What are the risks?
Alarmed, she went back to her doctor. She next tried Prozac -- that had
problems too -- and finally settled on 50 milligrams of Zoloft each day. Never
once has she gone to a psychiatrist or psychologist during these five years.
Such expense seemed unnecessary; after all, she is taking antidepressants.
Lately, though, she wonders. She's starting to feel depressed again, and her
once-a-day Zoloft doesn't seem to help much. "My biggest frustration is
that I wish I could enjoy sex more," Carla says.
Today, some psychiatrists question whether patients like Carla really need
to take antidepressants for years, or whether a dummy pill or therapy alone
might work just as well. Several recent studies indicate that many of the
beneficial effects attributed to antidepressants can be explained by the
"placebo effect" -- the improvement many people experience when they
believe they're taking medicine.
In the April issue of the journal Archives of General Psychiatry,
researchers analyzed studies of seven new antidepressants, using the Food and
Drug Administration's vast database. Their conclusion? The rates of suicide and
suicide attempts were just as high among patients treated with antidepressants
as for those who took placebos.
"When you look at the reviews, it appears that about six out of 10
patients do achieve some level of benefit. But the issue is, how many of those
six are achieving a benefit that they wouldn't achieve with a placebo or some
other approach?" asks Roger Greenberg, PhD, a psychologist at SUNY Upstate
Medical University at Syracuse and author of From Placebo to Panacea.
"I'd say that out of the six, only about two are receiving a unique benefit
from antidepressants, and even that is questionable."
Should people who feel better on Prozac shred their prescriptions? Not just
yet. This debate is far from settled.
Some leading psychiatrists and mental health advocates are outraged at the
views of Glenmullen and other critics. "Patients say to me, 'I feel normal
for the first time in my life,' " says Harvey Ruben, MD, a clinical
professor of psychiatry at the Yale School of Medicine.
Ruben calls much of Glenmullen's book "pure speculation." Yes, the
antidepressants cause side effects in some patients -- every drug does.
"For any drug, if you look in the Physician's Desk Reference, there
are probably 150 side effects, many of them so severe that you'd probably never
take the drug if you read them," he says. "Glenmullen has taken
legitimate side effects, which are very rare, and some terrible case histories,
and written a book that makes the uninitiated reader believe that these side
effects happen to everybody."
Several psychiatrists also dispute the studies that question the clinical
effectiveness of antidepressants. "If you look at all of the studies in the
world literature, there are no studies in which a placebo is better than an
antidepressant," says Columbia psychiatrist Frederic Quitkin, MD. "In
60% to 70% of the studies, the antidepressant performs better than a placebo.
It's simply impossible for that to happen by accident."