Do antidepressants help those who have been diagnosed as being clinically depressed? Most people, including doctors, would say yes. One can hardly watch TV without seeing an advertisement for an antidepressant promising help and hope to the defeated and depressed. In 2005, 27 million people took antidepressants.
But a recent Newsweek article, “The Depressing News About Antidepressants,” reports, based on numerous studies, that antidepressants are no better than placebos.
Yes, the drugs are effective, in that they lift depression in most patients. But that benefit is hardly more than what patients get when they, unknowingly and as part of a study, take a dummy pill—a placebo. As more and more scientists who study depression and the drugs that treat it are concluding, that suggests that antidepressants are basically expensive Tic Tacs.
So why do so many people feel better after taking antidepressants?
The lion’s share of the drugs’ effect comes from the fact that patients expect to be helped by them, and not from any direct chemical action on the brain, especially for anything short of very severe depression.
But what about the oft-repeated claim that certain antidepressants increase serotonin levels and correct a depressed person’s brain’s “chemical imbalance”?
Unfortunately, the serotonin-deficit theory of depression is built on a foundation of tissue paper. How that came to be is a story in itself, but the basics are that in the 1950s scientists discovered, serendipitously, that a drug called iproniazid seemed to help some people with depression. Iproniazid increases brain levels of serotonin and norepinephrine. Ergo, low levels of those neurotransmitters must cause depression. More than 50 years on, the presumed effectiveness of antidepressants that act this way remains the chief support for the chemical-imbalance theory of depression. Absent that effectiveness, the theory hasn’t a leg to stand on. Direct evidence doesn’t exist. Lowering people’s serotonin levels does not change their mood. And a new drug, tianeptine, which is sold in France and some other countries (but not the U.S.), turns out to be as effective as Prozac-like antidepressants that keep the synapses well supplied with serotonin. The mechanism of the new drug? It lowers brain levels of serotonin. “If depression can be equally affected by drugs that increase serotonin and by drugs that decrease it,” says Kirsch, “it’s hard to imagine how the benefits can be due to their chemical activity.”
Pastors, what’s your perspective on antidepressants? If a church member tells you his or her doctor has prescribed antidepressants for that person’s depression and asks you if he or she should take them, how would you respond? How do you counsel someone who is on antidepressants?