In this blog post, we examine whether antidepressants are truly effective or merely placebos, based on various research findings. We also consider their side effects and the need for regulation.
In April 2008, doubts were raised at a conference of the European Psychiatric Association regarding the efficacy of currently available antidepressants. Since antidepressants had occupied a corner of pharmacies without incident for over 20 years, raising such doubts within the psychiatric community was akin to questioning the fact that the sun rises in the east. Dr. Brett Deacon, a psychiatrist at the University of Wyoming, raised doubts about the efficacy of antidepressants at this conference, citing various experimental data. One of the pieces of evidence presented was experimental results showing that prescribing antidepressants to people with mild or moderate depression was no more effective than prescribing a placebo. In this experiment, the depressive symptoms of patients with “very severe” depression—those scoring between 25 and 52 on the Hamilton Depression Rating Scale—were assessed. While antidepressants were more effective than placebos for these patients, the difference was only 1.8 points on average. In fact, since scores can rise by 2 points just from a good night’s sleep, a 1.8-point difference was insignificant as a therapeutic effect, supporting the claim that antidepressants are either ineffective or have only a very slight effect.
Yet people still believe in the efficacy of antidepressants without question and continue to take them in large numbers. Furthermore, most psychiatrists are convinced of the effectiveness of antidepressants based on various published research findings and clinical experience. However, the author argues that antidepressants are either ineffective or have very limited efficacy, citing the fact that their mechanism of action has not been scientifically verified and that their therapeutic effect is no different from that of a placebo.
First, let us examine whether the mechanism of action of antidepressants has been clearly elucidated. Although medicine has advanced significantly, scientific research on the complex nervous system—the target of antidepressants—remains insufficient. For example, a closer look at the mechanism of action of the antidepressant Paxil, as claimed by psychiatrists, reveals problems. Antidepressants contain ingredients that inhibit the reuptake of serotonin outside nerve cells. By blocking the reuptake of serotonin, they induce its accumulation within nerve cells; this accumulated serotonin then activates nearby neurons, thereby alleviating depression. Based on this, psychiatrists conclude that an increase in serotonin resolves depression. However, the validity of this conclusion has not yet been confirmed. There is merely an argument that raising serotonin levels alleviates depression, based on the fact that blood tests of patients with depression show low serotonin concentrations.
There are two problems with this conclusion. First, because serotonin plays complex roles in the brain, medical researchers have not precisely identified its functions and are merely assuming—based on statistical data—that serotonin alleviates depression. However, this assumption has not been verified and lacks credibility. Second, even if serotonin were effective in improving depression, there is doubt as to whether it is possible to maintain high serotonin concentrations within the brain. Antidepressants work by preventing serotonin from escaping outside the neurons, thereby increasing serotonin levels within them; however, some neuropsychiatrists argue that this increase is subsequently reversed due to the activation of serotonin receptor production within the neurons. In other words, neurons possess at least two mechanisms for reducing serotonin levels. Based on this theory, some scholars argue that antidepressants cannot alleviate depression at all. In fact, some researchers reportedly reduced serotonin levels in the brain to induce depression but observed no effect. This serves as evidence that serotonin levels do not change due to feedback mechanisms within neurons, which could refute the claim that antidepressants increase serotonin levels.
However, it is true that antidepressants appear to effectively treat many patients with depression. But do antidepressants really work within the body according to the mechanisms described by psychiatrists to treat patients with depression? According to a clinical trial conducted by David Cohen, a professor in the Department of Social Work at the University of Florida, 50% of those taking antidepressants experienced a reduction in depression, while 40% of those taking a placebo did so. In other words, only 10% of patients experienced the effects of antidepressants. Based on these results, one could conclude that the actual effect of antidepressants is minimal, and that the placebo effect is merely being mistaken for a real effect. Furthermore, there are claims that even if antidepressants provide temporary relief from depression, in the long term they may actually worsen depression or fail to alleviate it at all.
In March 2006, the FDA analyzed 23 studies on antidepressant products and concluded that antidepressants induce suicidal impulses in adolescents. In 2007, the FDA warned that the well-known antidepressant Paxil increases the risk of suicidal impulses not only in children and adolescents but also in young adults. In addition, various experimental results and statistical data demonstrate the ineffectiveness of antidepressants.
Based on these experimental results, I argue that antidepressants have little meaningful therapeutic effect, and even if they do work, the effect is very minimal.
So, should the sale of antidepressants, whose therapeutic efficacy has not been verified, be regulated? Or should their sale be permitted in order to achieve even a temporary placebo effect? The author argues that the sale of antidepressants should be strictly regulated. The reason is that the side effects of antidepressants are severe. If antidepressants caused no harm to the human body, their sale could be permitted in the hope of a placebo effect. However, since antidepressants are drugs that manipulate neurotransmitters, they typically have more than 20 side effects, which cause more harm than benefit to patients. Common side effects include sexual dysfunction, gastrointestinal disorders, bleeding and stroke in the elderly, increased mortality rates, and developmental disorders in infants. These risks can cause greater harm than the benefits that might be gained from an uncertain placebo effect. In fact, cases where antidepressants have had negative physical effects are common. If you search the internet for information on antidepressants, you can easily find cases of people who have been taking them for years and complain of headaches and dizziness. Some scholars argue that the recurrence of depression after taking antidepressants is also a side effect of the medication. In October 2007 and July 2008, studies were published in the U.S. and Spain, respectively, indicating that antidepressants may increase the risk of gastrointestinal bleeding. Furthermore, the suicidal impulses and mental instability mentioned earlier can also be considered side effects of antidepressants.
Antidepressants also harbor other risks, such as dependency and withdrawal symptoms. This is because some people take large doses of antidepressants in an attempt to regulate their emotions with medication. When people who have taken antidepressants for three or four years suddenly stop taking them, changes in hormone levels and mechanisms within the body can lead to withdrawal symptoms. Since the withdrawal symptoms of antidepressants are similar to those of other harmful substances, special caution is required. In fact, at a well-known U.S. online bookstore, one can easily find many books on how to safely stop taking antidepressants. This reflects the reality that many people cannot escape the withdrawal symptoms of antidepressants and that many are suffering due to these medications.
In addition, there may be side effects of antidepressants that we are unaware of. These can be divided into those that are not yet known and those that have been concealed. The multinational pharmaceutical company Eli Lilly faced allegations that it attempted to conceal the side effects of the antidepressant Prozac even before its release. The British Medical Journal revealed that it possessed confidential documents from Eli Lilly regarding the side effects of antidepressants, which included information that Prozac could cause physical instability and panic attacks. The mass shooting carried out by Joseph Wesbecker, who suffered from depression, after taking Prozac demonstrates the possibility that this antidepressant may have caused mental instability and panic.
Thus, antidepressants not only fail to produce the expected therapeutic effects but may actually cause mental and physical instability. However, because these issues are not widely known, global consumption of antidepressants continues to rise.
According to a report by market research firm IQVIA, there were over 300 million prescriptions for antidepressants in the United States alone in 2022. Furthermore, the global antidepressant market surpassed $17 billion (approximately 22 trillion won) in 2023 and is projected to reach $220 billion (approximately 290 trillion won) by 2030. This demonstrates that antidepressants have evolved beyond mere treatments to become a massive industry.
Therefore, thorough verification of the efficacy and side effects of antidepressants is necessary, and strong regulations must be established that prioritize patient safety over pharmaceutical companies’ profits. Only when a cautious and responsible treatment environment is created will patients be able to make the right choices.
