This morning an article was published on the BBC News website: “Anti-depressants: Major study finds they work.” Apparently there has been some debate about this. “Scientists say they have settled one of medicine’s biggest debates after a huge study found that anti-depressants work. The study, which analysed data from 522 trials involving 116,477 people, found 21 common anti-depressants were all more effective at reducing symptoms of acute depression than dummy pills.”
Well that would seem like good news. Until that is you read a little deeper. Then we find that “the study found they ranged from being a third more effective than a placebo to more than twice as effective.”
Just a minute. If a drug is one third more effective than a placebo I think that means that in a trial where the placebo cures 3 people the drug cured 4 people. So this means that for every extra person cured by the drug three other people are cured, but would have also been cured if they took a sugar pill, and would have suffered none of the side effects.
Even the most effective drug on the list of 21 studied was only “more than twice as effective.” Given that they didn’t say “nearly three times as effective,” let’s assume that it was at best 2.5 times as effective. That means that if 10 people could be cured by a placebo 25 people are cured by the drug. In other words, nearly half the people taking the drug would have been better off without it. And this is for the best drug available.
Now let’s be clear: depression is a terrible thing, and it blights the lives of some people, or even leads them to take their own life, and sometimes the lives of others too. However, most of the data in the study came from trials covering just eight weeks of treatment. If all of those people had been treated with a placebo for eight weeks a bunch of them would have become better with no side effects at all. And if those that didn’t improve were then given the drug that would result in about the same number again getting better, albeit some weeks later. Wouldn’t that be a great result?
For some reason giving people placebos is seen as unethical but I can’t quite work out why. Sure, it’s important to address the needs of someone with suicidal thoughts as fast as possible. We should trust the doctors to have some idea who those people might be. Let’s also bear in mind that some anti-depressants have also been linked to increased risk of suicide and we trust the doctors to prescribe them appropriately.
All I can say is that if a drug is only twice as effective as a placebo, then for my own case, in a non-critical situation, I would much rather be prescribed a placebo in the first instance.