If you go by American Psychiatric Association diagnosis standards, half of us meet the criteria for mental illness at some point in our lives. And sometimes it seems like all of us are on antidepressants. But do we need to be?
It is important that clinical trials, particularly those dealing with subjective conditions like depression, remain double-blind, with neither patients nor doctors knowing whether or not they are getting a placebo. That prevents both patients and doctors from imagining improvements that are not there, something that is more likely if they believe the agent being administered is an active drug instead of a placebo. Faced with his findings that nearly any pill with side effects was slightly more effective in treating depression than an inert placebo, Kirsch speculated that the presence of side effects in individuals receiving drugs enabled them to guess correctly that they were getting active treatment – and this was borne out by interviews with patients and doctors – which made them more likely to report improvement. He suggests that the reason antidepressants appear to work better in relieving severe depression than in less severe cases is that patients with severe symptoms are likely to be on higher doses and therefore experience more side effects.
—Marcia Angell, “The Epidemic of Mental Illness: Why?” [emphasis mine]