Antidepressants beat placebo but often not by a meaningful margin

Transcript

Transcribed by machine (Whisper) from the episode’s audio, so a word may be off here and there.

1. 3:22:22

   study of these antidepressants. They beat placebo in a statistically significant margin, but not necessarily in a clinically significant margin. And this is when you see drug ads, be very careful, this one significantly improves X or Y. Does that mean clinically or does it mean statistically because when we measure improvement with depression, we tend to use rating scales of various sorts. And if you improve on one of the major scales that's used by one or two points on a 60-point scale, it may be enough to show statistical significance. This drug's a little better than placebo, but it doesn't really affect your quality of life much. And for most patients, antidepressants are marginally better than placebo, but a lot of the effect is the placebo effect.

2. 3:23:31

   And they come with very difficult side effects. A lot of people describe them as numbing drugs. They flatten everything out. So you can't experience the highs and lows that normally we take as part of human experience. And then the numbing extends elsewhere in your body. In particular, lots of patients find a complete loss of libido. They can't get an erection. They can't climax if they're a woman. Their sex life just goes away. And sometimes it doesn't come back after you stop the drugs. Next layer of problems, getting off the drugs for some people turns out to be hell on wheels. They get worse depression than they had before. They get terrible feelings. Their brain is sparking something's wrong. And so many patients find themselves trapped on those drugs for a long time. And we don't know what the effects of that

3. 3:24:38

   are going to be. So it's a very mixed picture. You know, that's why I think groups like NICE in England are saying, use CBT as the first line, not drugs. But again, it's also fair to say, I think what we find, and there was a recent Lancet study that I think was revealing on this point. It's like this with both antipsychotics and antidepressants. You have a group of people who respond. pretty well. And the side effects for them are bearable, or even they don't experience them.

4. 3:25:15

   That's great. You have a group of people, and it's significant. With depressed patients, we're talking north of 40% who aren't responding. So drugs aren't doing anything for them, and they're running a risk. And then in the middle, you have a group of people who get some positive improvement, but they also get side effects. And that's where this cost-benefit analysis, if we can call it that, comes into play, and it's very difficult. And the problem is going in, you don't know which group you're going to fall in, and your doctor doesn't know which group you're going to fall in. And more importantly, one of the things the drugs revolution