Depression is almost always treated with depression pills, although their effect is so small that it lacks clinical relevance. In most placebo-controlled trials, the effect is measured as an improvement on the Hamilton Depression Scale, and meta-analyses have shown that the effect is considerably less than the smallest effect that can be perceived, even for patients with very severe depression.
The pills are not curative and only have small benefits, if any. In contrast, they have many harms, which are readily felt by the patients. Their main effect is to ruin people’s sex lives. Half of the patients who had a normal sex life before will have it disturbed or made impossible. And yet, in the upside-down world of psychiatry, the pills that destroy your sex life are called happy pills. I call them unhappy pills or anti-sex pills.
A highly relevant question is what the patients think about the pills. Do they feel that their benefits outweigh their harms? Benefits and harms are not measured on the same scale but we can get an idea about this balance if we look at drop-outs in placebo-controlled trials. When patients decide whether to continue in a trial till the end or to drop out, they have, at least indirectly, made a judgment about whether they like taking the pills.
It has been abundantly demonstrated that published depression trials are not reliable. My research group therefore used the 71 clinical study reports we had obtained from drug agencies to study drop-outs. No one but us had ever read the 67,319 pages about these trials (18,426 patients), which amounted to a stack 7m high. We found that 12% more patients dropped out while on drug than while on placebo.
The patients preferred the placebo even though some of them had been harmed by cold turkey withdrawal effects when being randomised to a placebo from a depression drug they were already on. Thus, the drugs are even worse than what we found.
Quality of life is a more direct measure of whether the patients get any benefit from taking the pills. We therefore also looked at quality of life, which we expected would be worse on pills than on placebo. But we had now come too close to the secrets of depression pills. The reporting of quality of life was virtually non-existent. Even in the confidential clinical study reports submitted to regulators, a huge amount of data was missing, and selective reporting of outcomes that happened to be positive was common. Despite this bias, we found only small differences between drug and placebo.
Our two meta-analyses lead to the conclusion that that depression pills worsen quality of life.
I collaborated with a politician in the Danish Parliament and via her, the Minister of Health was asked on 26 September 2017 (question 1063): “Will the minister explain whether it is a serious conclusion when the Danish Drug Agency emphasises that in some of the studies an effect on quality of life has been found, when only three out of 131 studies have published data on quality of life?”
The Minister replied that the Agency had pointed out that there was an effect on quality of life in the studies where this was measured and that this supported the clinical relevance of the pills.
The Danish Drug Agency was ultra-comical and behaved like the drug industry’s useful idiots. Quality of life was measured in many more studies than three. We included 15 trials in our review! What has been published are data that happened to be positive by chance or after they had been tortured till they confessed.
And the amusement continued. The Minister said that, “Concluding on clinical relevance as such requires nuanced considerations and the involvement of professional expertise. A number on a scale (such as Hamilton’s depression scale, ed.) is not sufficient.”
Curiously, “professional expertise” never involves asking the patients what they think. But this has been done in some placebo-controlled trials. In contrast to the psychiatrists, the patients, both children and adults (page 56), say that the pills don’t work.
In my view, depression pills should not be used by anyone, also because they double the risk of suicide, both in children and adults, and they make it more difficult for people to return to a normal life. The rate of disability pensions follows the usage rates for depression pills closely, and that after SSRIs came on the market, a 35-fold increase in disabled mentally ill children in the USA was seen in just 20 years.