Taking the debate about antidepressants forward

Joanna Moncrieff’s book Chemically imbalanced at least seems to have ruffled a few feathers, as it has led to a Lancet editorial. It’s not clear, though, from the editorial how the debate about antidepressants can be taken forward.

Of course many people say they have been helped by antidepressants. But the question is whether the outcome is any better than placebo. Although short-term clinical trials show a significant advantage for antidepressant over placebo, the effect size is small and there is a substantial non-response rate. Over the long-term recurrence is high and many still report residual symptoms. Moreover, it is possible that the significant difference in short-term trials is an artefact because of methodological problems, such as unblinding. Making people dependent on antidepressants is not necessarily in their best interest.

Mainstream psychiatry and medicine in general will never accept that antidepressants are ineffective. Unless people themselves no longer wish to see their mental health difficulties as biologic and are no longer interested in oversimplistic resolution of them by a pill or a bit of psychological therapy, then psychiatry will continue to exploit the placebo effect. The Lancet editorial is right to conclude we remain a long way from providing the level of mental health care that so many people need. It’s been a mistake to look for the solution in psychotropic medication.