Further evidence that antidepressants simply don’t work (or, at least, don’t work the way the pharmaceutical companies insist they should) comes with the long overdue publication of Professor Irving Kirsch’s aptly named book,  The Emperor’s New Drugs: Exploding the Antidepressant Myth (The Bodley Head).

Professor Kirsch, now at the University of Hull, has published several papers before, including one extensive study in 2002, based on data extracted from the pharmaceutical industry by means of the Freedom of Information Act. This clearly demonstrated that all antidepressants, including the popular SSRIs, had no clinically significant benefit over placebo.

We have written and lectured about this for some years now, and, in Magic in Practice, refer to the curious finding that the so-called placebo effect is particularly marked when testing antidepressants, compared with other drugs.  Astonishingly, around 60% of patients respond to treatment, regardless of how the antidepressant works. Raising serotonin levels (and, even lowering it, as one drug does) and boosting dopamine and other neurotransmitters all perform equally. No matter what drug is used, the outcome is the same.

We also said that the relationship between practitioner and patient was probably responsible for much of the positive effect ... echoing Michael Balint’s view that the doctor him or herself is a particularly powerful drug[1].

 In fact, absolutely central to the principles of Medical NLP is the relationship between practitioner and patient – even though many more orthodox medical specialists still dismiss any suggestion that this could actually affect clinical outcomes.

But several studies (including one at Harvard headed by Professor Kirsch) have supported the idea that a positive relationship between patient and provider enhances the effect of treatment.

What we most welcome is Professor Kirsch’s suggestion that the placebo effect should be harnessed in the treatment of depressed patients, if not by lying to the patient (there is still a strong and misplaced idea that the placebo effect of necessitates deceiving the subject) then by the health professional developing and employing a warm and encouraging attitude with his or her patients.

However, we predict with some sadness that despite the mounting evidence against antidepressants, doctors will continue prescribing them in huge numbers.  Published evidence – even spurious evidence presented by manufacturers with vested interests, and despite the huge iatrogenic toll of this particular class of drugs – continues to be regarded as more reliable than observation, experience and common sense.