Just as it is reported that treatment by meds alone is rising, we have this report today:
Broad Review of FDA Trials Suggests Antidepressants Only Marginally Better than Placebo
A new review of 4 meta-analyses of efficacy trials submitted to the US Food and Drug Administration (FDA) suggests that antidepressants are only "marginally efficacious" compared with placebo and "document profound publication bias that inflates their apparent efficacy."
In addition, when the researchers also analyzed the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, "the largest antidepressant effectiveness trial ever conducted," they found that "the effectiveness of antidepressant therapies was probably even lower than the modest one reported...with an apparent progressively increasing dropout rate across each study phase.
Now this should not come as a shock as there have been reanalyses and meta-analyses of data showing this for at least 12 years. But the weight of them seems to be beginning to register.
The question in my mind is, given that these drugs have side effects that are not inconsequential, how ethical is it to continue to even tacitly support advertising touting an effectiveness they do not have? And is there a duty to inform patients? If it is questionably ethical to prescribe a placebo ... well, you can see the swamp that develops here.
I am not arguing that these drugs have no value -- unquestionably they do for some people, but we have no way to identify those people nor do we know why they are helpful to them and not to others nor do we have a good handle on the whole placebo issue. To my mind, this growing body of research evidence points more strongly to the advisability of at least combining medication treatment with psychotherapy.
It doesn't look like this issue is going to go away or become simpler any time soon.