Antidepressants, placebo and medicalising moodAntidepressants, placebo and medicalising mood
All In The Mind
When Professor Irving Kirsch and colleagues got hold of the unpublished data from drug company trials of antidepressants, it hit the headlines. But their analysis – that antidepressants and placebo pills have about the same clinical impact – was widely misreported. Hear it from the horse's mouth, from the stage of the 2009 Happiness and Its Causes Conference.
30:16•23 May 2009
Antidepressants, Placebos and the Question of Medicalising Sadness
Episode Overview
- Antidepressants and placebos both show large improvements in depression, but the difference between them is often too small to count as clinically meaningful under UK guidelines.
- The popular chemical imbalance explanation for depression is questioned using examples of drugs with opposite effects on serotonin that show similar response rates.
- Antidepressants can involve significant side effects, increased suicide risk in younger people and withdrawal symptoms, so any changes to treatment should be done gradually with medical advice.
- Research cited in the episode suggests exercise programmes can outperform antidepressant medication for remission over ten months in some groups.
- Psychotherapy, particularly cognitive behaviour therapy, is reported to reduce long-term relapse rates compared with medication alone.
“"Antidepressants work in the sense of people getting better. But it doesn't matter what's in the drug. Placebos work as well."”
What are the common struggles and victories in addiction recovery? This conversation from All In The Mind zeroes in on depression, antidepressants and whether everyday unhappiness is being turned into a medical condition. Psychologist Professor Irving Kirsch sets the scene with his headline-grabbing research, explaining that, while "people get better" on antidepressants, "people who are given placebo, inert sugar pills... also get better" and that the difference is statistically real but often "not clinically significant" by UK guidelines.
He questions the popular "chemical imbalance" story, pointing to drugs that act in opposite ways on serotonin yet show similar response rates.
Kirsch also raises tough issues for anyone considering medication: side effects, increased suicide risk in younger people, and withdrawal symptoms, while stressing, "If you are currently taking antidepressants, don't stop without consulting your doctor." He highlights exercise and psychotherapy as alternatives, noting studies where exercise outperformed SSRIs over ten months and where cognitive behaviour therapy sharply reduced relapse compared with drug treatment alone. A panel discussion then tackles the big question: are we medicalising sadness?
Psychiatrist Professor Ian Hickey draws a line between normal emotional pain and clinical depression, arguing that sadness is "to be cherished" and that first steps for many should be time, serious listening, information and evidence-based psychological care. GP Dr Ruth Gawler questions high prescription numbers, especially for children, and talks about helping people build skills around lifestyle, connection, diet, sunlight and practices like meditation or yoga.
Across the episode, anyone interested in mental health, antidepressants or alternatives like exercise and therapy will get plenty to think about. It might leave you asking: what kind of help would you actually want on your hardest days?
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