What are the risks?
"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."
What about the studies that seem to indicate that placebos work just as well
as antidepressants? Quitkin believes that some of these results may be
attributable to flaws in the way the studies were designed and conducted. If a
study isn't long enough, or uses an inappropriate dose, it may show a drug is
less effective than it really is.