is largely a placebo effect, it is important that we know this. It means that improvement can be obtained without reliance on addictive drugs with potentially serious side effects.”
When Kirsch’s book The Emperor’s New Drugs: Exploding the Antidepressant Myth came out in 2010 with proof that antidepressants do not have a clinically meaningful advantage over placebo, his analysis was acknowledged by researchers as a valid albeit provocative contribution to medical literature. But it didn’t change clinical psychiatry or the number of antidepressants prescribed, and it continued to incur the criticism and even rage of prescribing psychiatrists desperate to pick apart his findings to defend their now baseless practices. It’s hard to blame them—they put a lot of time, money, and effort into learning mistruths around antidepressants! The irony in Kirsch’s findings is that the results came from studies that were underwritten and designed by the drug companies themselves. These studies were conducted in a way that would give the drugs an advantage, yet they still didn’t outperform the placebo.46
In order for a drug to be approved, it must be shown to be superior to placebo. As you can imagine, drug companies despise placebo effects. They will do everything in their power to minimize the impact of placebo in their studies. That the FDA allows them to use these techniques is wrong, another example of Big Pharma’s shameless misconduct.
Because the FDA database contains all of the data from initial trials, both published and unpublished, analyzing its data is exceptionally useful. Keep in mind that drug companies normally don’t publish negative results. They prefer to file away those studies in a drawer where they will never be found; hence the “file drawer” phenomenon.
A fascinating 2014 study published in the Journal of Clinical Psychiatry, one of my field’s most respected journals, explored—and exposed—the real power of belief in psychiatric treatment. A group of researchers at Columbia University analyzed data from two large, multicenter discontinuation trials encompassing 673 people diagnosed with major depressive disorder and who were taking fluoxetine (generic Prozac) for twelve weeks.47 After those three months, they were told that they’d be randomized to either a placebo or continued fluoxetine. So while they all knew they were taking the antidepressant in the first three months, they didn’t know if what they were given afterward was an active antidepressant or a sugar pill. The results spoke for themselves: both groups—the ones still taking the fluoxetine and those on the placebo—experienced a worsening of depressive symptoms. This outcome suggests two significant interpretations: (1) the initial effect during the first three months was attributable to placebo, as all patients knew they were receiving treatment; and (2) the worsening of symptoms upon the mere possibility of getting just a placebo is indicative of the undoing of the placebo effect, what’s sometimes called the nocebo effect.
Identifying a tremendous placebo effect has been further echoed by other meta-analyses. The power of belief and the expectation of healing cannot be dismissed when medical treatments appear to work. In my opinion, the use of medications associated with serious short- and long-term side effects and which primarily ride the placebo effect represents an ethically questionable practice.
I work with the placebo effect every day in my office because I aim to inspire a different set of beliefs. Even people who claim to be suicidal can experience the placebo effect under my care. The decision to consider taking your own life is not a trait that would have been selected for over the millennia of human evolution. It’s more logical to assume it has roots in physiological imbalances, which is where I like to spend my time searching for solutions with my patients. I look for problems like nutrient deficiencies, endocrine disruption, and autoimmunity. The first and most important thing I like to convey to patients is that they are in charge. They have agency. This sensibility can go a long way, because they’re coming to me thinking I have what they don’t have—a quick fix. A quick fix is a lovely idea, and if one existed, it could be great. Unfortunately, the weight of the data suggests that it doesn’t and that we may be doing more harm than good by collectively pretending it does. The challenge is that it’s human nature to feel better after doing something we think will make us feel better. But sometimes inaction is the best medicine.
LONG-TERM SIDE EFFECTS: MORE MEDS, MORE DEPRESSION, MORE DISABILITY . . . AND DEATH?
But you might ask, “What if these drugs are in fact working some of the time for some people?” They still wouldn’t be worth the consequences for the placebo effect, particularly given their side effects, which are notoriously hidden from the lay public. I find it outrageous that drug companies can use any number of tactics to establish efficacy, including the suppression of data, and then use those tactics to legitimize long-term prescribing with no thought or attention to the real side effects over time.
When I lecture on the futility and perils of antidepressants, I like to employ the following analogy courtesy of Dr. David Healy, an internationally respected psychiatrist based in the UK: Let’s say you’re somebody who experiences a lot of social anxiety. You have a couple glasses of wine at a party as a preemptive strike. A sense of calmness washes over you and your symptoms evaporate. Through deductive reasoning, you could say, “Well, I must have an alcohol deficiency, so I should continue to consume alcohol every time I have this symptom, and I might want to drink regularly to prevent it altogether.” This analogy is emblematic of the practice of dishing out antidepressants without any consideration of their long-term consequences.48
We’ve arrived at a place in psychiatry’s abuse of antidepressants where we have a half-baked theory in a vacuum of science that the pharmaceutical industry raced to fill. We have the illusion of short-term efficacy and assumptions about long-term safety. The potential emerging side effects are nothing short of horrifying, from suppressed libido and sexual dysfunction, abnormal bleeding, insomnia, migraine, weight gain, and blood sugar imbalances to risk of violent, irrational behavior and suicide. Before I get to the ugliest of side effects and withdrawal complications, let’s focus on how your ability to function long term in the world with depression is significantly sabotaged by treating that first episode of depression with medication. This too has been expertly explored by Robert Whitaker, whose website (www.madinamerica.com) is a virtual library of published data and thoughtful reviews of multiple long-term studies that have followed large groups of people taking antidepressants. Time and time again these studies demonstrate poor functional outcomes for people treated with antidepressants relative to those with minimal to no medication treatment.49 They are at greater risk for all the acute side effects I’ve already listed, as well as increased risk of relapse, cognitive impairment, secondary diagnosis and medication treatments (first a depression diagnosis followed by a bipolar one), and recurrent hospitalization.
A breathtaking 60 percent of patients are still diagnosed with depression one year into treatment, despite temporary improvement within the first three months.50 Two prospective studies in particular support a worse outcome in those prescribed medication. In one such British study, an unmedicated group experienced a 62 percent improvement by six months, whereas the drug-treated patients experienced only a 33 percent reduction in symptoms.51 And in another study of depressed patients conducted by the World Health Organization (WHO) in fifteen cities across the UK, it was found that at the end of one year, those who weren’t exposed to psychotropic medications enjoyed much better “general health,” their depressive symptoms were much “milder,” and they were less likely to still be “mentally ill”!52
Now let’s consider the more serious possible side effects of violent behavior, relapse, and crippling withdrawal among those who try to escape their grip. Antidepressants have a well-established history of causing violent side effects, including suicide and homicide. In fact, five of the top ten most violence-inducing drugs have been found to be antidepressants.53 Over the past three decades there have been hundreds of mass shootings, murders, and other violent episodes that have been committed by individuals on psychiatric drugs. Big Pharma spends around $2.4 billion a year on
