For those of you who haven't seen it, 60 Minutes recently did a segment (you can watch it at the end of this post) on the effects of antidepressants, specifically the difference in results between antidepressants and placebos. Now, everyone knows I have depression. No secret there. Most people also know that I've been on antidepressants of one variety or another since I was thirteen years old. So naturally, I was curious when people on Facebook started paying attention to this segment and decided to watch it all the way through. Now, as someone who has repeatedly had to try to convince people that depression actually exists, that it's a serious disorder, that medication and therapy can help, and that I'm not just weak and/or crazy, I'm of course a little defensive when it comes to these kinds of stories. So, take this post with a grain of salt if you'd like, but also keep in mind that I do recognize my own bias and try to push it back so I can be more objective.
The point of this 60 Minutes segment was to examine the opinions and research of one Irving Kirsch, a psychologist and assistant director of the Placebo Studies Program at Harvard. Kirsch claims that, according to his research, antidepressant drugs usually only provide relief from depression because of a placebo effect. In his own research studies and trials (and many others, according to the segment), antidepressants had little or no more effect on patients than placebo pills. In other words, patients on antidepressants do get better, but only because they think they're supposed to since they're on medication.
Now, the segment goes on and on about studies that back this up and about various experts who at least partially agree with these findings. I'm not saying that these experts are wrong. I'm not a scientist or expert in any way, shape, or form. However, there were several things about this segment that I disliked.
First of all, I thought this segment did a lot of damage to those of us who have spent our lives trying to get people to take the disorder seriously. This felt like a major boost to the "there's nothing actually wrong with you" and "it's all in your head" crowds, simply because the segment didn't take time to address the disorder itself, only the medication... and if you're claiming the effectiveness of the medication is all due to mentality and not chemistry, you REALLY need to address the fact that the same rule does not apply to the disorder itself. 60 Minutes lightly patted that issue on the head for five seconds when Kirsch spoke about the placebo effect surrounding knee surgery as well (apparently just having your knee cut open and sewn back up without any repairs taking place is enough to restore you to health and help you climb mountains again?), but that didn't do much to ease the overall "you can fix your own depression with the power of thought" feeling surrounding the segment.
Now, if you listen carefully to the experts featured in the segment, there are some phrases and points that keep getting mentioned, though the segment doesn't go into much depth or explanation with them. The most obvious of these repetitions is how these experts keep saying that this lack of effectiveness from antidepressants was found only in patients with mild to moderate depression, not those patients with severe depression. In fact, I found it very frustrating that Kirsch never explained WHO the patients were in his research. What disorders did these people have? Antidepressants are used to treat a variety of conditions including major depressive disorder, dysthymia, fibromyalgia, eating disorders, ADHD, and various anxiety disorders. If these patients all had major depressive disorder (as the segment would lead you to believe, even though it's never actually stated), what severity of the illness did this research participants have? Was there a fair representation of the entire spectrum or was he strictly trying to look at the placebo effect on patients with mild to moderate depression, since those are the only findings he keeps giving us? This segment goes on and on about how antidepressants have a clinically insignificant effect on the disorder in patients with mild to moderate depression, but it doesn't give any findings at all in connection with patients with severe depression. It also doesn't bother to give any information at all on the differences between these varying degrees of depression. How is anybody watching this segment supposed to get the full picture or decide how meaningful Kirsch's research really is?
Another thing the segment never mentions is what antidepressants were researched. "Antidepressant" is a very general term to cover a variety of drugs. Most people on antidepressants at least know that there are many significant differences between MAOIs, SSRIs, and SNRIs. Just looking at my own history, I've been on four or five different antidepressants, each with its own unique formula. Not once does this segment tell us which drugs are tested or whether or not there's any difference in the effectiveness of these drugs when they're compared with one another.
Finally, at the end of the segment, 60 Minutes sloppily tacked on two very important pieces of the puzzle. Previously in the segment, it was stated that all this data on whether or not antidepressants are any more effective than placebos was based on the patients' short-term results. However, Eli Lilly, the company that produces the drug I take, stated at the end of the segment that their own research showed that antidepressants were more effective than placebos in the long-term. As someone who has suffered from depression for a decade, that's kind of an important piece for me. But did the segment shed any light on that? Not at all. Eli Lilly also stated that patients on placebos were more prone to relapses than patients on the actual antidepressants. That's also an extremely significant point to examine. The cycle of remission and relapse is something so important to patients suffering from depression, so if the studies show that antidepressants prove more effective in preventing relapse than placebos, that's really something that needs to be made clear.
In other words, I thought that the segment was thought-provoking and raised an important issue, but it left much to be desired. In the end, I found it too inflammatory and one-sided to do any real good for those suffering from depression. So basically, I just want people who watch it to be very careful about falling for what Kirsch is saying without asking some really important questions not covered by the segment. But you don't have to listen to me. Watch the segment and form your own opinions on it.
Treating Depression: Is there a placebo effect? - 60 Minutes
