The drugs don't work for everyone

Abstract

![][1] In February this year, Irving Kirsch from the Department of Psychology at the University of Hull, UK, published a study that came as a crude wake‐up call for millions of patients taking medication to combat depression. The report examined a large set of clinical trials data, including unpublished findings. These data had been submitted to the US Food and Drug Administration (FDA; Rockville, MD, USA) in order to gain approval for the most commonly prescribed selective serotonin re‐uptake inhibitors (SSRIs) for the treatment of depression: fluoxetine (Prozac; Eli Lilly, Indianapolis, IN, USA), paroxetine (Seroxat; GlaxoSmithKline, Brentford, UK), venlafaxine (Effexor; Wyeth, Madison, NJ, USA) and nefazodone (Serzone; Bristol‐Myers Squibb, New York, NY, USA). A comparison between patients who took the drugs and those who took placebo pills revealed that the mean difference between the two groups was below the level of clinical significance along the continuum of depressed states. With the exception of the most severely affected patients, the drugs were no better than the placebos in treating mild‐to‐moderate depression (Kirsch et al , 2008). The study received wide attention in the media, which prompted comments such as the following in The Guardian : “For 12 years I've stayed on the drug \[Prozac\] \[…\] and now I'm reading that it doesn't work anyway unless you've got severe depression […] Perhaps the truth is that Prozac doesn't work for people who are not clinically depressed (why should it?) and lots of people who are not clinically depressed are prescribed it by doctors” (Leader, 2008). > “Perhaps the truth is that Prozac doesn't work for people who are not clinically depressed […] and lots of people who are not clinically depressed are prescribed it…” Now, the pertinent question for millions of people is do antidepressants work and, if so, for what severity of … [1]: /embed/graphic-1.gif