The Emperor's New Drugs: Exploding the Antidepressant Myth

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The Emperor's New Drugs: Exploding the Antidepressant Myth

3.84 of 5 stars 3.84 · rating details · 117 ratings · 27 reviews

Everyone knows that antidepressant drugs are miracles of modern medicine. Professor Irving Kirsch knew this as well as anyone. But, as he discovered during his research, there is a problem with what everyone knows about antidepressant drugs. It isn't true.

How did antidepressant drugs gain their reputation as a magic bullet for depression? And why has it taken so long for t...more

Paperback, 240 pages

Published September 3rd 2009 by Bodley Head (first published 2009)

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Feb 12, 2011 Kelly Maybedog Hawkins marked it as to-read

Shelves: to-sort

THE VERY TITLE OF THIS BOOK IS DANGEROUS! Whether the antidepressants are working because they work or because of a placebo is irrelevant: they are still working for a lot of people and the vast majority have almost no side effects and no serious ones. But suggesting that their antidepressant may not work or is all in their head is enough to send a person with a serious depressive illness into a downturn that could prove fatal. It messed with my head and I was skeptical to begin with.

I'm willing...more

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May 16, 2013 Jenifer rated it 5 of 5 stars · review of another edition

Excellent book - anyone who wants to speak on the subject of anti-depressants will have to contend with Kirsch's findings. They are especially relevant given the current "crisis" in psychiatry regarding the NIMH's rejection of the DSM-5.

As a researcher, Kirsch has studied placebo effects for many years. His initial investigation into the placebo effect in depression spurred this book and his resulting rejection of the conventional view of antidepressants. Using the US Freedom of Information Act...more Excellent book - anyone who wants to speak on the subject of anti-depressants will have to contend with Kirsch's findings. They are especially relevant given the current "crisis" in psychiatry regarding the NIMH's rejection of the DSM-5.

As a researcher, Kirsch has studied placebo effects for many years. His initial investigation into the placebo effect in depression spurred this book and his resulting rejection of the conventional view of antidepressants. Using the US Freedom of Information Act, Kirsch and colleagues conducted a series of meta-analyses on published and unpublished data from clinical trials of antidepressant drugs. They found that most of the effects of antidepressants could be explained as placebo. This is Kirsch's main argument throughout the book - that antidepressants essentially function as active placebos.

I found a great deal of the reading to be dry. Kirsch gives a straight forward and detailed description of how he went about gaining information, how it was analyzed, and what he found. The writing is not too technical, however. It is written in a documentary style, meant to be accessible to the general reader. It is very clear. The book unfolds in a logical fashion as he explains terminology and critiques the findings of key clinical trials. He does so using research in his area of expertise, creating a convincing argument.

The strongest argument set forward, for me, was in Chapter 4 of the book - "The Myth of the Chemical Imbalance." Here, Kirsch's critique is solid and damning. He reviews basic aspects of how the brain functions and then introduces the chemical-imbalance hypothesis, or monoamine hypothesis of depression. He does this by recalling the history of the first antidepressant drug, iproniazid, and goes onto to discuss research on reserpine, as well as research on neurotransmitter depletion. I found this chapter fascinating. Common sense has it that the effectiveness of anti-depressants proves the chemical-imbalance theory. However, Kirsch's earlier research on the placebo effect challenges this familiar assertion. Also, challenging it is the fact that many different types of antidepressants "work" too well for the theory to make physiological sense. Basically, if depression can be equally effected by drugs that increase serotonin, decrease serotonin, and drugs that do not effect it at all, then the benefits of these drugs can't be chalked up to their specific chemical activity. Kirsch delivers this conclusion in clear and precise detail.

There is nothing more aggravating than folks who believe that any challenge to conventional views of antidepressants (or psychiatry) are the product of superstition or religious dogma. It seems that within the U.S., assertions by pharmaceutical companies and conventional understandings of anti-depressants are taken as truth without critical inquiry. Outside of the U.S., groups such as the Critical Psychiatry Network - not to be confused with antipsychiatry - have granted some legitimacy to the critiques of diagnosis, coercive practices, and pharmaceutical industry involvement within psychiatry. They have also served to critique the philosophical basis for psychiatric knowledge. It's my hope that Kirsch's book can serve to bolster critique within the U.S. - although it seems that we've already reached a critical juncture.

As a psychology student, I had to read and use this book extensively for one of my classes. I'd highly recommend it to anyone who studies psychology - as well as to anyone who's taken antidepressants. One doesn't have to agree with Kirsch's ultimate conclusions to see the value in the critique. I'm of the opinion that it's only a matter of time before the knowledge presented here becomes less controversial and more generally accepted.
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Feb 19, 2012 Matt rated it 4 of 5 stars

This book is fascinating from several different points of reference. I expect that the title draws people who are interested in depression and antidepressants specifically, and that question is certainly an important part of the story he's telling. Clinical depression is a particularly difficult disease in many respects. There is no consensus on its causes, although there are clear environmental and genetic factors that make people more prone to depression. Consequently, there is no one-size-fit...more This book is fascinating from several different points of reference. I expect that the title draws people who are interested in depression and antidepressants specifically, and that question is certainly an important part of the story he's telling. Clinical depression is a particularly difficult disease in many respects. There is no consensus on its causes, although there are clear environmental and genetic factors that make people more prone to depression. Consequently, there is no one-size-fits-all solution either. Kirsch emphasizes that the widespread idea that depression is caused by chemical imbalances in the brain is unproven. And as you might expect from the title, he argues that the effectiveness of antidepressants is a myth as well. But what makes this story especially compelling is that he's not arguing that they don't work. On the contrary – they do work. The problem is that they don't work very significantly (meaningfully) or very reliably, and more to the point, they don't work better than a placebo. And because antidepressants are expensive and frequently cause unwanted side effects, it means Kirsch is telling us that we've made a pretty big mess of things.

Kirsch didn't start out interested in antidepressants. His interest is in placebo studies. And that is really where this book shines. The power of the placebo is fascinating on its own. A placebo won't make someone grow taller and it won't prevent HIV, but for certain diseases – like depression – it offers the potential to make a difference. A key part of the story here is that antidepressants can act as an "extra-strength" placebo, because patients suffer side effects like nausea and drowsiness. And because they are certain they are getting a drug and not a sugar pill, it makes it even more likely to work. According to Kirsch, drug trials of medication that doesn't cause side effects tend to fail because the side effects make a big difference in activating that placebo effect. The implication is that we have a lot of approved drugs on the market that work, but none work as well as they should, and all offer negative side effects. From a bioethical standpoint, this causes a great dilemma. Ultimately, Kirsch argues that psychotherapy is a much more advisable route, since it works as well as existing medications but without side effects and without the questionable ethics.

By far the most disturbing part of this book is what it suggests about the drug approval process and about medical testing in general. On the one hand, it offers a good logical explanation as to why we have approved all of these drugs: Antidepressants produce more side effects than a standard placebo, so patients in clinical trials typically know they are not getting a standard placebo, so consequently, those drugs 'work' as an 'active' placebo, better than a standard one. But on the flip side, these active placebos don't work so much better than standard ones that they should have been approved by the FDA. There are several things about our current process that are extremely disturbing. First, not all studies are appropriately designed as double-blind. Even in cases where the active drug has side effects, those side effects could be replicated for the control cases. Second, not all studies are published. This is a very big and more general problem we have in that most research only gets published if it produces a positive result. Consequently, there is pressure on researchers to get positive results, and most meta-analysis of published studies would give a result that would be biased in favor of positive results. Finally, the FDA doesn't solely have consumer interests at heart when it comes time to decide whether the drugs should be approved for the market. Even with all the relevant data available to it, the FDA tends to act more in the interests of the drug companies than the consumers, which is unfortunately a story that's pretty easy to believe.

The book is pretty short, considering the number of things it touches on. Like many science-centered books, you don't exactly get raw data to chew on when you read an account meant for popular consumption. But what Kirsch does offer is a lot of sensible, compelling, and intuitive arguments and explanations, which is enough in this setting.
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Nov 20, 2011 Lumpenprole rated it 4 of 5 stars · review of another edition

Shelves: 2011, borrowed, law, philosophy, psychology, reference

I cannot decide if the author of this work is a crackpot pushing a dubious agenda or someone who is in fact on to something about the way "Big Pharma" can, does and will do anything in their power to keep the current status quo regarding anti-depressants in place. And how in pursuit of this end basic science is tossed aside, the methodology for the approval of new -- and theoretically better -- medicines has been turned into something resembling a joke with a bad punchline, and even that a great...more I cannot decide if the author of this work is a crackpot pushing a dubious agenda or someone who is in fact on to something about the way "Big Pharma" can, does and will do anything in their power to keep the current status quo regarding anti-depressants in place. And how in pursuit of this end basic science is tossed aside, the methodology for the approval of new -- and theoretically better -- medicines has been turned into something resembling a joke with a bad punchline, and even that a great many clinicians seem to have embraced the current state of psychopharmacology with what I can only think of as almost a religious fervor.

Without doubt, the biggest shock delivered to MY system was contained in the chapter "The Myth of the Chemical Imbalance." Kirsch here attacks not the "branches" of the tree of antidepressants but aims straight at the "roots." He describes the central dogma of the whole theory behind anti-depressant effectiveness, that an excess or deficiency of neurotransmitters is behind many forms of depression, has little empirical evidence in its support. And that there is at least as much -- if not more -- evidence against such a theory as in favor of it. Not only that, the history behind the theory is as dubious as anything else related to it.

There is a great deal in the book on the "placebo effect" and how it used to "prove" the effectiveness of such and such a drug. Unfortunately, Kirsch seems to think the average reader will find this whole topic both exciting and as something of a revelation. It is not that -- insofar as I can tell -- Kirsch is wrong, just that he probably spends more time on this topic than any other. And I submit that it is hardly as earth-shattering a topic as he seems to think, though admittedly the bits commingled with the topic on how clinical trials that work against a drug are deliberately buried, and trials in their favor published and re-published to make a drug appear more effective perhaps was...but that goes into areas not directly related to any placebo effect.

Still and all, a very thought provoking read. But as I noted at the outset of the review I'm a bit reluctant to jump on his bandwagon; I simply lack the scientific background to evaluate his claims. But must admit I'm intrigued that if any direct rebuttal to the work has been written, I've not seen it. It is almost as though the "true believers" want this swept under the rug in preference to offering any sort of defense.(less)

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Sep 09, 2011 P Chulhi rated it 4 of 5 stars

Shelves: biomedical

Based on his analysis of all of the published and unpublished clinical trials submitted to the FDA, Kirsch argues that antidepressants (SSRIs) do work but aren't better than placebos. This in itself isn't a problem except that antidepressants come with a host of undesirable side effects including increased risk of suicide, sexual dysfunction, seizures, anxiety, increased cost to patients, etc. He also explains the "theory" of chemical imbalance and why it isn't a plausible explanation for depres...more

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Mar 04, 2013 Joseph rated it 5 of 5 stars

The most exciting book on psychology I have read since graduate school. Written primarily for a lay audience, but meticulously cited, Kirsch does exactly what his subtitle promises. This is an absolutely incredible account of the placebo effect and its enormous role in the healing of depressed individuals who are on psychoactive medications. Here is a too-simple account of his more controversial (but incredibly substantiated) claims:

His claim most controversial to scientists: anti-depressants a...more

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Sep 06, 2011 Doug rated it 3 of 5 stars

Shelves: nonfiction

I don't know what to think, it's hard to believe that the antidepressant drugs basically amount to a $19 billion/yr placebo effect but the evidence he brings is persuasive. It still boggles the mind - and it's hard to get my head around the face that this guy might have been right about antidepressants all along. His explanation of the placebo effect was really interesting, I was having a conversation with a friend a couple weeks ago about The Secret and how it her ideas seem so ridiculous, but...more

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Aug 26, 2012 Kate rated it 4 of 5 stars

Very interesting book (if you can muddle through some of the more dry statistical paragraphs). Kirsch makes a compelling argument really in the effectiveness of placeboes. Beyond the anti-depressant research, there are fascinating notes about placebo knee surgeries and even placebo heart surgery and more that may make you question the efficacy of healthcare as we know it. Note to other "readers" who had a few negative comments- this is a book that you should read through to the end before tossin...more

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Nov 20, 2011 Sami Sundell rated it 4 of 5 stars

Shelves: fact, psychology, science, medicine

Kirsch starts the book by stating some simple facts from his original metastudy of efficacy of the antidepressant drugs, then continues deeper into the possible meanings of those results, and ends up debunking the whole chemical imbalance theory. Nice job!

The whole book is interesting read. It gives insight on how the drug approval process works, and also about the double standards evident in the field. Even if you take out the debunking of antidepressants, it has plenty of information about how...more

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Sep 09, 2011 Karen rated it 4 of 5 stars · review of another edition

Shelves: educational

I think we all like to read things that support the way we feel, so, I liked this book. Clearly I now need to go and read the other side of the viewpoint to balance it all out.

I was unaware of the details about the anti-depressant drug studies, but I have always felt that we JUST DON'T KNOW ENOUGH about any of it, and I really have had a hard time believing in the 'depression as a simple medical problem' theory. Clearly there is a medical aspect, but the human brain is such a magnificently comp...more I think we all like to read things that support the way we feel, so, I liked this book. Clearly I now need to go and read the other side of the viewpoint to balance it all out.

I was unaware of the details about the anti-depressant drug studies, but I have always felt that we JUST DON'T KNOW ENOUGH about any of it, and I really have had a hard time believing in the 'depression as a simple medical problem' theory. Clearly there is a medical aspect, but the human brain is such a magnificently complicated thing.

I appreciated immensely that he didn't just spew out all of the placebo info and then leave you hanging. He's not saying, too bad for your, your medicine doesn't work, there is no cure. He spends the last few chapters discussing options that have been clinically proven to be JUST AS EFFECTIVE, or even more effective in the long run. His point is that there are other forms of treatment that have proven to be equally as effective, without the harmful side effects. But he is always careful to point out that if a treatment is working, don't stop! And don't ever take yourself off of an anti-depressant, always talk to your doctor!

If anything, this book made me more amazed by the power of the human mind. He talks about one study where, after being told that ipecac was a medicine that would abolish nausea, it did, and not just mentally. The gastric activity within the stomach actually subsided. The human brain is amazing.

Sometimes depression is way beyond simple techniques. I am not talking about serious cases. But in general, I feel like we, as a world, are becoming less and less able to understand how to reconcile and deal with feeling bad. As factors in our regular everyday life, in today's world, we don't have to do as much manual labor, we don't have close neighbors to chat with about our day. There are skills that have to be taught and learned, to understand how to pull your mind out of a downward spiral, find the positives, plan for the future. He talks about psychotherapy/CBT, that are just as effective in the short term, but clinically show to have longer lasting results due to actual changes that you can make in thinking patterns, etc. But it requires work and effort, and belief that there is an end and belief in oneself...that you CAN overcome.

I think the section on exercise as an effective tool rang true for me because that is definitely one of my 'drugs' of choice. Although, I've always used it more as a vitamin (preventative) than a drug (cure) so I can't speak for it's effectiveness in other ways from personal experience.

I don't know all of the answers, but my conclusion asserts itself even more powerfully after reading this book....neither do "they". There's not a quick fix. We are still learning. I truly hope that better answers come soon. Because it's real. Of that I am sure.
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May 13, 2010 Pat rated it 3 of 5 stars · review of another edition

Recommended to Pat by: Emma

Shelves: non-fiction

Interpreting data from a meta-analysis, Kirsch sets out to debunk the myth put forth by the multi-national pharmaceuticals that antidepressants are revolutionary, blockbusters drugs. He looked at clinical trials that compared the efficacy of various treatments for depression. "Drug effect," the response to drug minus the response to placebo minus the response to spontaneous response or doing nothing, was surprisingly, significantly small. Rather, he claims, the efficacy of these drugs in managin...more Interpreting data from a meta-analysis, Kirsch sets out to debunk the myth put forth by the multi-national pharmaceuticals that antidepressants are revolutionary, blockbusters drugs. He looked at clinical trials that compared the efficacy of various treatments for depression. "Drug effect," the response to drug minus the response to placebo minus the response to spontaneous response or doing nothing, was surprisingly, significantly small. Rather, he claims, the efficacy of these drugs in managing depression are largely due to the placebo effect--except technically placebos are inert substances without appreciable side effects, and most of us know the small print that comes along with SSRIs, SNRIs, etc. Kirsch gives some history of the chemical imbalance theory, claiming that it's way too weak and way to sketchy to support the explanation that ADs work.

Kirsch gives a good critique of the research process, pointing out serious flaws in various studies as he plods through the material.He also gave accessible, clear explanations of complex brain processes. Incomplete citations were a big problem for me, though. The biggest disappointment was the conclusion, which gave alternate suggestions for dealing with depression. Beyond some superficial recommendations of some self-help books and glib mention of exercise, there's not much there of substance. He mentioned the need for social change--e.g. it's not the level of a country's poverty that makes its citizens more susceptible to depression; it's the disparate distribution of wealth and resources. Exploring the imperative of social change was certainly not the intent of his book, but it's hugely important.

Kirsch has a long history of civil rights activism and participation in anti-war movements. In his pre-psychological career, he was a violinist who backed up Aretha Franklin. As a grad student in 1975, he worked with the National Lampoon to produce an album that won a Grammy for Best Comedy Recording. Judging from the fall-out he has received for his interpretation of the pharmaceutical industry's research, although he likes to "rock the boat," that boat won't be tipped over easily or soon. (less)

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Jun 05, 2010 Books Ring Mah Bell rated it 3 of 5 stars

Shelves: science-med-psych

I was attracted to this book for a few reasons:
1. I like good debate over hot topics in the medical field, and the use and efficacy of antidepressants is a hot topic.
2. I have struggled with depression off and on for a few years and (once again) have taken myself off my antidepressant. There are many reasons for my choice, one of them is that I simply do NOT want to rely on a pill if I don't have to.
(DO NOT ATTEMPT REMOVING YOURSELF FROM YOUR MEDS WITHOUT MEDICAL SUPERVISION!)
3. It has a very se...more

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Mar 06, 2013 Yong Yi rated it 4 of 5 stars · review of another edition

Shelves: non-fiction

Kirsch makes a rather convincing argument for the controversial claim that antidepressant medication works no better than placebo, and may even be due to an active placebo effect rather than the result of a biochemical change caused by the medication. I was fairly sceptical when I read the claims of the book, but he has presented the evidence for his argument well and in an easy-to-read fashion. I still wonder if his hypothesis will be embraced by the broader scientific community. Only time will...more

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Jun 05, 2010 Sally rated it 4 of 5 stars · review of another edition

Shelves: medicine, psychology-consciousness

A specialist in the placebo effect discusses his findings, based on extensive reviews of pharmaceutical trials by manufacturers and regulators, that antidepressants' effects are no better than placebos -- that, in fact, they are active placebos. He also discusses the placebo effect more generally and gives a critical evaluation of the chemical-imbalance theory of depression.

A persuasive scientific argument that came as no surprise to drug manufacturers though it has been upsetting and controver...more

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Jun 19, 2012 Kimberly is currently reading it · review of another edition

Shelves: history-of-mental-health, mental-health, psychiatry, psychology

Read through half of the preface, then needed to return the book to the library. I have *serious* doubts about the author's thesis that antidepressants merely have a placebo effect, and that major depressive disorder is *not* an actual chemically-based disorder!

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Oct 30, 2011 Kyndra rated it 4 of 5 stars · review of another edition

I'm not sure what bothers me more about antidepressants, the fact that they have so many side effects or the fact that they hardly work. But I think the one that takes the cake is that drug companies aren't spending all of their time and money on making the drugs work better (which is impossible, since the chemical-imbalance theory is utter nonsense), but they're spending all of their time and money on making the side effects less bad. Meaning, they're spending time and money on a drug that does...more

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Oct 11, 2011 Gwen rated it 4 of 5 stars · review of another edition

Very interesting! New science about depression and antidepressants. Do antidepressants actually work any better than placebos? Maybe not.

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Apr 17, 2011 Judy rated it 3 of 5 stars · review of another edition

Shelves: mostly-skimmed, mental-health, health

Even though I agree with a lot of his premise (it's best to avoid drugs and use counseling [especially cognitive-based therapy), St. John's Wort, exercise, self-help, and social change), I doubt whether anti-depressant effects are almost ALL placebo. Otherwise, why would they sometimes work with animals?

A lot of tedious reading, which is why I skimmed (read some parts more thoroughly, though).

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Apr 26, 2011 Laura rated it 3 of 5 stars

I wasn't sure what to think. The author presents a variety of studies showing that antidepressant drugs work only slightly better than placebos. Also debunks chemical imbalance in brain theory. I'd like to hear from the other side.

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Mar 12, 2012 Emily rated it 2 of 5 stars

What I liked about this book was the Kirsch's actual conclusions that antidepressants are a multi-billion dollar scam. What I disliked was his repetitive way of backing up the conclusion. I felt like he kept writing the same thing in slightly different ways. He analyzed data, he conducted studies, he formed conclusions. These three steps happened over and over throughout the book with only slight variations. I understand that this method is probably the official scientific way to prove his theor...more

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Dec 06, 2010 Priscilla rated it 3 of 5 stars · review of another edition

This whole book can be sumed up in two words: placebo effect.

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Mar 31, 2012 Vanessa rated it 5 of 5 stars

Shelves: psychology-therapy, the-body, library-book, 2012

LOVED THIS BOOK! I was pleased that I took Qualitative and Quantitative Research because the book used a lot of research lingo but it was so important for me to read this book at this particular juncture in my life.

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Nov 15, 2011 Margaret Heller rated it 3 of 5 stars

Shelves: science

I skimmed most of this. It wasn't quite what I was expecting. I guess I thought it would be more exciting. Anyway, drug trials show that antidepressant medications don't really work better than placebo, depression is complicated and not caused by just one thing, and it's better to learn coping skills than become reliant on a not-chemically-helpful medication. I think I have to delve into the literature more before I really understand this concept.

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Jun 20, 2012 Trisha rated it 3 of 5 stars · review of another edition

A very interesting glimpse at interpreting research, studies, trials and analyses - none to be taken for granted at face value again! He makes a strong case against the theory of depression as a chemical imbalance, and sprinkles excellent points about the human psyche in between. Some of his suggested alternatives, however, would employ methods of socialism.

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Feb 02, 2013 Jo Ann rated it 3 of 5 stars

My next non fiction offering. Do anti depressants really work? Kirsh believes that there is evidence that they do NOT.

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Aug 23, 2011 Corinne rated it 3 of 5 stars

Shelves: library

Depressing.

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May 19, 2013 Mdh Hale marked it as to-read

Shelves: priority

May 15, 2013 Mammokoane marked it as to-read

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“Depression is not caused by a chemical imbalance in the brain, and it is not cured by medication. Depression may not even be an illness at all. Often, it can be a normal reaction to abnormal situations. Poverty, unemployment, and the loss of loved ones can make people depressed, and these social and situational causes of depression cannot be changed by drugs.” — 10 people liked it

“Like antidepressants, a substantial part of the benefit of psychotherapy depends on a placebo effect, or as Moerman calls it, the meaning response. At least part of the improvement that is produced by these treatments is due to the relationship between the therapist and the client and to the client's expectancy of getting better. That is a problem for antidepressant treatment. It is a problem because drugs are supposed to work because of their chemistry, not because of the psychological factors. But it is not a problem for psychotherapy. Psychotherapists are trained to provide a warm and caring environment in which therapeutic change can take place. Their intention is to replace the hopelessness of depression with a sense of hope and faith in the future. These tasks are part of the essence of psychotherapy. The fact that psychotherapy can mobilize the meaning response - and that it can do so without deception - is one of its strengths, no one of its weaknesses. Because hopelessness is a fundamental characteristic of depression, instilling hope is a specific treatment for it it. Invoking the meaning response is essential for the effective treatment of depression, and the best treatments are those that can do this most effectively and that can do without deception.” — 9 people liked it

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