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Robert Hitchins – Book Review 3 July 2011
THE EMPEROR’S NEW DRUGS: EXPLODING THE ANTIDEPRESSANT MYTH
Irving Kirsch is Professor of Psychology at Hull in the UK and Emeritus Professor at Connecticut in the USA. His published research into placebos is highly regarded.
Before training in psychology, he played strings in Aretha Franklin’s backing band, which is sufficient to get my R-E-S-P-E-C-T at least. More recently, he has examined clinical trials of antidepressants as reported in The Emperor’s New Drugs.
Drugs became the mainstay of modern psychiatry coincident with the theory that neurotransmitter imbalances in the brain, correctable by specific drugs, caused mental illness after those psychoactive drugs were shown to affect levels of neurotransmitter breakdown products in spinal fluid. Chlorpromazine lowered dopamine levels so it was postulated schizophrenia was due to too much dopamine; antidepressants increased brain serotonin levels so depression was due to lack of Using this logic, you could argue all pain is due to deficiency of morphine or that fevers are all due to lack of aspirin. And after decades of research, the neurotransmitter theory remains unproven.
Staring in 1995, Hirsch reviewed published clinical trials comparing various depression treatments with placebos, and psychotherapy with no treatment. Most studies lasted 6-8 weeks during which time patients can improve somewhat without any treatment. Kirsch was unsurprised to find placebos were three times as effective as no treatment but disturbed that placebos were 75 percent as effective as antidepressants when judged by common scales of depression.
He then obtained all data submitted to the US Food and Drug Administration (FDA) between 1987 to 1999 about fluoxetine, paroxetine, sertraline, citalopram, nefazodone, and venlafaxine. Drug companies must submit all clinical trials they Robert Hitchins – Book Review 3 July 2011
have sponsored but only need two positive ones to get approval. Positive studies are published and widely publicized while negative ones are regarded as proprietary and therefore confidential, so remain unseen. Again, most studies were negative and placebos were 82 percent as effective as the drugs tested. Average difference between drug and placebo on the Hamilton Depression Scale (HAM-D) was 1.8 points—statistically significant but clinically meaningless. All six drugs were equally This book is concise, readable, and very disturbing. Lacking prescribing rights himself, Hirsch could be accused of ‘sour grapes’ but similar concerns are raised by Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker (a journalist), and Unhinged: The Trouble With Psychiatry—A Doctor’s Revelations About a Profession in Crisis by Daniel

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