This blog post examines whether antidepressants are truly effective or merely placebos, based on various research findings. It also explores the need for regulation and the issue of side effects.
In April 2008, at a conference of the European Psychiatric Association, doubts were raised about the effectiveness of antidepressants currently available on the market. Since antidepressants had occupied a corner of pharmacies without incident for over 20 years, raising such doubts within the psychiatric community was akin to questioning the fact that the sun rises in the east. Dr. Brett Deacon, a psychoanalyst at the University of Wyoming, presented experimental data at this conference questioning the efficacy of antidepressants. One piece of evidence presented was experimental results showing that prescribing antidepressants to individuals with mild to moderate depression yielded no greater effect than prescribing a placebo. In this experiment, the Hamilton Depression Rating Scale scores of patients with ‘very severe’ depression—those scoring between 25 and 52 points—were measured. While antidepressants were more effective than placebo for these patients, the difference averaged only 1.8 points. In fact, since a person’s mood can improve by 2 points just by sleeping well, a 1.8-point difference was clinically insignificant. This supported the argument that antidepressants have little to no effect.
Yet people still believe in the efficacy of antidepressants without question and take them extensively. Most psychiatrists also remain confident in their effectiveness based on published research and clinical experience. However, the author argues that antidepressants are either ineffective or have very little effect, citing the fact that their mechanism of action remains scientifically unproven and that their therapeutic effect shows little difference from placebo levels.
First, let’s examine whether the mechanism of action for antidepressants has been clearly elucidated. Despite significant advances in medicine, scientific research on the complex nervous system—the target of antidepressants—remains insufficient. For example, examining the mechanism of action claimed by psychiatrists for the antidepressant Paxil reveals problems. Antidepressants contain components that inhibit the reuptake of serotonin outside of nerve cells. By blocking serotonin reuptake into nerve cells, they induce serotonin accumulation within the cells. This accumulated serotonin activates nearby neurons within the nerve cell, thereby alleviating depression. Based on this, psychiatrists conclude that increased serotonin resolves depression. However, this conclusion has not yet been verified. It is merely an assertion based on the fact that blood tests of depression patients showed low serotonin levels, suggesting that raising serotonin levels alleviates depression.
This conclusion has two problems. First, because serotonin plays complex roles in the brain, medical professionals have not precisely identified its function. They merely assume, based on statistical data, that serotonin alleviates depression. However, this assumption remains unverified and lacks credibility. Second, even if serotonin were effective in improving depression, there is doubt about whether maintaining high serotonin concentrations within the brain is feasible. Antidepressants prevent serotonin from leaving the neuron, increasing its concentration within the cell. However, some neuropsychiatrists argue that this increased concentration is subsequently reduced due to the activation of serotonin receptor production within the neuron. In other words, neurons possess at least two methods to decrease serotonin levels. Based on this theory, some scholars argue that antidepressants may not alleviate depression at all. Indeed, some researchers claim that when they reduced serotonin in the brain to induce depression, they observed no effect whatsoever. This serves as evidence that serotonin levels remain unchanged due to feedback mechanisms within neurons, potentially refuting the claim that antidepressants increase serotonin concentration.
However, it is true that antidepressants appear to effectively treat many patients with depression. But do antidepressants truly work within the body according to the mechanism described by psychiatrists to treat patients with depression? According to a clinical trial by David Cohen, a professor in the Department of Social Work at the University of Florida, 50% of those taking antidepressants experienced reduced depression, while 40% of those taking a placebo experienced reduced depression. That is, only 10% of patients experienced the effect of the antidepressant. These experimental results suggest the true effect of antidepressants is minimal, and the placebo effect is mistaken for the real effect. Furthermore, even if there is a temporary relief from depression, some argue that antidepressants may actually worsen depression in the long term or provide no relief at all.
In March 2006, the FDA analyzed 23 studies on antidepressant products and concluded that antidepressants increase suicidal impulses in adolescents. In 2007, the FDA warned that the well-known antidepressant Paxil increases the risk of suicidal impulses not only in children and adolescents but also in young adults. Furthermore, various experimental results and statistical data demonstrate the ineffectiveness of antidepressants.
Based on these numerous experimental findings, I argue that antidepressants have little meaningful therapeutic effect, and even if they do work, the effect is very minimal.
So, should the sale of antidepressants, whose therapeutic efficacy has not been proven, be regulated? Or should sales be permitted to allow for even a temporary placebo effect? I strongly advocate for strict regulation of antidepressant sales. The reason is the severe side effects of these drugs. If antidepressants caused no harm to the human body, sales could be permitted in the hope of a placebo effect. However, as drugs that manipulate neurotransmitters, antidepressants typically have over 20 side effects, which cause more harm than benefit to patients. Common side effects include sexual dysfunction, gastrointestinal issues, bleeding and stroke in the elderly, increased mortality rates, and developmental disorders in infants. These risks can outweigh any uncertain benefits from a placebo effect. In fact, cases of antidepressants causing physical harm are frequently documented. A simple internet search on antidepressants easily reveals cases of individuals complaining of headaches and dizziness after years of taking them. Some scholars argue that the recurrence of depression after taking antidepressants is also a side effect of these drugs. In October 2007 and July 2008, studies from the US and Spain successively reported that antidepressants could increase the risk of gastrointestinal bleeding. Furthermore, the previously mentioned suicidal impulses and mental instability can also be considered side effects of antidepressants.
Antidepressants harbor another risk factor: dependence and withdrawal symptoms. This is because some individuals take large quantities of antidepressants to regulate their emotions with medication. When people who have taken antidepressants for three or four years suddenly stop the medication, changes in hormone levels and mechanisms within the body lead to withdrawal symptoms. The withdrawal symptoms from antidepressants are similar to those from other harmful substances, requiring particular caution. In fact, many books detailing how to safely stop taking antidepressants can be easily found at a well-known American online bookstore. This reflects the reality that many people cannot escape the withdrawal symptoms of antidepressants and that many suffer due to them.
Beyond this, there may be unknown side effects of antidepressants. These can be divided into those not yet known and those concealed. The multinational pharmaceutical company ‘Eli Lilly’ faced allegations that it attempted to conceal the side effects of its antidepressant ‘Prozac’ even before its release, despite being aware of them beforehand. The British Medical Journal revealed it possessed secret documents from Lilly regarding the antidepressant’s side effects, which included information that Prozac could cause physical instability and panic. The mass shooting incident where Joseph Wesbacker, who suffered from depression, killed many people after taking Prozac, suggests the possibility that this antidepressant may have caused mental instability and panic.
Thus, antidepressants not only fail to deliver the expected therapeutic effects but may also potentially cause mental and physical instability. However, as these issues remain insufficiently known, antidepressant consumption continues to rise globally.
According to a report by market research firm IQVIA, over 300 million antidepressant prescriptions were issued in the United States alone during 2022. Furthermore, the global antidepressant market size surpassed $17 billion (approximately 22 trillion won) in 2023 and is projected to reach $220 billion (approximately 290 trillion won) by 2030. This demonstrates that antidepressants have evolved beyond mere therapeutic agents into a massive industry.
Therefore, thorough verification of antidepressants’ efficacy and side effects is essential, and robust regulations prioritizing patient safety over pharmaceutical company profits must be established. Only when a cautious and responsible treatment environment is created can patients make informed choices.
