What Do Antidepressants Prove?
One of the pieces of “evidence” used to support the current model of mental health labeling has to do with the supposed relationship between the presence of a “disease” and the availability of a “drug” that treats that disease. In a sense, drugs verify diseases. Consider antidepressants. It’s easy enough for both lay folks and professionals to think, “Don’t antidepressants prove that there is such a thing as depression? I mean, when you treat an illness with a drug and you get better, doesn’t that prove that you were ill in the first place?”
No, it doesn’t.
To begin with, it’s fair to debate whether or not antidepressants actually “work.” That they regularly do or really don’t isn’t so clear. The definition of what constitutes antidepressant effectiveness sets the bar very low. Mark Hyman explained in the Huffington Post:
Just because antidepressants are popular doesn’t mean they’re helpful. Unfortunately … most patients taking antidepressants either don’t respond or have only partial response. In fact, success is considered just a fifty percent improvement in half of depressive symptoms. And this minimal result is achieved in less than half the patients taking antidepressants. That’s a pretty dismal record.
Second, drug companies regularly suppress research demonstrating the ineffectiveness of the antidepressants they sell, thus producing an inflated sense of drug effectiveness. One example of this widespread practice is the following, as reported in NewsInferno:
Reboxetine, an antidepressant sold by Pfizer … is ineffective, and could even be harmful, according to a new study conducted by German researchers … Researchers from the German Institute for Quality and Efficiency in Health Care have accused Pfizer of failing to disclose negative clinical trial results for reboxetine, after finding that eight out of 13 significant trials were never published.
Third, the extremely high “relapse rate” after discontinuing antidepressants suggests that “effectiveness” is being defined as the temporary alleviating or masking of symptoms. Sharon Begley reported in the Wall Street Journal:
Unless patients continue taking the drugs, they have a considerable risk of suffering a relapse in the year after they stop … A large 2001 study found that the risk of relapse in patients taking antidepressants only, in the year after they stop, is 80%. In contrast, patients receiving only cognitive behavior therapy in that study had a relapse rate of 25% in the year after ending treatment.
Fourth, multiple studies indicate that a large percentage of the effectiveness of antidepressants may be the placebo effect. Maia Szalavitz wrote in Time:
A small, but vocal minority of researchers have also questioned whether the mood-enhancing benefit of antidepressants amounts to anything more than a psychological artifact. They point to studies that suggest the drugs’ seemingly powerful effects are the same as those of a sugar pill. Most recently, a headline-grabbing Journal of the American Medical Association paper published in January  found that antidepressants worked no better than a placebo in patients with mild or moderate depression.
John Kelley explained in Scientific American,
In clinical practice, many people suffering from depression improve after taking antidepressants. But the evidence indicates that much of that improvement is a placebo response. Antidepressants do work in the sense that many patients in clinical practice show substantial improvement. However, if the standard is efficacy in comparison to placebo, the best available scientific evidence suggests that antidepressants do not work very well. Given their cost and side effects, the psychiatric community and the general public should not be satisfied with antidepressant medications that provide only a marginal benefit over placebo.
The fact that antidepressants are now prescribed for a myriad of very different-looking and different-seeming “ailments” further suggests that we are looking at a placebo effect rather than a chemical effect. Peter Breggin wrote in Talking Back to Prozac:
While Prozac was originally approved for depression—and only recently for obsessive-compulsive disorder—it and the other SSRIs quickly began to be prescribed for a wide variety of ailments and difficulties, such as seasonal affective disorder (SAD) or ‘winter blues,’ obesity, anorexia, bulimia, phobia, anxiety and panic disorder, chronic fatigue syndrome, premenstrual syndrome (PMS), post-partum depression, drug and alcohol addiction, migraine headaches, body dysmorphic disorder (BDD), and, finally, behavioral and emotional problems in children and adolescents.
There are more reasons than these to suspect the ineffectiveness of antidepressants. But let’s grant that antidepressants sometimes generate genuine effects. Even if it were proven to everyone’s satisfaction that antidepressants do work to “relieve the symptoms of depression,” would that constitute proof that “depression” is a “mental disorder”? Not hardly. All it would prove is that chemicals have effects and that chemicals can alter a human being’s experience of life.
Is that news?
Chemicals can make you giddy, they can cause you to hallucinate, they can give you an adrenaline rush, they can make you forget your troubles, they can give you an erection, they can cause you to skip your period—chemicals have effects. Chemicals can have an effect on how your mind works. Chemicals can have an effect on how you sleep. Chemicals can alter your moods. That a chemical, called an antidepressant, can change your mood in no way constitutes proof that you have a “mental disorder” called “depression.” All that it proves is that chemicals can have an effect on mood.
There is a fundamental difference between taking a drug because it is the appropriate treatment for a medical illness and taking a chemical because it can have an effect. This core distinction is regularly obscured in the world of treating depression. The mental health industry routinely makes the leap from “We don’t know what you have and we surely don’t know what’s causing it” to “Take this chemical.” This leap has naturally confused a lot of smart, sensible people who are not informed enough to ask “Are you prescribing this drug because I have a biological disorder or are you prescribing this chemical because it is known to have an effect on my symptoms?”
An antidepressant may elevate your mood and rid you of symptoms. If those effects really are available they aren’t to be sneezed at. You would need to factor in the characteristic side effects of antidepressants—among them sexual dysfunction, fatigue, insomnia, loss of mental abilities, nausea, and weight gain—and make your informed decision. But that certain chemicals called antidepressants sometimes have positive effects does not prove that there is a “mental disorder” called “depression.” It doesn’t prove it by a long shot.
You may desperately want those effects and opt for chemicals to deliver them. To the extent that the chemicals really do deliver those positive effects and to the extent that their side effects aren’t worse than their positive effects, antidepressants may be a reasonable choice. It certainly wouldn’t be the first time someone took a chemical to get a respite from human unhappiness. But antidepressants on their best day do not constitute proof that they are a “treatment for a mental disorder called depression.” They are only proof that chemicals have effects.
We must get clearer on this. The fate of any new naming system rests on “getting over” the putative relationship between “mental disorders” and the “drugs used to treat them.” That a chemical can have an effect is obvious. To leap from that truth to the world of “drugs” and “illnesses” requires more than a financial incentive!