“Prozac Nation”? Try Placebo Nation…

Freedom of information opens up the file drawer on Prozac, with The Guardian reporting today that Prozac and similar antidepressants are no more effective than placebo for mild to moderate depression:

“Prozac, the bestselling antidepressant taken by 40 million people worldwide, does not work and nor do similar drugs in the same class, according to a major review released today.

The study examined all available data on the drugs, including results from clinical trials that the manufacturers chose not to publish at the time. The trials compared the effect on patients taking the drugs with those given a placebo or sugar pill.

When all the data was pulled together, it appeared that patients had improved – but those on placebo improved just as much as those on the drugs.

The only exception is in the most severely depressed patients, according to the authors – Prof Irving Kirsch from the department of psychology at Hull University and colleagues in the US and Canada. But that is probably because the placebo stopped working so well, they say, rather than the drugs having worked better.

“Given these results, there seems little reason to prescribe antidepressant medication to any but the most severely depressed patients, unless alternative treatments have failed,” says Kirsch. “This study raises serious issues that need to be addressed surrounding drug licensing and how drug trial data is reported.” “

The study is published here.

Treating depression is a serious, and lucrative, business (hence the industry-standard practice of consignment to the file drawer for negative results, that this study managed to dig up). The cultural effect of Prozac seemed to fuel the business nicely as well, remember all the triumphalist stuff in the 90s about Prozac being part of a new wave of psychopharmacological tinkering with our very beings?

I’m sure critics of this study will wade in with various statements about the need to correct chemical imbalances in depression, etc. another area where rhetoric (and advertising) is not quite square with the evidence.

As Prof Kirsch has written previously : “listening to Prozac, but hearing placebo”.

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1 Comment

Filed under Mental Health

One response to ““Prozac Nation”? Try Placebo Nation…

  1. My layman’s theory: a lot of depression is about not naming (not being allowed, for ideological reasons, to name) the practical problem (which can be political, societal, structural) that is really getting to you. So the solution can be in some cases an intellectual or political one (although therapists will tell you not to think, but to feel, and not to look outside yourself, but within … and/but I suspect these are false dichotomies). It is of course easier to medicate people and say it is all about “feeling happy” … although again, I would say that happiness is a general disposition and also an epiphenomenon or a passing emotion, and that what really counters depression is not “feeling happy” but being integrated, autonomous, open, free.

    The reason I never believed in Prozac is that the science behind it never seemed to make sense, and also (importantly) that the effect was supposed to be so slow and subtle. How could one then ever know if the drug was working or if it was something else? And if it didn’t, it was easy to make excuses (“you aren’t doing your work,” etc.).

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