People who take antidepressants often say they feel better, but some researchers claim that’s due to the placebo effect. If it is, aren’t drug companies abusing depressed people by getting them to buy pricey, useless drugs? On the other hand, if antidepressants genuinely make you feel better, is the feeling lasting, and are they addictive? —ssdfssasdva asdfascaasa
So your question is, are antidepressants bad because they don’t work, or bad because they do? We can eliminate a few possibilities right off the bat. For starters, if I’m in the antidepressant business, I’m not about to sell a product that permanently cheers people up. What I want is something they need on a regular basis, like a nice glass of wine—an antidepressant that works on a lot of levels, including financially for the winemaker and therapeutically for everybody else. But I take it you’re more interested in pills.
First some statistics:
Summing up a common medical attitude, take your Prozac and don’t come back.
Onto the possibility raised in your letter, namely that all those mother’s little helpers don’t actually help. Here’s what we find:
So why are antidepressants prescribed so often? We find a clue in a review of 35 antidepressant clinical trials submitted to the FDA. (Bear in mind, the FDA requires that clinical trials show a significant difference between a drug and a placebo but doesn’t limit the number of trials, enabling drug manufacturers to keep rolling the dice until they get the desired result.) The review found that, on average, antidepressants didn’t meet the criteria for “clinical significance”—in other words, they didn’t do anything, except for one group: patients rated as extremely depressed.
We further note that: (1) the U.S. population is aging, and elderly patients require more medical attention; and (2) the percentage of primary care physicians has dropped significantly, from half of doctors in 1950 to barely more than 30 percent now.
The upshot is that primary care doctors have higher patient loads and less time to spend per patient. Since everyone nowadays expects the doctor to do something, and since antidepressants make many others feel better, if only through the power of suggestion, the default response is to prescribe drugs for anyone with a mood beef—next patient, please.
The number of primary care physicians entering the field between now and 2020 isn’t expected to keep up with demand. How all this will play out in the face of rising health care costs and the Affordable Care Act remains to be seen, but for a lot of people pills might be all they ever get. —Cecil Adams
Have something you need to get straight? Take it up with Cecil at straightdope.com.