Do anti-depressants work?

It’s a strange thing for a physicist to host a panel discussion on medial science in an auditorium full of doctors. Last Thursday I chaired the second of the monthly science public debates at the new Science Gallery at Trinity College Dublin.

The topic for debate was ‘Do Anti-Depressants Work?”. On the panel was Professor Irving Kirsch, author of that recent controversial study that suggested that anti-depresssants do little better than placebos in all but the most severe cases – you can see the study in full here.

We kicked off the session with psychologist Kirsch giving a brief overview of his meta-analysis. (Our format for the debates is to allow each panellist to make a 5-minute pitch, then to throw open the floor to questions). He was then suceeded by well-known consultant psychiatrist, Dr Veronica O’ Keane, who flatly disagreed with much of his analysis. One disagreement concerned “all but the most severe cases” – what Kirsch deemed severe depression O’Keane deemed more like average (a not unprecedented point of disagreement beteen psychiatrist and psychologist). Dr O’ Keane also pointed out the lack of longterm data. Most of all, she was deeply unhappy with media reporting of the Kirsch study, saying she felt it could lead to severe patients discarding vital medicine.

Another member of the panel, Dr Harold Barry, spoke of his day-to-day experience as a GP, emphasising the importance of a multi-modal approach, and spoke of his despair of the perception of family doctors giving out anti-depressants at the drop of a hat. I liked the sound of his approach, but I got the feeling he was talking mainly about people you and I might meet walking around, a good remove from O’ Keane’s patients.

Question time was lively, as you can imagine. A lot of the questions touched on the placebo effect – it seems that, in a way, the real result of the Kirsch analysis is how effective placebos can be….(for you scientists out there, a placebo is basically a dummy pill). However, one problem is that longterm comparative studies with placebos can’t be done (for obvious ethical reasons). Another point was increased incidence of suicide with the use of SSRIs in some cases. For a while, I thought it was going to degenerate into a battle between psychologists and psychiatrists. However, a common thread that kept coming through was the importance of a multi-modal approach. Certainly, the audience seemed equally hostile to drugs-only or therapy-only approaches. Apparently, there is great emphasis on cognitive behavioural thrapy in Britain at the moment. If you want to know more, you can see a recording of the debate at www.sciencegallery.ie.

All in all, a very interesting evening. I certainly learnt a lot! After the debate, panel and audience retired to the gallery restaurant, where the discussion continued. Unfortunately, I was enjoying this so much, I forgot about my damn car, which Trinity car park locked in for the night with relish. Thanks. So I had to crash on a friend’s sofa in Dublin, and hare back to Waterford at the crack of dawn next morning for class. Well done Einstein.