Sugar pills, antidepressants, and the miracle of the human brain

Chasing other links I stumbled across this:

As a proportion of the drug response, the placebo response was constant across different types of [antidepressant] medication (75%), and the correlation between placebo effect and drug effect was .90. [...] These data raise the possibility that the apparent drug effect (25% of the drug response) is actually an active placebo effect.

In English: it's possible that all reported effects of antidepressant medication are placebo effects. It's quite likely that 75% of reported effects are placebo.

More recently, these authors replicated the work using studies from the FDA database. FDA studies are done as part of drug approval processes. They're generally not published in refereed literature and there have been accusations that they're slanted in favor of the drugs. That is, the studies are done in order to speed drugs through the approval process and may overreport positive effects and underreport negatives. So in theory you'd see a larger effect for ADs if you analyzed these studies. In fact:

Kirsch et al. reported an 18% difference between drug and placebo.

The debate is actually fairly nuanced. There's been some good work recently looking (via MRI) at the neurochemical mechanisms triggered by placebos. There is some evidence that the difference between AD and placebo increases with the severity of depression, though that might be due to differences between active and inert placebos - people with serious depression are often familiar with the side effects of ADs and can recognize when given a sugar pill that doesn't have the expected side effects.

Nobody's claiming that ADs don't work. The claim is that they do work... and sugar pills work, too.

Title: "Listening to Prozac but hearing placebo: A meta-analysis of antidepressant medication."
Authors: Kirsch, Irving; Sapirstein, Guy
Publication: Prevention & Treatment. 1(1), Jun 1998
<http://content.apa.org/journals/pre/1/1/2>

Title: "The emperor's new drugs: An analysis of antidepressant medication data submitted
 to the U.S. Food and Drug Administration."
Authors: Kirsch, I., Moore, T. J., Scoboria, A., & Nicholls, S. S.
Publication: Prevention & Treatment, 5, art. 23
<http://journals.apa.org/prevention/volume5/pre0050023a.html>

Sugar pills, antidepressants, and the miracle of the human brain

Chasing other links I stumbled across this:

As a proportion of the drug response, the placebo response was constant across different types of [antidepressant] medication (75%), and the correlation between placebo effect and drug effect was .90. [...] These data raise the possibility that the apparent drug effect (25% of the drug response) is actually an active placebo effect.

In English: it's possible that all reported effects of antidepressant medication are placebo effects. It's quite likely that 75% of reported effects are placebo.

More recently, these authors replicated the work using studies from the FDA database. FDA studies are done as part of drug approval processes. They're generally not published in refereed literature and there have been accusations that they're slanted in favor of the drugs. That is, the studies are done in order to speed drugs through the approval process and may overreport positive effects and underreport negatives. So in theory you'd see a larger effect for ADs if you analyzed these studies. In fact:

Kirsch et al. reported an 18% difference between drug and placebo.

The debate is actually fairly nuanced. There's been some good work recently looking (via MRI) at the neurochemical mechanisms triggered by placebos. There is some evidence that the difference between AD and placebo increases with the severity of depression, though that might be due to differences between active and inert placebos - people with serious depression are often familiar with the side effects of ADs and can recognize when given a sugar pill that doesn't have the expected side effects.

Nobody's claiming that ADs don't work. The claim is that they do work... and sugar pills work, too.

Title: "Listening to Prozac but hearing placebo: A meta-analysis of antidepressant medication."
Authors: Kirsch, Irving; Sapirstein, Guy
Publication: Prevention & Treatment. 1(1), Jun 1998
<http://content.apa.org/journals/pre/1/1/2>

Title: "The emperor's new drugs: An analysis of antidepressant medication data submitted
 to the U.S. Food and Drug Administration."
Authors: Kirsch, I., Moore, T. J., Scoboria, A., & Nicholls, S. S.
Publication: Prevention & Treatment, 5, art. 23
<http://journals.apa.org/prevention/volume5/pre0050023a.html>