Interestingly enough, SSRIs are only slightly but statistically significantly better than active placebos. While early trials showed a big difference between antidepressants and placebos, more recent studies have significantly narrowed that gap. FDA data shows a reduction of symptoms of about 30% in placebo vs 40% in antidepressants. [1]
[edit] Doctors note that the difference between antidepressants and placebo isn't clinically significant. They do something, but not much which is why the revival and breakthrough drug designation of psychedelics in the treatment of - especially major - depression is so exciting.
Contrarians and cynics have been trying the "barely better than placebo" angle for decades, but antidepressants are indeed superior to placebo.
You can find articles and reviews that play games with statistics, cherry pick studies, and use various thresholds for effect size to try to downplay it, but they do work for a lot of people.
> While early trials showed a big difference between antidepressants and placebos, more recent studies have significantly narrowed that gap.
The part you're leaving out is that the placebo effect is quite strong in studies for depression and even pain. It's misleading to say "barely better than placebo" without explaining that placebo works quite well in those studies.
I don't think they're contrarians and cynics although some undoubtedly are. They seem to be study authors. The fact is treatments, even broadly used ones, aren't always super effective. Sometimes they're just the only ones we have, and we as humans have a bias towards action being over inaction in medical care.
I may be contrarian and cynical in a lot of things, but modern medicine isn't one of them. I just like to be data driven.
> ... but they do work for a lot of people.
They work for most of those people just about as well as a sugar pill would, yes. Slighly better. There's a real mismatch in terms of public perception of how much better they actually work.
> Contrarians and cynics have been trying the "barely better than placebo" angle for decades, but antidepressants are indeed superior to placebo.
The study that I linked showing the 30%-40% numbers are from FDA data. There's no games played, the study authors got the FDA data by FIOA.
The fact that placebo effect is strong doesn't really mean much other than depression is something that you can treat through things like therapy, which the data shows is exactly as effective as antidepressants. A psychosomatic angle, even if that's not the right word. The desire to heal is sufficient to change the way you think about your situation, and that exists no matter what you're taking.
If taking your conclusion to an extreme, the placebo effect was exactly as strong as an antidepressant - or stronger - why wouldn't we just prescribe sugar pills instead? In fact since the delta between SSRIs and sugar pills is clinically insignificant - while SSRIs have tons of side-effects - why wouldn't we just prescribe sugar pills now? Does that mean sugar pills are effective against depression, or are SSRIs treating depression largely through placebo?
Putting it another way, the placebo effect doesn't treat punch biopsy wounds. [1]
>The study that I linked showing the 30%-40% numbers are from FDA data. There's no games played, the study authors got the FDA data by FIOA.
Most people who take SSRIs and swear by them have had to try multiple of them to find one that works (usually very well) for them. A study that only looks at one drug will have a much lower rate of success than a study that looked at SSRIs as an entire class of medicine.
[edit] Doctors note that the difference between antidepressants and placebo isn't clinically significant. They do something, but not much which is why the revival and breakthrough drug designation of psychedelics in the treatment of - especially major - depression is so exciting.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592645/