Antidepressants and the placebo response.
OBJECTIVE
To evaluate new generation antidepressants in relation to the placebo response.


METHODS
I review meta-analyses in which response to antidepressant medication and response to placebo were calculated.


RESULTS
All but one of these meta-analyses included unpublished as well as published trials. Most trials failed to show a significant advantage of SSRIs over inert placebo, and the differences between drug and placebo are not clinically significant for most depressed patients. Documents obtained from the U.S. Food and Drug Administration (FDA) revealed an explicit decision to keep this information from the public and from prescribing physicians.


CONCLUSIONS
Because they do not incur drug risks, exercise and psychotherapy, which show at benefits at least equal to those of antidepressants, may be a better treatment choice for depressed individuals.
Kirsch
Irving
I
Department of Psychology, University of Hull, Cottingham Road, Hull, HU6 7RX, United Kingdom. i.kirsch@hull.ac.uk
D000928:Antidepressive Agents / Q000627:therapeutic use*; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D003863:Depression / Q000188:drug therapy*; D005473:Fluoxetine / Q000627:therapeutic use; D006801:Humans; D015201:Meta-Analysis as Topic; D015990:Placebo Effect; D014481:United States; D014486:United States Food and Drug Administration
D000928:Antidepressive Agents; D018687:Antidepressive Agents, Second-Generation; D005473:Fluoxetine