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The Emperor's New Drugs: Exploding the Antidepressant Myth Hardcover – January 26, 2010

4.3 out of 5 stars 67 customer reviews

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Editorial Reviews

From Publishers Weekly

Starred Review. When he began a new research project on antidepressants and placebos (a "meta-analysis" of a large number of published studies), practicing psychotherapist and research psychologist Kirsch (How Expectancies Shape Experience) was surprised to uncover evidence that inadequate supervision by the FDA had allowed pharmaceutical companies to cherry-pick test results for publication and submission to the feds, suppressing unwanted outcomes; further, apparent evidence of active drugs' effectiveness when compared to placebos could often be attributed to patients correctly guessing which group they were in based on the side effects (or the lack thereof) they had come to expect in conjunction with anti-depressants. When his results were published in early 2008, Kirsch was surprised to find himself and his research the subject of front page newspaper stories, TV and radio coverage, and a vigorous debate in the medical community that continues to this day. Writing with a broad audience in mind, Kirsch expands on this important topic in a lively style with clear, cogent explanations of the science involved, and many examples of the differences between solid and flawed research. The result is a fascinating book with broad implications for science policy.

From Booklist

Recent surveys show almost 30 million Americans taking Prozac, Paxil, and their ilk at a cost of more than $10 billion annually. With decades of persuasive clinical trials and testimonials from patients and physicians attesting to it, such antidepressants’ overall effectiveness has long been deemed indisputable by psychiatrists. Yet according to psychologist Kirsch’s damning expose of pharmaceutical industry greed, that efficacy is entirely due to the placebo effect. Kirsch makes the bulk of his case by reviewing data from dozens of clinical trials dating back to the 1960s, including ones kept hidden by drug companies, which demonstrate that antidepressants work no better than pills that mimic antidepressants’ side effects. Kirsch also dismantles drug company assertions that newer antidepressants, such as serotonin reuptake inhibitors, work by balancing faulty brain chemistry. His contentions have already stirred controversy, including the predictable criticism from Big Pharma. Yet his work is an overdue wake-up call to the psychological professions to begin treating depression with more compassionate methods than expensive pill-popping. --Carl Hays

Product Details

  • Hardcover: 240 pages
  • Publisher: Basic Books; 1 edition (January 26, 2010)
  • Language: English
  • ISBN-10: 046502016X
  • ISBN-13: 978-0465020164
  • Product Dimensions: 5.5 x 0.8 x 8.2 inches
  • Shipping Weight: 12.8 ounces (View shipping rates and policies)
  • Average Customer Review: 4.3 out of 5 stars  See all reviews (67 customer reviews)
  • Amazon Best Sellers Rank: #387,437 in Books (See Top 100 in Books)

Customer Reviews

Top Customer Reviews

By Druin Burch on February 12, 2010
Format: Hardcover
I have conflicts of interest to declare. I'm a physician but I also write. I share a publisher (Random House UK) with Irving Kirsch and have written for them about the damage done by doctors who don't subject their ideas to reliable tests. Because of this I was asked if I'd provide a recommendation to go on the dust jacket of Kirsch's book. I was familiar with his work, having read his medical journal articles analysing the evidence behind antidepressant tablets. On that basis I sat down to his book expecting that I'd probably be able to say something nice about it. I thought it'd most likely amount to saying that Kirsch's research is important and interesting and should be mandatory for doctors involved with antidepressant prescriptions.

This book, though, isn't worthy & technical - it's fascinating. It's a remarkably readable account of how we got carried away with an idea about the brain that isn't true. You don't need to have an interest in depression and you don't have to be a medic; this is a thoughtful look at how bright & well-meaning people get enchanted with an idea & go on to fool themselves and everyone else. It isn't a doctor-bashing book, nor one that pushes the author's own pet therapy. Instead it gives a lovely insight into the way science works, and the way it can sometimes gets done so badly that it doesn't work at all. Kirsch argues antidepressant tablets are based on a false pharmacological model of the brain, and that the balance of evidence shows they don't work except as placebos. Even if you're not persuaded by Kirsch's thesis - and I think you should be - you'll find his ideas thought-provoking.

For most of human history, going to see a doctor was a bad move. We did more harm than good.
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Format: Hardcover
I've often felt that there should be an Anti-Nobel Prize for Medicine. This would be given not for discovering something new, but for discovering that something we believed deeply wasn't true. If there were such an award, Irving Kirsch would be up for it.

We have known some fundamentals about depression for decades: It is caused by a biochemical imbalance, the imbalance is in the serotonergic system, antidepressant drugs targeting this system somehow correct the problem, and they do so safely and with an excellent risk to benefit ratio. As the data have accumulated, however, the elegance and sense of these ideas have given way to confusion. In terms of Kuhn's concept of paradigm shifts, the evidence is tilting us uncomfortably from a belief in the origins, nature, and pharmacological treatment of clinical depression, toward a period of confusion where the older ideas collapse but have yet to be replaced by a newer model.

Few have done more elegant and powerful work in this area than Kirsch. As a psychologist specializing in depression, I have followed his articles closely since his work on this topic began coming out over ten years ago. As you read the book, you can begin to get a small chirping annoyance that takes a while to find its way into awareness. With all due respect to Kirsch: "This seems like good work, but it's not exactly rocket science. It's a bit obvious to go back and look at all the data to see what has actually been done, which of it has been published, and what it actually shows in terms of effectiveness. How is it that no one did this before?" You are led to two possibilities: Either people connected with the work see the problems and ignore them, or the quality of the science in this field is pretty low.
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Format: Paperback Verified Purchase
I am a Senior Ombudsman in the State of California, which means I go out to care homes for the elderly, inspect, and take complaints.

I got this book because of a seminar on the elderly being over medicated. I see it every time I go out. It is sad to see people looking up at the ceiling, comatose, withering away. And at the heart of it for many people is over medication.

The book is well researched and accurate. It is readable. But it is not pleasant reading because it is the truth. It made me angry.
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Format: Hardcover
Irving Kirsch presents exquisite and exhaustive research which concludes antidepressant drugs are in fact, placebos. He explains why and how placebos work. He argues against the chemical imbalance theory of depression and says it has never been proven. He also compares outcomes of Cognitive Behavioral therapy with and without antidepressant medication and concludes that a patient's "hope" for recovery is the fulcrum on which successful treatment rests. As a clinician, I have experienced the power of hope in alleviating suffering in moderately and severely depressed diagnosed patients and those in the throes of an existential crisis, which often is misdiagnosed as depression or an anxiety disorder. Sometimes in treatment, less is more. Kirsch states that SSRIs can help ... as much as any placebo... but instilling hope in a patient is what really works; there are no detrimental side effects, and hope and tools aquired in CBT have been shown to have more lasting results.
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It's common knowledge now that antidepressants are no better than placebo for the majority of patients. It's true that antidepressants successfully treat depression. The problem is that sugar pills ("placebos") also successfully treat depression, and the sugar pills are about as effective as antidepressants, without any of the drugs' side effects.

Irving Kirsch, a researcher who pioneered the use of meta-analysis in studying antidepressants, writes about the chimera of antidepressant effectiveness in his book. Kirsch's main argument is that placebos are effective treatments for depression, and that antidepressants add very little except side effects.

After analyzing 38 clinical trials involving more than 3000 depressed patients, Kirsch found that only 25% of the benefit of antidepressant treatment was due to the drug effect. The placebo effect, the patient's hope that he will improve from treatment, was twice as powerful as the drug effect.

When analyzing the data, Kirsch also found that the newer antidepressants (e.g. SSRI's) were no better than the older antidepressants. Even more surprisingly, he found that sedatives, barbiturates, antipsychotic drugs, stimulants, opiates, and thyroid medications were as effective as antidepressants in treating depression. The only thing that these drugs have in common is that they produce easily noticeable side effects. Kirsch explains that in a clinical trial, patients are randomly assigned to either a treatment (drug) group or a placebo group. If the patient knows that he's been assigned the drug, he'll feel more hopeful and optimistic--i.e. he'll feel less depressed. Since the studies are supposed to be double-blind, the only way the patient can know this is if he gets side effects.
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