Cracked: Why Psychiatry is Doing More Harm Than Good

Was this just an isolated example, or is it quite representative?

In other words, despite the damning research about antidepressant efficacy, and despite the NICE recommendations that we pull back on antidepressant use, continued regulatory approval has allowed prescriptions to just keep going up and up. Of course, this raises uncomfortable questions regarding the precise relationship between the regulatory agencies and the pharmaceutical industry. Do the agencies have an incentive to set the bar so low?

Given the results of studies outlined above, why do the regulatory agencies that evaluate antidepressants continue to approve these drugs for public use? Well, the key to answering this question is to realise that the regulatory agencies do not take into account the results of negative trials when deciding whether to approve an antidepressant.

Just three months after his work was published, for instance, a survey was conducted on nearly 500 British doctors asking them whether Kirsch’s findings would affect how they’d prescribe antidepressants in the future. Almost half of them, 44 per cent, said they would change their prescribing habits and consider alternative treatments. But this, of course, still meant that over 50 per cent intended to go on prescribing as usual

In other words, side-effects increase the placebo effect. And this is how Kirsch could account for the tiny 1.8 per cent improvement in the antidepressant over the placebo group.

As in his first meta-analysis, which looked only at the published trials, Kirsch’s second meta-analysis, which assessed both published and unpublished trials, revealed that both placebo and antidepressant groups got better. But his second meta-analysis also revealed that the difference in rates of improvement between the antidepressant group and the placebo group was insignificant. And that’s the important bit.

As the results came in from this second meta-analysis, Kirsch grew even more alarmed: they showed that the results of his first study were plainly wrong. Antidepressants didn’t work moderately better than placebos – they worked almost no better at all.

Their study had therefore failed to include the drug trials left unpublished by the pharmaceutical companies who conducted them. Kirsch and Sapirstein had been unaware that pharmaceutical companies regularly withhold trials from publication. When Kirsch looked into how many trials this amounted to, he was aghast at what he found: nearly 40 per cent of all the trials on antidepressant drugs had not been published – a staggering amount.

You’ll also see that both psychotherapy and drug groups get significantly better. But, oddly, so does the placebo group. More bizarre still, the difference in improvement between placebo and antidepressant groups is only about 0.4 points, which was a strikingly small amount.

nstead of doing a brand-new study’, said Kirsch, ‘we decided to do what is called a meta-analysis. This worked by gathering all the studies we could find that had compared the effects of antidepressants to the effects of placebos on depressed patients.