The psychologist and associate director of the Placebo Studies Program at Harvard University Irving Kirsch and his team have been the architects of a revealing and promising line of research that has questioned the efficacy of antidepressants to cure this terrible disease, questioning the models of mental illness and the usual medical practice, based mainly on the pharmacological intervention for this type of patients.
According to Kirsch, “at most, antidepressants have a significant effect only for a minority of patients with depression who are prescribed drugs, 10-15% of patients with major depression. The rest of the patients, the best thing to do is take placebos, since they produce practically the same improvement but avoid side effects and the health risks that antidepressants produce. ”
The theory of chemical imbalance in the brain
The theory about the chemical imbalance in the brain seems to be increasingly questioned every day. For example, people with depression improve equally by taking Selective Stimulants of Reuptake of Serotonin -ESRS- (drugs that decrease serotonin in the brain) such as taking Selective Serotonin Reuptake Inhibitors -ISRS- (drugs that are supposed to increase the level of serotonin), which is a great contradiction.
He also states that "Diagnoses for psychological disorders generally face problems. The Depression It is a very serious "situation" that may not even be a disease as such. Perhaps it is a normal reaction to life circumstances or a sign that the person needs to change important aspects of his life. ”
It has been observed, for example, that depression is associated with economic difficulties and discrimination. So preventing depression would require very broad social and economic changes, as well as individual interventions such as psychotherapy.
“Antidepressants should not be a treatment of choice in depression. - Kirsch continues - Instead, treatments such as physical exercise and psychotherapy should be used first. If it is finally necessary to use antidepressants, they should only be used as a last resort only when the rest of the treatments have not worked.. As regards research, funds should be made available for research for a better evaluation of non-pharmacological treatments aimed at depression. ”
Medication vs psychotherapy
His research has created some controversy in different sectors, such as the pharmaceutical industry or psychiatrists.
In 1998, Irving Kirsch together with Guy Sapirstein reported for the first time that most of The results of antidepressants are explained by the placebo effect. The reaction to the results of this study was of enormous disbelief and these results were ignored. Luckily, more and more people are taking these findings seriously and are beginning to have an impact on clinical practice, at least in the United Kingdom. Of course, psychiatrists resist these results; their livelihood and their professional work are linked to the prescription of psychotropic medications, especially antidepressants.
Changing medical practice is a slow process. Doctors are still quickly inclined to prescribe antidepressants to patients who are slightly depressed, without exploring other alternative pathways. In the United Kingdom, they continue to do so despite the fact that official treatment guidelines indicate otherwise.
In addition, in the short term, the results of psychotherapy are the same as those of antidepressants, however, the long-term results of psychological treatments are considerably better. The cognitive behavioral therapy has shown that it can reduce the risk of relapse for six years. On the other hand, psychotherapy does not carry the health risks associated with antidepressants, including sexual dysfunction and the risk of mortality. It is for this reason that psychological treatments should be the treatment of choice. In the case that the drugs were used, they should be used as a last resort, only when other less invasive methods have failed.
On the other hand, the cost / benefit evaluations show that providing cognitive psychotherapy for depression is cheaper in the long term than prescribing drugs. This is because these therapies are brief (no more than 15 to 20 sessions), and their effects are maintained over time. By contrast, the relapse rate is much higher when people stop taking antidepressants. In such a way that to prevent patients from relapsing, the medication has to be maintained for years. This is what makes, in the long term, drug treatment more expensive than psychotherapy.