Irving Kirsch Quotes

Anything that instills a sense of hope will at least temporarily help treat depression.

Perhaps 10 percent of patients who are prescribed antidepressants are really benefiting from the drugs' active ingredients.

Depression, we are told over and over again, is a brain disease, a chemical imbalance that can be adjusted by antidepressant medication. In an informational brochure issued to inform the public about depression, the US National Institute for Mental Health tells people that 'depressive illnesses are disorders of the brain' and adds that 'important neurotransmitters - chemicals that brain cells use to communicate - appear to be out of balance'. This view is so widespread that it was even proffered by the editors of PLoS [Public Library of Science] Medicine in their summary that accompanied our article. 'Depression,' they wrote, 'is a serious medical illness caused by imbalances in the brain chemicals that regulate mood', and they went on to say that antidepressants are supposed to work by correcting these imbalances.
The editors wrote their comment on chemical imbalances as if it were an established fact, and this is also how it is presented by drug companies. Actually, it is not. Instead, even its proponents have to admit that it is a controversial hypothesis that has not yet been proven. Not only is the chemical-imbalance hypothesis unproven, but I will argue that it is about as close as a theory gets in science to being dis-proven by the evidence.

The big bulk of the response to antidepressants is the placebo response.

If doctors just spent more time with their patients so they felt more reassured, that might help.

According to an article in the Washington Post: The Food and Drug Administration has repeatedly urged antidepressant manufacturers not to disclose to physicians and the public that some clinical trials of the medications in children found that drugs were no better than sugar pills, according to documents and testimony released at a congressional hearing yesterday. Regulators supressed the negative information on the grounds that it might scare families and physicians away from the drugs, according to testimony by drug company executives. For at least three medications, they said, the FDA blocked the companies' plans to reveal the negative studies in drug labels.

The one thing we do know is that the chemical imbalance theory - the theory that people get depressed when they don't have enough serotonin in their brain - we know that that's wrong.

To someone who is not currently on anti-depressants, I would suggest trying other treatments first - for example, psychotherapy.

I do a lot of research on the placebo effect, not just in depression but in irritable bowel syndrome, pain, arthritis of the knee, migraine, asthma.

Depression is a serious problem, but drugs are not the answer. In the long run, psychotherapy is both cheaper and more effective, even for very serious levels of depression. Physical exercise and self-help books based on CBT can also be useful, either alone or in combination with therapy. Reducing social and economic inequality would also reduce the incidence of depression.

Patients who trust their doctors and have a psychological expectation of getting better could trigger a reaction in their body.

Antidepressants can have troubling side effects and are addictive for some people.

If you're taking an antidepressant, it's working, and you're not experiencing side effects, go on taking it. But if it's not working, or not working well enough, or if you have side effects you don't like, talk to your doctor about an alternative approach.

The results of decades of neurotransmitter-depletion studies point to one inescapable conclusion: low levels or serotonin, norepinephrine or dopamine do not cause depression. here is how the authors of the most complete meta-analysis of serotonin-depletion studies summarized the data: Although previously the monoamine systems were considered to be responsible for the development of major depressive disorder (MDD), the available evidence to date does not support a direct causal relationship with MDD. There is no simple direct correlation of serotonin or norepinephrine levels in the brain and mood.' In other words, after a half-century of research, the chemical-imbalance hypothesis as promulgated by the drug companies that manufacture SSRIs and other antidepressants is not only with clear and consistent support, but has been disproved by experimental evidence.

For people who are depressed, and especially for those who do not receive enough benefit from medication of for whom the side effects of antidepressants are troubling, the fact that placebos can duplicate much of the effects of antidepressants should be taken as good news. It means that there are other ways of alleviating depression. As we have seen, treatments like psychotherapy and physical exercise are at least as effective as antidepressant drugs and more effective than placebos. In particular, CBT has been shown to lower the risk of relapsing into depression for years after treatment has ended, making it particularly cost effective.

Like antidepressants, a substantial part of the benefit of psychotherapy depends on a placebo effect, or as Moerman calls it, the meaning response. At least part of the improvement that is produced by these treatments is due to the relationship between the therapist and the client and to the client's expectancy of getting better. That is a problem for antidepressant treatment. It is a problem because drugs are supposed to work because of their chemistry, not because of the psychological factors. But it is not a problem for psychotherapy. Psychotherapists are trained to provide a warm and caring environment in which therapeutic change can take place. Their intention is to replace the hopelessness of depression with a sense of hope and faith in the future. These tasks are part of the essence of psychotherapy. The fact that psychotherapy can mobilize the meaning response - and that it can do so without deception - is one of its strengths, no one of its weaknesses. Because hopelessness is a fundamental characteristic of depression, instilling hope is a specific treatment for it it. Invoking the meaning response is essential for the effective treatment of depression, and the best treatments are those that can do this most effectively and that can do without deception.

One problem I have with drug companies is that they don't make all their data public.

Depression is not caused by a chemical imbalance in the brain, and it is not cured by medication. Depression may not even be an illness at all. Often, it can be a normal reaction to abnormal situations. Poverty, unemployment, and the loss of loved ones can make people depressed, and these social and situational causes of depression cannot be changed by drugs.

In 2004, the FDA urged drug companies to adopt a 'Don't ask, don't tell' policy with respect to their clinical-trial data showing that antidepressants are not better than placebos for depressed children. If the data were made public, they cautioned, it might lead doctors to not prescribe antidepressants. The FDA believed that the jury was still out on antidepressants for children. Even if the clinical trials show negative results, an FDA spokesperson was reported to have said to a Washington Post reporter, it doesn't mean that the drugs are ineffective. The assumption seems to have been that doctors should prescribe medications that have not been shown to work, until it has been proven that they don't work.

There are a variety of techniques to help people change the kind of thinking that leads them to become depressed. These techniques are called cognitive behavioral therapy.

Many of the benefits of CBT (cognitive behavioral therapy) can be obtained without going into therapy. There are a number of self-help books, CDs and computer programs that have been used to treat depression and some of these have been tested in clinical trials with positive results. I can particularly recommend these two books. One is 'Control Your Depression', the lead author of which is Peter Lewinsohn, a Professor of Psychology at the University of Oregon ... The other book that I can recommend with confidence is 'Feeling Good' by the psychiatrist David Burns. 'Control Your Depression' emphasizes behavioral techniques like increasing pleasant activities, improving social skills and learning to relax. 'Feeling Good' puts greater emphasis on changing the way people think about themselves. But both books include both cognitive and behavioral techniques.

There seem to be many causes of depression. One cause is profound loss, grief. Economic hardship we know is linked to depression. We don't have a full picture.

There seems little reason to prescribe anti-depressant medication to any but the most severely depressed patients.

Depression comes back over time in about 90 percent of people on antidepressants. Studies show that relapses are far less common when people are treated with psychotherapy.

Physicians do not systematically prescribe placebos to their patients. Hence they have no way of comparing the effects of the drugs they prescribe to placebos. When they prescribe a treatment and it works, their natural tendency is to attribute the cure to the treatment. But there are thousands of treatments that have worked in clinical practice throughout history. Powdered stone worked. So did lizard's blood, and crocodile dung, and pig's teeth and dolphin's genitalia and frog's sperm. Patients have been given just about every ingestible - though often indigestible - substance imaginable. They have been 'purged, puked, poisoned, sweated, and shocked', and if these treatments did not kill them, they may have made them better.