“Clinical trials grossly overestimate antidepressant efficacy.” This is the conclusion and title of a study published in November 2018 by the American Psychological Association.
The author, Dr. Irvin Kirsh, PhD, is a lecturer at the Harvard Medical School and Professor Emeritus of Psychology at the University of Plymouth (UK), University of Hull (UK), and University of Connecticut (US). He has written 10 books and more than 250 scientific journal articles and book chapters on placebo, hypnosis, antidepressants, and suggestions.
Kirsh contends that the overestimation stems from the exclusion of about 80% of clinically depressed patients from conventional trials. Surprisingly, they exclude the mildly and moderately depressed patients (who represent the majority of patients taking the drug) and the patients who are chronically depressed, suffer from suicidal thoughts or abuse substances.
Another physician, Dr Ben Goldacre, highlights the publication bias in all fields of medicine in a TED talk called “what doctors don’t know about the drugs they prescribe”: most of positive findings are published while most negative findings are never exposed to the public and doctors. Said differently, if many studies focus on the same drug, the studies that portray the drug in a positive light are more likely to be published.
“We were misled, and this is a systematic flaw in the core of medicine”, says Dr Goldacre because of this publication bias.
A Caltech neurobiologist, David Anderson, reminds us that we know much less about depression’s pharmacological treatments. According to him, we understand less their basic mechanisms less than diseases in the body. He provides the interesting analogy of a car that someone is trying to fix. It will never occur to us to fill up the engine with oil in the hope that it will fix the car.
“The brain is not a bag of chemicals.”
When someone ingest some antidepressant, it bathes the whole brain with chemicals as if they were pouring oil over the whole of their mental engine. Instead, Anderson advocates the use of targeted treatments by allowing some chemicals to act on specific parts of the brain.
Most people who are prescribed antidepressants end up discontinuing the treatment because of the side effects: the drowsiness, light-headedness, and headaches that can prevent them from engaging in activities. Insomnia, blurred vision can really impair a person’s ability to function as they used to. When you add bloating and constipation, the discomfort can worsen the quality of life. No wonder people stop taking the pills.
A 2010 study by Barbara McCann, PhD and Sara Landes, PhD, contends “there are several compelling arguments for the inclusion of hypnotic approaches in the array of strategies for dealing with depression”. Hypnosis can help solve symptoms such as insomnia, build a more positive outlook and produce a mindset shift by facilitating the retrieval of past positive experience.
There have not been as many studies on hypnosis to treat depression as we would hope. One reason is the perception that the current solutions (antidepressants or psychotherapy) are sufficient. Dr Kirsh’s study clearly shows that the first solution might have been overestimated.
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