Why there’s no such thing as an ‘antidepressant’

by Arran James

Joanna Moncrieff

Antidepressants have been in the news recently. The general feeling seems to be that although they are being overused and may have some unpleasant side effects, they certainly ‘work,’ at least in some people (1).

So what is the evidence that antidepressants ‘work’? If you compare them with a dummy tablet or placebo in a randomised trial, scores on rating scales that are meant to measure depression sometimes go down a few points more in people taking antidepressants compared to people on placebo. But what does this mean? Well, firstly, the differences are small. The commonly used Hamilton Rating Scale for Depression has a maximum score of 54 points and across studies  differences are less than two points (2). A two point difference is unlikely to have any real (clinical) significance. Whether these scales actually measure a complex emotional state like depression is another question.  They consist of lists of…

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