Living Skillfully: Your Mind and Health

There’s been a lot of attention paid to a study called Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration, by Irving Kirsch of the University of Hull and colleagues, which appears to show that the effectiveness of four major antidepressant drugs is little better than a placebo (inactive pill).

Pills by Fillmore Photography

Because it’s on the wonderful Public Library of Science, you can read the whole study yourself online for free and you don’t have to rely on my summary or anyone else’s. But I’m going to give you one anyway.

Summary

What the researchers did was take the studies submitted by drug companies to the US Food and Drug Administration for approval of four antidepressant drugs, along with some other studies which weren’t submitted to the FDA but probably should have been, and use statistical methods to get an overall view of the effectiveness of the drugs.

They concluded:

Drug–placebo differences in antidepressant efficacy increase as a function of baseline severity, but are relatively small even for severely depressed patients. The relationship between initial severity and antidepressant efficacy is attributable to decreased responsiveness to placebo among very severely depressed patients, rather than to increased responsiveness to medication.

As the study authors note, that last sentence is very interesting and is ripe for follow-up. Why did the most severely depressed patients not respond as well to the placebo? Was it because they were so depressed that they didn’t believe anything would help them? If so, why did the actual drugs help them anyway?

The PLOS editors’ summary is also useful, and says in part:

Given these results, the researchers conclude that there is little reason to prescribe new-generation antidepressant medications to any but the most severely depressed patients unless alternative treatments have been ineffective.

This, to me, is the key thing to highlight. Not, as some media have irresponsibly reported, that these drugs “don’t work”; they do work. It’s just that, as far as this study is concerned, a large part of how they work is by suggestion – something which hypnotherapy, for example, uses much more deliberately and effectively. These people are improving because of something that they are doing with their minds, not, primarily, because of drugs which are influencing their neurochemistry directly.

Drug or Non-Drug?

Now, a good doctor isn’t just going to push a pill at you as his or her first response; but not all doctors are good doctors, and comparatively few doctors – even the good ones – are as aware as they should be of non-drug treatments that are more effective than drugs in particular circumstances. The other factor, as mentioned by the Mental Health Foundation’s Judi Clements in the TVNZ report last night, is that these drugs are publicly funded (at huge cost), whereas effective non-drug treatments like talk therapy (and hypnotherapy) are not. So it can be cheaper for a depressed person to get a less effective treatment, because it is at taxpayer expense.

There are all kinds of issues about public funding of non-drug treatments in NZ, of course, because counseling, psychotherapy and hypnotherapy are unregulated here, registration and professional membership are voluntary, and so there is no official Government-recognized way of recognizing the well-trained and effective therapists. (Tip: look for the professional membership, it does mean something.)

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