Are antidepressants glorified placebos?
June 16th, 2011
04:41 PM ET

Are antidepressants glorified placebos?

Which came first, the mental illness or the drug? While in other areas of medicine this is a no-brainer (no pun intended), some argue that certain psychiatric conditions are created and classified because of the effects particular drugs have on the body, and not the other way around.

Three new books, reviewed in Dr. Marcia Angell's article "The Epidemic of Mental Illness: Why?" in The New York Review of Books, raise startling possibilities about the truth behind the explosion of prescriptions of pharmaceutical treatments for mental illness. (Dr. Angell, by the way, was the first woman to ever be editor-in-chief of the prestigious New England Journal of Medicine).

All of the authors of the new books agree on two thought-provoking viewpoints:

1. Our understanding of categories of mental illness and their treatments has been influenced by drug companies, through both legal and illegal marketing.
2. Mental illness is not caused by chemical imbalances in the brain.

These views, however controversial, are documented well, Angell says.

For instance, even though the goal of psychoactive drugs is to alter levels of neurotransmitters - brain chemicals - which affect mood, scientists have not found good evidence that it's the chemicals themselves that cause the mental illness. Before treatment, neurotransmitter function seems to be normal, they say.

"By this same logic one could argue that the cause of all pain conditions is a deficiency of opiates, since narcotic pain medications activate opiate receptors in the brain," writes Daniel Carlat, author of "Unhinged: The Trouble With Psychiatry - A Doctor’s Revelations About a Profession in Crisis."

So if drugs don't treat the cause of mental illness, what are they doing? Irving Kirsch argues in "The Emperor’s New Drugs: Exploding the Antidepressant Myth" that antidepressants work merely because patients believe they work, and the pills' side effects reinforce that belief.

As I wrote earlier this month, the placebo effect is the idea that a sham medical treatment, with no inherent healing properties, can sometimes operate as if it were an actual drug in alleviating pain and changing blood pressure, digestion and other involuntary functions. The more complex and involved the fake treatment, the more effective it's likely to be.

So keep that in mind when you consider that, according to Kirsch's research on Food and Drug Administration reviews of clinical trials of antidepressants, placebos were about 82% as effective as the drugs. And non-antidepressant treatments such as sedatives and opiates were just as effective. In fact, he found that "nearly any pill with side effects was slightly more effective in treating depression than an inert placebo," Angell writes. Kirsch speculates that, in fact, the side effects themselves are what convince patients that their antidepressants are working, and lead to them saying they feel less depressed.

Our CNNHealth.com mental health expert - Dr. Charles Raison, a psychiatrist at Emory University School of Medicine - says there is some truth to the idea that antidepressants work at least in part by the placebo effect, and science has borne that out. And that's not necessarily a bad thing, as physicians can harness this effect - for instance, in terms of the doctor-patient relationship itself being therapeutic - he says. But in patients with more severe depression, the placebo effect diminishes, so the drug must be doing something. You could even look at it like this: antidepressants may potentiate the placebo effect.

"Antidepressants are not perfect, but they definitely have saved many people’s lives," he says.

And if the myth of the chemical imbalance suggests that depressed people simply need more or less of certain brain chemicals, that's right, Raison says: "It’s pretty clear that depression is not like you’re running out of gas." But, of course, all emotions and thoughts are generated by physical interactions in the brain and the body, so at its core, depression is indeed a biologically based disorder. The brain is obviously quite complex, and antidepressants seem to help reset and recalibrate systems in the brain to help you feel better.

Angell will address the "wonder drug" popularity of mental illness treatments in the second part of her series.

soundoff (334 Responses)
  1. Greg

    I participated in a trial and I have hard time believing they could get accurate information by their methods. The doctor even tried to tell me what I'm feeling.; not sure how he would know more about what I was feeling than me. The side affects make you think you are really taking something and could enhance the placebo effect; kind of like, the if it tastes bad it must be good for you effect. How much does placebo treatment cost? Money for nothing, where are the chicks for free? I guess the doctor gets the girl.

    June 16, 2011 at 17:14 | Report abuse | Reply
    • Mike

      Stay on your meds, buddy. It sounds like you need them.

      June 16, 2011 at 17:35 | Report abuse |
    • Richard

      Too funny, no wonder people with real depression are reporting that it is not helped! so maybe were not crazy after all? if the drug really doesn't help then it doesn't help! (a ten year plus cronic pain patient) why wouldn't I be depressed?

      On the other hand, it is a good way of telling real depresson from fake, Fake Depression is helped by the fake drugs, Real Depression is not! lol

      June 16, 2011 at 18:40 | Report abuse |
    • CatMan

      I refuse to take them, even with BAD depression. I've tried them all in the past. The most innocuous of them did nothing. Zip, zilch, nada. The worst of them made me suicidal and in one case, even homicidal, even though the homicidal thought was just generalized in nature. No urge to do anything, but thought almost always there. Doctors keep offering them, I keep refusing them. I get through the days but as far as quality of life goes, it blows. I've gone without for 8 years now. Despondency is something I've just gotten used to.

      June 16, 2011 at 22:45 | Report abuse |
    • joebob

      Lexapro made me intensely homicidal. My doctor would not believe me so I took myself off the drugs. I am soooo glad I did, even though the withdrawals are horrific and cause brain damage. If I didn't I really think I would be one of those people high on antidepressants that goes out on a shooting spree killing many people in a shopping mall. It was so bizarre the way these made me feel.

      June 16, 2011 at 23:40 | Report abuse |
    • kake79

      What in the world?! Coming off of antidepressants does NOT cause brain damage!

      June 17, 2011 at 14:48 | Report abuse |
  2. Aaron L.

    I was prescribed and addicted to anti-depressants for years. I developed high blood pressure from Peroxitine(Paxil). I'm 27 years old. I weened myself off and I am doing fine. RX drugs are some of the most addictive , expensive, and dangerous drugs available. They kill 100,000 people a year. Dr. Gupta, save us from ourselves. Save us from the pharmaceuticals that we do not need.

    June 16, 2011 at 17:37 | Report abuse | Reply
    • jota

      It seems easy and popular to dismiss the benefits of anti-depressants; however, on days during which I start to feel particularly agitated and/or depressed, I rethink my activities that morning and realize that I've forgotten to take my med. How do you account for that? It's not a matter of thinking, "I forgot to take my meds, therefore I must be more depressed or anxious."

      June 16, 2011 at 22:12 | Report abuse |
    • ME too

      I got off the med merry go round as well and have been better than ever for over a year! The side effects are worse than what it is supposed to help and who knows what the brain will do on them after 10 or so years! I know stick to all natural!

      June 16, 2011 at 22:14 | Report abuse |
    • mo'

      jota- while you may not have consciously realized you didn't take your medication, subconsciously you know you didn't take it. i'm not saying your subconscious made up your symptoms so you'd take the drug, but i'm not NOT saying it, either. i do believe mental conditions like depression are a chemical imbalance in the brain, or possibly the improper processing of those chemicals. either way, i don't think we know nearly enough about the brain to say these meds work or don't work. it's why i took several different anti-depressants, was dissatisfied with the results of each, and take none. i've dealt with this condition for 23 years, i deal with it better than i dealt with the sid effects. and the meds i was on only took away the mania, they did nothing for the depression. except possibly made it even worse. it's also why my aunt takes the same meds i didn't think gave me any results, and she does great on them. i think the real revelation with this study is that the pharmaceutical companies try so hard to sell their product and prove that it does what they say it does that they lose sight of making products that ACTUALLY solve a problem, instead of just making us believe they solve a problem.

      June 16, 2011 at 22:43 | Report abuse |
    • joebob

      Antidepressants clearly help some people but doctors need to be able to identify who those people are instead of just throwing spaghetti against the wall and hoping something sticks approach. They have to come up with a test. I have taken zoloft. paxil, nardil and they helped a ton but the side-effects were outrageous. But I have no doubt they helped my depression but overall they were not worth taking. The interesting thing is, I had allergies but didn't know it. So these drugs supress histamine. Maybe that is why it worked so well for me.

      June 16, 2011 at 23:44 | Report abuse |
    • Kat

      Jota, there is such a thing as SSRI withdrawal. Sometimes your skipped pill may be the result of your agitation itself, not your depression. Most doctors don't talk at all about withdrawal from antidepressants, but it can be very bad, much worse than the original affliction.

      June 17, 2011 at 10:04 | Report abuse |
  3. LG

    I think Dr. Raison is more on the right track – with more severe depression the placebo effect diminishes so the drugs must be doing something. The problem is that we don't know how they work – drug companies never emphasize the mechanism of action of these, because it hasn't been proven. I think anti-depressants must do more than just increase serotonin/norepinephrine levels – and it seems plausible that some people, by nature, need more serotonin (or whatever else the drugs do) etc. to not be depressed than 'normal' people.

    I wonder if there are studies of antidepressants focused on just severely depressed people. I'll have to look that up on PubMed later.

    June 16, 2011 at 17:55 | Report abuse | Reply
  4. JustAnotherGirl

    Well the side affects certainly haven't caused me to that the meds are working; I'm experiencing side affects and the meds aren't working (though I haven't been on these particular ones for too long). These folks should be careful, though; they could very well cause people who really should be on medications to stop taking them with possible disastrous results.

    June 16, 2011 at 17:58 | Report abuse | Reply
    • LG

      ^^They absolutely should be careful.

      June 16, 2011 at 18:00 | Report abuse |
    • BellaTerra66

      No one should suddenly go off their Rx. There has to be a tapering off. Took me 6 full months of acupuncture and herbs to finally wean myself off my anti-d.

      June 16, 2011 at 22:21 | Report abuse |
  5. Barb G.

    I literally had no idea what it felt like not to be depressed and anxious before I took Zoloft for the first time. I never realized how much energy I expended all day every day trying not to cry. I would guess that it was not entirely a placebo effect, but I certainly have no scientific proof. Anti-depressants are advertised almost as if they were beer – but without the warning to be responsible. I am glad that the scientific experts are asking the questions, but until something better comes aong, I'm staying with me medicine.

    June 16, 2011 at 18:01 | Report abuse | Reply
    • Liz R.

      I was recently diagnosed Bipolar (still unsure I or II) and have to say initially the symptoms were equally intense physically and mentally. Like Barb, once I went on the medication it was like I knew for certain what "normal" actually felt like. I am completely dependent on them right now and concurrently receiving psychotherapy, but hoping to one day in the future wean off the medication. The current definition of remission is 2+ months with some symptoms, I am setting the bar much higher.

      Obviously this mental illness did not spontaneously appear out of nothing, which is one of the main focuses for me during therapy. Everyone has a different experience and understanding what underlying reasons can most certainly help improve their illness (though it may get worse before it gets better).

      By the way, I often feel people who are completely against medication for mental illness are frequently completely ignorant in what the illness actually comprises of. They often have the luxury to not have to experience/deal with the topic they are giving their opinion or advice on. Many of these drugs have completely unknown mechanisms of action still and though one may say it would be crazy to take the drug for that reason, for some not taking the drug would ironically make them crazy.

      June 16, 2011 at 18:18 | Report abuse |
    • Jeff

      Try SAM-E. Works better than SSRI's and is much better for you.

      June 16, 2011 at 22:18 | Report abuse |
  6. Jane

    Why is it that there are only two camps on this. You are ether for or against meds. I did have an imbalance that meds. helped when I was so sick I couldn't get out of bed. Then I read self-help books and about eastern spirituality. I feel good about myself and meditate. Now I don't need meds. People are right though that the industry wants people to keep coming back to docs for help and keep taking meds. to make money. However, this doesn't mean that if you are really ill you shouldn't take them, especially if it could safe your life. Everyone use common sense.

    June 16, 2011 at 18:02 | Report abuse | Reply
    • mo'

      maybe among the medical community, you mean, but i think most people would say they're not 100% for or against meds. some work for some people, others work for other people, and for some people nothing works. you break your leg the treatment will be the same as if i break mine the same way. but treatment of depression is a whole different monster from one person to the next. i don't think popping a pill is the only answer but if you try it and you find the benefits outweigh the detriments, yay! if counseling alone works, i wouldn't advocate medication. i think meds should only be part of a much bigger plan of attack, and if they don't work (i didn't think they worked at all for me) then stop. i think the biggest obstacle to overcome with depression is the idea to try anything, because there's no definite answer for everyone.

      June 16, 2011 at 22:51 | Report abuse |
  7. Morgan

    I have taken antidepressants for 10 years and they helped me a lot. If you don't feel they are helping you, go back to your family doctor immediately, or better yet, see a psychiatrist, and ask for something else. (Psychiatrists are the experts in this area.) Some people I know are just helped by one type; others I know are taking two types successfully. If you are clinically depressed, please don't give up, either because you read this article or because of the comments. I'm not a doctor, but I never felt addicted, and no one I know who takes them is addicted. Anti-depressants are not narcotics. And just because they did not work for you, don't assume they are not helping others. Please don't discourage people with depression from taking these medications; they are life-savers.

    June 16, 2011 at 18:05 | Report abuse | Reply
    • Jane

      I have to disagree with you on that. The doctors don't know everything. I have read and continue to read everything I can about psychology. The mental health system will make you feel completely incompatant within 3 years. People should read as much as they can and learn everything. Be an educated patient. ...and that is what you are. Stop calling yourselves consumers. You are sick and you should want to get well ....and someday not be a patient anymore! There needs to be a recovery model that actually leads to recovery.

      June 16, 2011 at 18:37 | Report abuse |
    • jackthesnack

      Owned. This dude pretty much sums up everything. OP is definitely a doctor shopper

      June 16, 2011 at 23:06 | Report abuse |
    • Rob

      Jane, recovery comes only after a cure....for most things, there is no cure, only treatment....therefore, there can not be a "recovery"....so much for you being educated....you can read as many journals as you want, but it won't do much good if you don't have a grasp of the fundamentals and don't understand what you are trying to read...

      June 17, 2011 at 08:02 | Report abuse |
    • Rob

      you can disagree all you want. It would only make you wrong...NOTHING Morgan stated in his comment is inaccurate or untrue

      June 17, 2011 at 08:03 | Report abuse |
  8. Cin5456

    "scientists have not found good evidence that it's the chemicals themselves that cause the mental illness. "

    I know for a fact that my problems began long before I was prescribed drugs to make my life better. The drugs helped get me on track for a BA and continue to help while I get an MA. Without them I would not be able to sit comfortably in a classroom with twenty other humans that scare me.

    June 16, 2011 at 18:11 | Report abuse | Reply
  9. Truth Seeker

    How many 100's of BILLIONS of dollars have been wasted by people taking these medications (to the great benefit of pharmaceutical companies)! It's about time we demand PROOF that drugs work well (with few side effects) and demand explanations for how they work before we charge people hundreds of dollars to take them. There are also many older drugs which are much cheaper and work just as well (especially from a placebo standpoint). People (especially those with serious physical/mental problems) are far too gullible and susceptible to believing (or wanting to believe) there will be a "magic" pill for their problems (and who can blame them for seeking these). It has been shown that regular exercise is just as effective as most anti-depressants (works well in about 30-40% of cases)

    June 16, 2011 at 18:15 | Report abuse | Reply
    • Timothy

      I know replying to this probably wont do any good because you sound like a conspiracy theorist but here goes: There already are laws in place that mandate that a new drug must be deemed "Safe and Effective." The FDA does studies on these drugs that ultimately determine if the new drug can be put on the market. SSRIs and other antidepressants on the market have been statistically shown to improve depression for than placebo and they have also been shown to statistically improve overall mortality if one is depressed (a.k.a., you are more likely to die if you are depressed and dont take the med vs. if you are depressed and do take the med). As for the side effects, the individual patient should decide if their life is better with the current medicine after a few months and continue/stop it according to how they are feeling. Last, your comment about not allowing drugs on the market unless we know how they work is kind of silly as we still are not quite sure how tylenol works.

      June 16, 2011 at 22:04 | Report abuse |
    • Barbossa

      I cannot get over your ignorance. I exercise faithfully, and I still have a much fuller and healthier life because I take my SSRI. Please do not judge. You never know when you or some one you love will be faced with your own burden, and I warn you, the critics will find fault in what you do as well.

      June 16, 2011 at 22:49 | Report abuse |
    • Gilligan

      I have a lot to say (even more when I use parentheses).

      Drugs are bad because the companies that make them make money off of them (they don't get rich by giving money away).

      The goverment controls our minds (what's the frequency Kenneth?)


      June 17, 2011 at 05:58 | Report abuse |
  10. Fuyuko

    It depends on the condition. I do believe anxiety disorders are caused by chemical imbalances in the brain. As far as I'm concerned, articles like this just scare people from taking the meds they may need. My feeling is if antidepressants combined with therapy help you- take them. Life is too short to quibble how you find relief.

    June 16, 2011 at 18:16 | Report abuse | Reply
    • Richard

      But they can't show these "chemical" imbalances or any improvements, Most anxiety disorders are simply a slight bit of undirected parinoia, I know in my case anxiety and fear of humans was beaten into me early! and reinforced with ritilan and foolish unreasonable dignoses, totally without proff or merit,
      Be very aware of who your dealing with Doctors are just people with their own predjudices. Take care when starting any treatment especially from phyciitrists, they don't use real tests just personal judjements, again based on their predujudices, as opposed to real facts like measurements of your bloog or nueral chemistery! Beware!

      June 16, 2011 at 18:56 | Report abuse |
    • Bob

      Richard, you don't know what you are talking about. Try a few years in graduate school studying neurobiology.

      June 16, 2011 at 19:50 | Report abuse |
    • Dead Red

      If they were really working, why would this article scare them away from taking them?

      June 16, 2011 at 22:26 | Report abuse |
  11. B Ann

    Depression, fatigue and paranoia can be from low thyroid: http://tiredthyroid.com/index.html

    June 16, 2011 at 18:17 | Report abuse | Reply
  12. Jane Doe

    depression is not a disease just as things such as bi polar is not a disease. Just another way for the pharmaceutical co's and shrinks to make money.

    June 16, 2011 at 18:19 | Report abuse | Reply
    • sensible

      So a conspiracy theory is your explanation? Idiotic.

      June 16, 2011 at 19:12 | Report abuse |
    • JustAnotherGirl

      So you're saying that pharmaceutical companies and those in the mental health profession have convinced all these people that they are sick when they are in fact not? A little far fetched what with the prevalence of mental illness but if you choose to live in ignorance far be it from me to change your mind...

      June 16, 2011 at 20:04 | Report abuse |
    • Katie


      June 16, 2011 at 21:19 | Report abuse |
    • Dead Red

      A major industry taking advantage of people for a profit? THAT WOULD NEVER HAPPEN, YOU CONSPIRACY NUT!

      June 16, 2011 at 22:29 | Report abuse |
    • Miss Reba

      As a patient of a mood disorder, and as someone who has both depression and bipolar disorder in my family, I can assure you that both conditions are VERY real.

      June 17, 2011 at 00:02 | Report abuse |
    • Gilligan

      How are you not depressed from being so much smarter than everyone? If only we could all see the truth.

      Keep the faith!! You'll save us all one day.


      June 17, 2011 at 06:01 | Report abuse |
  13. Jonesy

    The same argument can be used for all medications. How do we know if we didn't just think we had a headache, but really it was caused by knowing that aspirin was available and we subconsciously wanted some.

    I am of course pulling your leg. Clinical trials are designed by trained statisticians to rule out the placebo effect by using control groups. Otherwise, if drug companies are intentionally selling a placebo, why don't they stop after the few months of research and sell whatever is in the beaker at that time, instead of spending years of research and development trying to find the right combination of chemicals that will produce the desired effect?

    Like the chicken and the egg, this is an argument that is impossible to win – or lose.

    June 16, 2011 at 18:20 | Report abuse | Reply
  14. DL

    Fascinating that even the companies that produce these meds can only say that they are "thought to work" by impacting the levels of neurotransmitters in the brain. Read the drug inserts. Its an educated guess at best, yet for 20 years they've aggressively marketed the stuff with the "chemical imbalance" phrase. If your doctor gave you the line about diabetics and insulin, raise your hand. How is that OK? How is dumbing it down, embellishing and stretching the truth acceptable when it comes to a patient's informed consent?

    Antidepressants do not cure anything. They simply mask the symptoms of depression, anxiety and panic. When they stop working – and they will for everyone at some point – you're back to square one and the medication merry-go-round starts. Hopping from pill to pill, tweaking doses, dealing with side effects and still feeling badly. That's absolutely ridiculous when non-medication interventions have been shown time and time again to be as effective short-time, and MORE effective long-term, than these products in most cases.

    Are antidepressants life savers for some? They sure are. I would not have as much of a problem if the meds were generally used on a short term basis in conjunction with non-medication strategies. Instead we pop them like some kind of "set it and forget it" magic pills, and we live with the weight gain, dampening of good judgement, lack of emotions, and all the other negative side effects for no good reason at all.

    Our desire for quick fixes and artificial comfort is costing us dearly.

    June 16, 2011 at 18:30 | Report abuse | Reply
    • Bob

      You don't know what you are talking about.

      June 16, 2011 at 19:48 | Report abuse |
    • Newmac

      nice post DL

      June 16, 2011 at 21:56 | Report abuse |
    • Dead Red

      According to Bob, Bob is apparently the only one who knows what he's talking about.

      June 16, 2011 at 22:36 | Report abuse |
    • Ryan

      Unless you change someone's genes, you need something to mask the symptoms. Look at any genetic disease.

      June 16, 2011 at 23:38 | Report abuse |
  15. Jonesy

    Isn't it true that scientists don't know how aspirin works yet it is accepted for treatment for headaches, inflammation, body aches, and as a preventative of heart attacks and strokes. It is not the big drug companies that are profitting from the sale of Prozac and other older SSRI anti-depressant drugs – it is the companies that are making the generics for these meds that are profitting now.

    By the way, these same anti-depressants are also successfully treating fibromyalgia and Obsessive Compulsive Disorder (OCD), among other things. Must we care about the whys and deny relief to so many people?

    June 16, 2011 at 18:50 | Report abuse | Reply
    • Bob

      They know how aspirin works. It inhibits COX 1 and COX 2 which reduces inflammation and the pain associated with it.

      June 16, 2011 at 19:48 | Report abuse |
  16. winnie

    Making a blanket statement that anti-depressants are glorified placebos and that depression isn't a brain chemistry disease is just irresponsible. The causes of depression are different for everyone – it may be environmental, genetic, chemical imbalance, hormone changes/postpartum... And everyone reacts to treatment differently partly because they may have a differet cause for their depression. Anti-depressants literally saved my life. I've suffered from depression for 25 years, but didn't begin taking medication until 2003. What a turn around! After beginning Paxil, I actually felt happy and excited about things. Those emotions were new for me, as I had never felt them before. I had motivation to get out of bed, go to work, exercise. I actually wanted to see my friends rather than blow them off like I did pre-Paxil. I do believe that anti-depressants work for people; they are not just a placebo. But I also do not believe everyone who has been diagnosed with depression actually has depression. And if you don't have depression, if your brain chemistry isn't "out of whack" then anti-depressants won't work for them. And yes, then they may even alter brain chemicals. Anti-depressants are not a cure, but they make it easier to cope and learn skills to deal with depression. In addition to anti-depressants, I participate in therapy. There, I learn how to deal with my depression and the symptoms I still experience. If I weren't on anti-depressants, I would not be functioning enough to use the skills I learn in therapy.

    June 16, 2011 at 19:22 | Report abuse | Reply
  17. happyprozac

    Prozac works!!!!!!!!!!!! Imma stay on it thanks!!

    June 16, 2011 at 19:29 | Report abuse | Reply
  18. lmew

    I took zoloft for awhile and I loved it. I started taking it because I was depressed, but it ended up helping some other issues I was having. For instance, I used to have a difficult time petting dogs because they seemed dirty to me, but when I started taking zoloft I was able to pet dogs. I'm pretty shy, but zoloft made me more confident and outgoing. I would never put my purse on the floor even at home because it just seemed so unsanitary, but zoloft changed that. There's a lot more zoloft helped with but there's too much to list.

    June 16, 2011 at 19:39 | Report abuse | Reply
  19. Bob

    The placebo effect may be real but it is never as strong as real medicines. Those who have done research know this – from that standpoint this article is misleading. Anti depressants do work primarily by reducing the relative strength of the thought patterns that caused the depression. This allows the individual to access more positive thoughts and more easily learn new ways of thinking. This may lead someone to think that depression can be eliminated solely by thinking differently. It is not so easy. The problem is going down this path would require a lot more visits to the counselor and the individual would need a lot more family and social support. This is rarely available – only the rich can afford it. Anti-depressants speed up the healing process but counseling is needed to help the individual learn new ways of thinking. Bottom line is that anti-depressants do work, they work much better than placebos and they have helped countless individuals and families.

    June 16, 2011 at 19:43 | Report abuse | Reply
  20. sealchan

    I've read other research that suggests that depression and many other psychiatric disorders may involve self-reinforcing circuits in the brain that have been pushed into a disabling pattern of self-sustaining feedback. Neurotransmitters are part of the low-level mechanics of brain function and particular neurotransmitters tend to be used in focused, yet varied contexts. It's hard to say just exactly what the impact is of tipping the mechanical scale of brain function when you are focused on the high-level aspect of motivation and life. Separating the psychological from the psychiatric is not something Western science is good at yet.

    June 16, 2011 at 19:56 | Report abuse | Reply
  21. Maria

    This blanket statement makes it seem that all antidepressants are created equal – but we have evidence that some drugs are more efficacious than others, and that's not just the ones that are newer. They also don't work equally for all people.
    My fiance had crippling OCD and social anxiety disorder. He tried 5 different SSRIs, none of which worked at all. Finally, he tried Lexapro, which has made a miraculous change. If it was all a placebo effect, wouldn't all the others have had some effect?
    Mental illnesses are multifactorial diseases, and to definitively state that they are NOT caused by chemical imbalance is grossly irresponsible.

    June 16, 2011 at 20:03 | Report abuse | Reply
  22. Tom

    Having coped with depression/anxiety for 15 years now, my observation is that all therapies work to the extent suffers believe they work including and especially so-called talk therapy such as cognitive behavioral therapy. Indeed, meditation and yoga seem to have as much effect as anything else.

    June 16, 2011 at 20:26 | Report abuse | Reply
  23. Susan

    A short course of Zoloft helped me through a very stressful time. Without it I would have suffered more, as well as my family. I will always say that my experience was very positive and I sure was glad for the relief while I got myself together.

    June 16, 2011 at 20:27 | Report abuse | Reply
  24. Jayden

    I think the real problem with antidepressants is that so many people are given them when they don't actually have clinical depression. Rather, they have anxiety disorders, undiagnosed ADHD, or some other condition and are legimately sad about how those symptoms have impacted their lives. Or, almost as commonly, they are going through some life experience (like divorce) that generates real sadness, which is misdiagnosed as depression. The emphasis on preventing addicts from having access to certain drugs has led many doctors to lump more any more conditions together as "depression" – primarily because antidepressants typically have so many side effects that no one takes them recreationally. Until psychiatry begins to do a better job of separating depression from legitimate sadness over life experiences or undiagnosed conditions like anxiety disorders and ADHD, it will be next to impossible to get any real assessment of whether antidepressants have any real effect on those with genuine depression.

    June 16, 2011 at 20:36 | Report abuse | Reply
  25. TheMayQueen

    I lost out on 6 years of my life because I was an addicted zombie. If you are truly depressed you need to see a PSYCHIATRIST–not a regular, family M.D. If you've got too much pride or you're not willing to shell out the extra cash to see a p-doc then you're not so depressed to use an antidepressant! It should be illegal for regular MD's to prescribe pschcoactive medication. They do NOT have the training or the skills that a p-doc has! If you're hooked on a Rx drug you've got to read THE ANTIDEPRESSANT SOLUTION by Dr. Joseph Glenmullen while under the care of a true PSYCHIATRIST!

    June 16, 2011 at 20:42 | Report abuse | Reply
  26. TheMayQueen

    Half of all people diagnosed with clinical depression are experiencing bipolar depression. Once an antidepressant is prescribed it will cause hypo- to full blown mania. A psychiatrist should catch this. If it is not caught, then suddenly, the patient experiences a crushing depression–worse than the initial depression. It could be days, weeks, or months later. An MD may prescribe a different medication or increase the dose. A p-doc would see this is as a HUGE RED FLAG for bipolar. If a p-doc catches this then it will be handled swiftly and the patient's life–literally and figuratively–will be saved. If an MD changes the meds or increases the dose, all hell could break loose!

    June 16, 2011 at 20:52 | Report abuse | Reply
  27. Rick Randolph

    Watch any evening news channel. Ad after ad after ad of medicines telling you to "ask your doctor". $$$$

    Anti-depressants are a plague on our society! Go to teenscreentruth.com for the awful truth.

    June 16, 2011 at 20:53 | Report abuse | Reply
  28. thinker

    The thing that concerns me about drugs for mental illness is the influence of big pharma and insurance companies. Used to be, you went to a doctor and spent some time talking about the issues you were facing, and were prescribed meds only if the "talk therapy" didn't work or needed a boost. Now, between the sales pitches of big pharma and the refusal of insurance companies to pay for therapy, it's straight to the drugs. As a result, we have a lot more people on meds than need be, AND these people are not addressing their issues. I do believe there are mental conditiona that warrant the use of medication; just not to the scale that is being currently prescribed.

    June 16, 2011 at 21:05 | Report abuse | Reply
  29. Mike

    Doctors are giving people meds for things that are just normal parts of life. People get depressed it happens. Just because a person feels sad doesn't mean they need medication. Maybe they are just sad? Maybe they need to just deal with a situation? Everyone wants a pill to fix them. Do I think many people feel better after taking a pill? yes why? because they "believe" it will help them. Is it really?

    June 16, 2011 at 21:42 | Report abuse | Reply
    • Micheal

      Are you out of your mind? My guess is that you dont suffer from any forms of mental illness. According to your theory, the complete lack of energy, thoughts of suicide, and self loathing (you do know what that word means, don't you?) experienced by depressed people is normal. Sounds like you also think they should just get over it. Take home message – wait until you know about a topic to comment on it. I have 3 years of clinical training in this field – I know about this topic.

      June 16, 2011 at 23:01 | Report abuse |
  30. judith

    I took Paxil for a number of years and over that 10 year period, I experienced a 75 pound weight gain. I eventually weaned myself off of it gradually, and am now beginning to slowly drop some of the unwanted weight gain. A physician told me that this is very common place and that those taking Paxil nearly always gain a significant amount of weight. Paxil did make me feel better and certainly helped me to worry less and sleep incredibly well, but one has to consider the side effects. Did I want to be obese and happier? The jury's still out.

    June 16, 2011 at 21:48 | Report abuse | Reply
    • Ryan

      I did that too, wait a couple months later though. It was all downhill for me after that. You lose the weight before the depression comes back. I was also on Paxil for 10 years.

      June 16, 2011 at 23:29 | Report abuse |
  31. Mike

    Placebo may have an effect, but the efficacy of these medications can not be denied. True it does not work for all patients. However, the reason the above argument can even take place is because there are no definitive objective markers for improvements in patients in depression, such as A1C or blood sugar levels in diabetics. Patients are monitored based on subjective scales, which clearly are not ideal.

    June 16, 2011 at 22:07 | Report abuse | Reply
    • Red Buttons

      "Patients are monitored based on subjective scales, which clearly are not ideal."

      That is, however, ideal for drug companies and doctors selling this crap.

      June 16, 2011 at 22:12 | Report abuse |
  32. R Burns

    I also took Paxil for a relatively short course while going through a divorce. It was tremendously helpful, and I would do it again if needed. During that time I was nearly hysterical and, as my doctor explained, it was instrumental in balancing brain chemicals that become out of whack in such a stressful situation. He also told me that, having such success, many people are afraid to discontinue the drug once balance has been restored. I took that into heavy consideration to overcome my own fear of ending the course of treatment, but when I did stop taking Paxil everything was fine. My daughter, on the other hand, seems to need medication to keep her emotions balanced continuously. I doubt articles such as this one that are saying that placebo medications are nearly as good as actual medication. For some folks, that approach may actually be dangerous.

    June 16, 2011 at 22:12 | Report abuse | Reply
  33. ME too


    It seems easy and popular to dismiss the benefits of anti-depressants; however, on days during which I start to feel particularly agitated and/or depressed, I rethink my activities that morning and realize that I've forgotten to take my med. How do you account for that? It's not a matter of thinking, "I forgot to take my meds, therefore I must be more depressed or anxious."

    Yes, however when you feel that way you know/think that you have to take the meds because that is what your body is used to. That is why when you feel that way to retrace your day and remember that you didn't take it. This is especially true if you take it at the same time everyday. Short answer, your drugs are calling you like any other. Study the mind, body, spirit connection and it will do you much good. Try something other than reaching for a bottle! I mean do disrespect, I was the same way for a long long time but you can get off if you want to.

    June 16, 2011 at 22:19 | Report abuse | Reply
    • JLS639

      Antidepressents cause side effects when treatment is discontinued. It may be quite easy to notice the side effects.

      June 16, 2011 at 23:38 | Report abuse |
  34. David55

    I think the problem isnt that people feel down, but that the media keeps telling you that if you are in a dead end job, stuck in a routine, not doing what you love, and working to hard, somehow you should be ecstatically happy. This isnt true. People for most of history have been moderately unhappy most of the time, grow a pair and deal with it.

    June 16, 2011 at 22:21 | Report abuse | Reply
    • Ryan

      Happiness has nothing to do with it. People like you don't understand depression. Clinical depression is not a mood. It's not feeling the blues for a couple weeks.

      June 16, 2011 at 23:32 | Report abuse |
    • joebob

      Boy that is a dumb comment. If someone is depressed they obviously can't grow a pair like you say so glibly. They need help.

      June 16, 2011 at 23:48 | Report abuse |
  35. Dead Red

    God save us from psychiatrists. Do some research and you'll find that the field of American psychiatry has been systematically abusing the mentally ill for as long as it has been around. Start with Benjamin Rush, a founding father, who believed most mental illnesses could be cured by tying the ill person to a plank and spinning them like a top. From there move on to the lobotomy: literally stabbing a pick through the eye socket into the frontal lobe of the brain, which often prevented the patient from feeling any emotion and making them a drooling mess. Don't forget insulin-shock therapy which "helped" by destroying brain tissue. Then add some electroshock therapy. It's really not very pleasant stuff.
    It didn't get better with time. At least now the psychiatrists have their hands in the drug companies' pockets so they can stop shoving ice picks into the brains of the mentally ill. Unfortunately, as we are seeing, the drug companies don't even know how their pills work. Call me stupid or crazy if you want but please, if anything, do some research. Psychiatry is not a nice field.

    June 16, 2011 at 22:22 | Report abuse | Reply
    • Ryan

      whatever, scientologist.

      June 16, 2011 at 23:25 | Report abuse |
    • Dead Red

      I really should have prefaced that by saying I'm not a Scientologist. Y'know what though, that's fine. Assume I'm a Scientologist. Keep your head in the sand and don't question anything, I'm sure you'll be much happier that way.

      June 17, 2011 at 12:00 | Report abuse |
  36. Ahmad Zubairi

    As a Psychiatrist my experience is that antidepressants are not just placebo, but life is more than a pill. Almost all depressed patients need psychtherapy in addition to medication.Either medication or just therapy is not effective. This is a wrong argument that medication are miracle cures or complete placebos.

    June 16, 2011 at 22:23 | Report abuse | Reply
  37. Jon

    I really think that attempting to cure "Depression" is a bad thing for humankind and it is probably a good thing that we suck at it so much. Depression is a natural instinct/feeling and it exists in order to drive people to achieve and do more. It sucks to be sucky at life – and if one is sucky at life, they don't normally help humankind much. If you give all of the sucky people pills to make them happy, then sucky people will be satiated with being sucky instead of trying to be not sucky. Then many not normally sucky people will take pills, lose motivation to be not sucky, and therefore become sucky. Perfect anti-depressants would be the downfall of civilization. A brave new world and soma come to mind...

    June 16, 2011 at 22:35 | Report abuse | Reply
  38. ...k

    anti depressants are for people who dont know why they're depressed. if your life just sucks they will not help you

    June 16, 2011 at 22:38 | Report abuse | Reply
  39. daktari ndogo

    "Which came first, the mental illness or the drug? While in other areas of medicine this is a no-brainer (no pun intended),etc....". A bit of a shame that you start off with the above sentence, Dr Gupta. Mental illness is a very complex concept, whichever way one looks at it. But the other branches of medicine, (and yes, it is a branch of medicine) aren't an exact science either, as a visit to your local friendly physician will attest. Is the " cold" just a viral illness, or has secondary infection set in. Rheumatology, Pain Medicine, Neurology, dare I say Neurosurgery, all examples of a craft, inexact, and certainly not no-brainers.

    June 16, 2011 at 22:39 | Report abuse | Reply
  40. ChrisK

    I was skeptic as well and lived with depression for 10 years in part because I did not believe they would work. Only started taking them when I had no choice. They literally saved my life. Weened off after 8 months and have lived relatively symptom free for the last 2 years. I am very grateful to the researchers who developed these meds. They worked for me, and I did not believe that they would. No placebo effect here.

    June 16, 2011 at 22:49 | Report abuse | Reply
  41. KRMJ

    I was on meds as a teen. I went off a few years later. After a while, my behavior became erratic and unsafe for myself and others to be around. I decided to go back on them in college. I probably would have needed to drop out without them. I know meds work for me. I had to go off them AGAIN after graduating and I didn't have insurance for a while. I experienced the same effects of being unsafe for myself and others. I honestly don't care what the side effects are as long as I feel in control of my mind and my body. When I'm not on medication and i get depressed or upset from my bi-polar disorder, it usually results in what little is left of my sanity screaming at myself to snap out of it while my brain and my body experience the symptoms of these horrible conditions. It's truly being lost inside yourself.

    I hate to see articles like this that dismiss medications as helpful. What's wrong with a placebo that makes someone feel better? That's the point. The person wants to feel better. That's it. Nothing else matters. I hope those of you out there who need help can find it. It can save your life and improve it's quality.

    June 16, 2011 at 22:50 | Report abuse | Reply
  42. tammy

    Taking anti depressants helps improve my quaility of life immensly. I rather put up with the side effects than be so miserable and unhappy i dont even want to be around myself. I take the minimum dosage that keeps me balanced. Still haver bad days but they are manageable. u wouldnt tell a diabetic not to take their meds would u?

    June 16, 2011 at 23:04 | Report abuse | Reply
  43. mstrmcds

    I believe these medications work. I was treated with 2 different drugs for postpartum depression 13 years ago. I was told not to expect any big changes in mood/symptoms right away. The first was Paxil and within a few days symptoms (crippling fear and anxiety) worsened to the point the docs were worried enough to send my husband home from work to bring me in. They changed over to Prozac and gave me the same advice on mood/symptoms. Within a week I felt normal. Normal felt so good I wanted to do handsprings! I also had regular psychiatric visits and counselling to recognize what I call "the descent" and strategies to stop it. After about 8 months, I was able to taper off my medication. I have no doubt that treatment saved my marriage and my life.

    June 16, 2011 at 23:05 | Report abuse | Reply
  44. bill

    Take two hits and call me in the morning. Everything is better with a bag of weed.

    June 16, 2011 at 23:05 | Report abuse | Reply
    • Andy

      thanks bill. now go have another brownie.

      June 16, 2011 at 23:17 | Report abuse |
  45. JJ

    I dealt with major depression for seven years, five of which I was medicated on-and-off. The last medication I took, Cymbalta, helped an immense amount, unlike the Zoloft, Lexapro, Wellbutrin, Seroquel, and Geodon. I've been unmedicated for almost three years now.

    Most definitely, I can see why people question whether anti-depressants are placebos; I've questioned this myself. That being said...if they are, would that matter? I ask this just for others to ponder, themselves. The aim of anti-depressants is to reduce symptoms of depression – if they work by way of placebo, doesn't that mean they still work? I would argue yes.

    June 16, 2011 at 23:14 | Report abuse | Reply
    • JJ

      Something I would like to add, and I think this is important for others to hear:

      Consider this: anti-depressants are meant to get you "up and about." They begin to work most notably in a physical sense before they do in a mental sense, i.e., you feel more energy before you begin to mentally feel better.

      Anti-depressants do not cause people to become suicidal. What happens is that they give an individual the ENERGY kick before helping out in a neurological way, so the individual has more of an "oomph" in their step despite the fact that they still mentally and emotionally feel like crap.

      This is a concern because if you have more motivation to ACT in a physical sense yet still mentally feel crappy, that is worrisome because you may have more motivation to harm yourself. That is why it is so important for psychiatrists (you should never see a regular doctor about psychiatric concerns) to closely watch and check-in with patients within the first 4-8 weeks of someone being put on anti-depressants.

      June 16, 2011 at 23:21 | Report abuse |
  46. Mickey

    Hell No, they are brain chemistry destroyers.

    June 16, 2011 at 23:19 | Report abuse | Reply
  47. Ryan

    Antidepressants saved me from suicide. I have tried getting off them numerous times and a couple months later feel horrible. You take them if there is something wrong in your head. Not because you are unhappy with life or want to suppress something horrible that happened. Yes drugs may potentially impact your brain in the long run, but so can depression. Severe depression can cause lesioning in the hippocampus destroying neurons, memories, and learning ability ability. It prevents you from enjoying life. You are always coping or just getting by. If you have an anxiety disorder along with depression like myself, you get to the point where the world around you becomes so frightening, you want to close your eyes and never wake up. Please don't bash antidepressants, I feel a mental change of state of calmness and I don't give two shatz what some so called "expert" says about them. When you actually take a pill for 10 years and try getting on and off it we can talk.

    June 16, 2011 at 23:22 | Report abuse | Reply
  48. William

    This article is pure hooey. Antidepressants are not just used to treat depression. They are also used to treat anxiety and obsessive compulsive disorder and for those disorders they work wonderfully and solid double blind placebo controlled studies substantiate this. So if a competent physician prescribes them, emphasis on competent, most patients will have a reduction in their symptoms. Not everyone will have a complete cessation of their symptoms, but most can achieve at least 50 to 70 percent reduction in their symptoms.

    June 16, 2011 at 23:25 | Report abuse | Reply
  49. JE

    CNN, you are increasingly irresponsible on your reporting on mental health issues and medications. Shame on you for your sensational and erroneous headlines and often slanted articles.

    June 16, 2011 at 23:39 | Report abuse | Reply
  50. aatami

    What a stupid article! A placebo has no actual effect. Anti depressants cause the suicides of many misdiagnosed individuals every year. Just try that stuff and you will see how utterly and absolutely they will affect your well being in either the negative or the positive, most probably the negative!

    June 16, 2011 at 23:45 | Report abuse | Reply
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.