Antidepressants: placebos with side effects?

Abstract

The controversy swirls around how we should interpret this data. [Irving Kirsch] believes that this two-point gap, while statistically significant, is not clinically significant. He accurately points out that a two-point difference on the Hamilton scale "can be obtained by no longer waking during the night, or by no longer waking early in the morning, or by being less fidgety during the interview, or by eating better." These appear, indeed, to be clinically rather trivial improvements. But Kirsch drives several more nails into the antidepressant coffin by arguing that even this tiny two-point difference may be an artifact of the "breaking of the blind," which refers to patients realizing they were assigned to the active drug because they notice side effects. Thus, any apparent advantage of antidepressants over placebo may be simply an "augmented" placebo effect. The inescapable conclusion, according to Kirsch, is that antidepressants are simply placebos with side effects.