Us talking therapists often work with people who are taking anti-depressants, and many clients speak of how helpful they can be when things have felt intolerable (not all, of course). People speak of an improvement to sleep, anxiety reduction, and a general sense of a “taking the edge” off painful feelings. Sometimes their effects allow people to engage in therapeutic work in the first place, as (it was once described to me) “they lifted the fog to enable me to think about my inner world with a useful measure of self-reflection”.
Having said all this, I do worry when I hear stories about prescriptions being readily given out, and I am critically aware of the sinister sounding practices of the mammoth and influential pharmaceutical companies. With this in mind, Irvin Kirsch’s The Emperor’s New Drugs makes fascinating, if unsettling reading. Taking the reader through two decades of research from an impressive range of sources, he concludes that SSRIs (selective serotonin reuptake inhibitors such as Prozac, Seroxat and Lustral) are, on balance, no better than placebos. The placebo effect is now well known (and brilliantly explored by Ben Goldacre if you ever get the chance to read him), and he devotes many words to exploring our well-known capacity to measurably respond to our belief or information about a treatment– eg brain scans/pulses/body temperatures. (Brain scans can show a placebo for depression activates the same cortical region as drugs can.)
Kirsch also asserts that the evidence he has unearthed suggests that the theory behind SSRI’s rests on wonky facts too – they don’t correct a chemical imbalance in the brain after all. He discovers (via the Freedom of Information Act in USA) that the drug’s manufacturers chose not to publish lots of research with negative results, while over-publishing the positive results that they were after. Evidence-based medicine this doesn’t seem to be.
However, Professor Kramer of Brown University thinks otherwise. He sees plenty of good enough evidence in favour of anti-depressants, lost in the tide of public opinion against pharmaceutical companies generally. He concedes that things do get debatable in the case of prescriptions for relatively mild cases of depression, but not, he argues, in cases of severe depression, strokes, multiple sclerosis and epilepsy.