Two of Psychiatry’s Gold Standards Are Fool’s Gold

     The American Psychiatric Association touts the “decades of rigorous research” that show that antidepressants are “safe and effective,” the FDA’s two criteria for approving a drug. That “rigorous research” has been conducted using psychiatry’s two gold standards: the randomized placebo-controlled trial and the Hamilton Depression Rating Scale to assess effectiveness.|

     But what do those decades of research actually show?

     They show that antidepressants are barely effective at all   compared to the placebos. From the early 1998 (Kirsch) meta-analysis of antidepressant trial results up to the more recent 2022 Stone meta-analysis, fourteen separate meta-analyses show that antidepressants are effective only about four percent of the time over placebos.

     That’s a might skimpy “effective.”

     In fact, even the 2014 guideline report from the U.S. National Institute of Health and Care said that this four percent difference is “unlikely to be of clinical importance.” These gold standard placebo trials do not take into account the effects on all trial participants of improvement solely from increased hope, expectancy of any treatment being effective, and receiving some type of care.

     The placebo consuming participants do not know they are not receiving any medication, and so it could be these other factors – rather than the antidepressant itself – are accounting for the reported improvement, minimal as it is.

     So much for that gold standard.

     And what about the Hamilton Scale?

     Psychiatrist Max Hamilton published his first depression rating scale in 1960, and it has become a staple of assessment in the psychiatric world over the last 66 years, perhaps mostly through its convenience and availability. It is the scale most often used in random placebo-controlled trials to measure improvement or decline from antidepressant treatment.

     It has many shortcomings. Critics particularly note the questionnaire’s focus on merely physical conditions such as insomnia and weight gain, its short term view, and especially its validity being dependent on the skill of the interviewer asking the questions. That random subjectivity alone is enough to make even the four percent antidepressant improvement outcome an unreliable result.

     Two gold standards. Two cases of fool’s gold. 

     Of course in an industry rife with unconscionable profit margins, that’s hardly surprising, is it?