Antidepressants are over-prescribed, but genuinely help some patients

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Subscribe to enjoy similar stories. Around 10% of Western adults take antidepressants, making them one of the world’s most popular types of drugs. On the surface, their prevalence seems hard to reconcile with the underwhelming evidence of their utility.

For most people, they are only slightly more effective than a placebo, and can often induce dependency or inflict unwelcome side-effects. Why, then, are they prescribed so often? A potential explanation is bias in scientific literature, on which doctors rely when deciding on treatment. Studies that make drugs look useful are much more likely to appear in journals than are those showing little effect.

One analysis of antidepressants approved by the Food and Drug Administration (fda) in America found that, among the 51 relevant trials cited in academic papers in 1985-2006, the agency had classified 37 (73%) as yielding “substantial evidence of effectiveness". A further 11 (22%) did not meet this standard, but still touted a positive result—for a different outcome than the one the authors had originally planned to measure. By contrast, the results of 23 trials of these drugs that went unpublished painted a grim picture.

Just one had an fda-recognised positive finding, reducing the share of such results in the full sample to 51%. In 2022 the bmj published a breakdown of the full universe of trials filed with the fda in 1979-2016. It found that placebos replicated most of the pills’ benefits.

Among mildly depressed patients, who began trials with scores of 13-17 on the widely used Hamilton Rating Scale of Depression, those who got the drugs improved by 7.1 points on average. People given a placebo saw depression decline by 6.1 points, a one-point gap. For severely depressed