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Shake-up and wake-up

Posted by plosmedicine on 31 Mar 2009 at 00:21 GMT

Author: Martin Russell
Position: Medical Practitioner
Institution: Solo Practice, Adelaide, South Australia
Submitted Date: February 27, 2008
Published Date: February 28, 2008
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Congratulations to Irving Kirsch and those behind this article.

It is interesting to see the commotion this has caused, and rightly so. Even more interesting has been the reporting that has combined the biological description of depression (eg biochemical imbalance in the brain) with the fact that they are reporting the drugs don't work to anywhere near the level previously promoted. The media is brainwashed to parrot what it has been told, even when there is a gaping hole in the theory. Brain chemistry is not like insulin for diabetics.

It is also interesting to hear people who have received anti-depressants, and clinicians who prescribed them, somehow thinking they could not be responding to a placebo. "All this evidence I have seen with my own eyes can't be wrong" had been the catch-cry of quacks and the quasi-scientific, but it seems it is just the same here. Too many doctors, and patients, are not going about this scientifically.

If this paper is right then it says these drugs should not have gotten onto the market in the first place. The criticism that these studies were no more than 6 weeks long just means that the longer-term studies should have been done before these drugs are prescribed in all but the most severe cases.

Too bad this sort of data is not available for the original Tri-cyclic anti-depressants. There may be a return to these medications en mass, and we still made need good data similar to this to decide if TCAs do any good either.

We can't offer talk therapy to the 5-15% of the western world that is supposedly "depressed", but it's no value overstating the benefits of medication either.

Far from being a step backwards I would like to see medicine, and psychiatry in particular, take this as a giant wake-up call for the 21st Century.

No competing interests declared.