Human Givens Institute welcomes Irving Kirsch's meta analysis of antidepressant drug trials

This week, Professor Irving Kirsch and his colleagues at the University of Hull released the long-awaited results of an extensive meta-analysis of clinical trial data for new generation antidepressants. Their findings were splashed (in simplified terms) over the front pages of most of the major newspapers: "Antidepressants do not work".

The Royal Society of Chemistry's website (http://www.rsc.org/chemistryworld/News/2008/February/26020802.asp#) summarises the research and its results eloquently:

"Kirsch and colleagues found that there was a statistically significant benefit in the use of SSRIs over placebo - but that the difference was smaller than the standard of 'clinical significance' set down by the UK's National Institute for Clinical Excellence (NICE) for all but the most depressed patients. ... Interestingly, the team also found that patients' response to placebo across all the trials was 'exceptionally large' - an indication of the complexity of the disorder. It was only the fact that the most severely depressed patients showed a much lower response to placebo that made the drug response clinically significant in this group of patients."

By carrying out a meta-analysis (a statistical review of many trials which combines all the results into one overall conclusion), Kirsch and his colleagues were attempting to discover any trends that have not previously shown up in individual studies.

One of the reasons this latest research is so significant is that it also included a number of previously unpublished studies which Kirsch obtained from pharmaceutical companies under the Freedom of Information Act. By so doing, Kirsch says that his meta-analysis avoids the data bias caused by pharmaceutical companies selectively reporting only positive results. Although these additional studies had been submitted to the Food and Drug Administration (FDA), not all of them were made available to NICE when it was drawing up its guidelines.

An interesting, related article ('It doesn't work, but do it anyway') in the forthcoming issue of the 'Human Givens' journal (LINK) discusses the limitations of the current 'Gold Standard' of evidence-based healthcare – the randomised controlled trial (RCT) – and how easily the results from such trials can be distorted to mean almost whatever the agency funding the trial wants it to mean (whether they choose to publish the trials or not).

The Human Givens Institute welcomes Kirsch's research as it throws more light on whether SSRIs are as helpful as is often maintained and supports the position we have maintained on antidepressants for many years. However a caution is needed as antidepressants have been shown to be demonstrably beneficial for certain patient groups, particularly those with severe cases of depression, and until we have enough people trained to treat depression effectively by other methods, such as human givens therapy, they still have a helpful role to play in relieving distress.

Fundamental to truly effective treatment of depression – whether therapeutic or pharmaceutical – is a solid, scientific understanding of what depression is, and what perpetuates it. See: http://www.hgi.org.uk/archive/Depression.htm