Is Antidepressant a Misnomer?

A research review in this week's Journal of the American Medical Association finds a risk of increased "suicidal ideation" in children and adolescents taking antidepressants half as big as the already small risk the FDA cited when it ordered scary "black box" warnings for the drugs three years ago. A.P. reports:

The researchers analyzed data on 5,310 children and teenagers from 27 studies involving the antidepressants Prozac, Paxil, Zoloft, Celexa, Lexapro, Effexor, Serzone and Remeron. They found that for every 100 treated with antidepressants, about one additional child experienced worsening suicidal feelings above what would have occurred without drug treatment. In contrast, the F.D.A. analysis had found an added risk affecting about two in 100 patients. There were no suicides in any of the studies. 

SSRI boosters argue that the FDA's daunting label has resulted in more deaths by scaring doctors away from antidepressants that would have prevented suicides. That may be true, but this review shows once again that the benefits of antidepressants, like their risks, are overrated:

The new analysis found that antidepressants worked best when used to treat anxiety. They worked moderately well in treating obsessive-compulsive disorders. They worked less well, though still effectively, in treating depression….

In the studies involving depression, 61 percent of patients improved while on antidepressants. But 50 percent of depressed patients taking dummy pills also improved.

Among young patients with obsessive-compulsive disorders, 52 percent improved on antidepressants, compared with 32 percent who improved on dummy pills.

And in the studies of anxiety disorders, 69 percent improved on antidepressants and 39 percent improved on dummy pills.

If antidepressants work better in treating anxiety than in treating depression, and if they relieve depression only a little better than a placebo, antidepressant  is something of a misnomer, isn't it? Prozac et al. may be even less effective than these numbers suggest: Skeptics (including psychologists, who do not enjoy the legal privilege of prescribing antidepressants) argue that the  physiological side effects of antidepressants may tip off some subjects that they are getting the real thing, knowledge that could create an enhanced placebo effect that may account for the improvements attributed to the drugs. Then again, as Maia Szalavitz has argued in Reason, the clinical trials may underestimate the potential effectiveness of antidepressants because they throw together people who benefit dramatically with people who don't respond at all.