost to human health.
Depression is a heterogeneous condition and is much more complex than lowered levels of say, serotonin, Kirsch asserts. In fact rigorous research shows that reducing serotonin levels, even dramatically, in healthy individuals has absolutely no effect whatsoever on their depression levels. That is to say, they do not get depressed at all! If reducing serotonin levels does not cause depression in a healthy person, how could we make the illogical leap that raising serotonin levels will make a depressed person feel better? We have been bombarded with “low serotonin” and/or “low name-your-chemical” as the root causes of depression for some time.
Dr. Kirsch not only questions this theory, but offers evidence of the faulty “depression as chemical imbalance” theory—a theory that focuses blame on a handful of named neurotransmitters, thereby creating a strong case (and thereby fertile marketing environment) for “correcting” such “imbalances” via targeted drugs. Much like cholesterol-reducing drugs, depression drugs are big business—a business that can “scale” only if large swaths of the population can be deemed first to be depressed and second, curable through concerted, long-term use of antidepressants. Longer-term use here equals a lucrative, annuity-type revenue stream for pharmaceutical firms.
Via freedom-of-information requests to the FDA, Dr. Kirsch unearthed and analyzed raw data on all clinical trials pertaining to major antidepressants that were recently marketed. He discovered that in fact drug companies employed various nefarious schemes to dress up results that ranged from mixed to completely negative. They withheld negative studies from publication and published positive studies multiple times, thereby making it appear as though positive studies and outcomes in the drug trials outnumbered negative studies when in fact they did not. In several instances, clinical trials undertaken outside the United States mysteriously showed positive results, whereas the same trial carried out within the U.S. did not show these results. Yet the FDA was persuaded to accept the foreign studies as valid while the U.S. study was ignored. In other words, drug companies routinely cherry-picked results from the multi-site studies. There is good reason to believe that trials in foreign countries where the FDA does not have jurisdiction can be far more readily manipulated. Drug companies also published data that were different from what they submitted to the FDA; that is, they lied.
Dr. Kirsch asserts that equal or better efficacy in combating depression can be obtained from measures such as vigorous exercise, herbs that do not have the harmful side effects of antidepressants, the quintessential placebo called “psychotherapy,” and even through disclosed placebos—and all with far fewer side effects compared to antidepressants.
Citing an example of the complexity of the interrelationship between mind and body, the author reminds us of E.M. Forster’s novel A Room with a View, and in its context tells us of an interesting experiment. Roger Urich, a researcher at the University of Delaware, tested the hypothesis that rooms with pleasing views had a positive therapeutic effect on gall bladder surgery patients. Patients were divided into two groups: one group with a window view overlooking a park-like setting and a second group of patients with a window view onto a brick wall. He discovered that the former group required less medication, were in better spirits, recovered faster and were discharged earlier than patients in the second group. Thus in Dr. Kirsch’s opinion, the ability of emotions to affect health, for better and worse, is real, and the quality of any therapeutic relationship enhances physical improvement.
Cultural historian and professor, Dr. Morris Berman, who also reviewed this book, compares the psychiatric drugs of our time to the widespread and ultimately deadly use of leaden forks by early Romans: “The (same) leaden forks that wiped out a thriving earlier civilization” can do the same to us.
For the millions of Americans who are on long-term antidepressant prescriptions the future on these drugs does not bode well. However it bodes very well for the financial bottom lines of the drug companies. For anyone who might seek counsel for depression, I would recommend The Emperor’s New Drugs as required reading, and I would also recommend that everyone heed the warning that prescription antidepressants represent a poor health bargain.
This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly magazine of the Weston A. Price Foundation, Fall 2012.