Abstract:

Antidepressants are supposed to work by fixing a chemical imbalance, specifically, a lack of serotonin or norepinephrine in the brain.  However, analyses of the published and the unpublished data that were hidden by the drug companies reveal that most (if not all) of the benefits are due to the placebo effect, and the difference in improvement between drug and placebo is not clinically meaningful (Kirsch et al., 2002, 2008).   This conclusion has been replicated in a new patient-level analysis, authored by officials at the FDA, of all the antidepressant data sent to them by the pharmaceutical companies between 1979 and 2016 (73,000 patients in 228 clinical trials).  Some antidepressants increase serotonin levels, some decrease serotonin, and some have no effect at all on serotonin.  Nevertheless, they all show approximately the same therapeutic benefit.  Instead of curing depression, popular antidepressants may induce a biological vulnerability making people more likely to become depressed in the future.  Other treatments (e.g., psychotherapy and physical exercise) produce the same short-term benefits as antidepressants, show better long-term effectiveness, and do so without the side effects and health risks of the drugs.