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The Emperor's New Drugs: Exploding the Antidepressant Myth Paperback – March 8, 2011
| Irving Kirsch (Author) Find all the books, read about the author, and more. See search results for this author |
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The Emperor's New Drugs makes an overwhelming case that what had seemed a cornerstone of psychiatric treatment is little more than a faulty consensus. But Kirsch does more than just criticize: he offers a path society can follow so that we stop popping pills and start proper treatment for depression.
- Print length241 pages
- LanguageEnglish
- PublisherBasic Books
- Publication dateMarch 8, 2011
- Grade level11 and up
- Reading age13 years and up
- Dimensions5.5 x 0.61 x 8.25 inches
- ISBN-100465022006
- ISBN-13978-0465022007
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Editorial Reviews
Review
“[Kirsch’s] case that the drugs’ benefits are due to placebo and enhanced placebo effect is fascinating and demands urgent research…Clearly, it's time for a big rethink of what constitutes mental illness and about how to treat it.”
Literary Review (UK)
“[B]rilliantly subversive… a fascinating and disturbing book.”
Kelly Lambert, PhD, Professor of Psychology, Randolph-Macon College; President, International Behavioral Neuroscience Society; Author of Lifting Depression
“Considering the crude and nonspecific therapies that have been historically available for depression, the thought of a pill acting as an effective agent against the tumultuous symptoms of this disease was appealing to everyone in the mental health industry. But, as Irving Kirsch points out in this provocative and informative treatise, The Emperor’s New Drugs, this dream ultimately turned out to be a fairy tale. There was no prince of healing to provide the promised relief for patients. Kudos to Dr. Kirsch for his impressive scientific investigative reporting described in this book, forcing our attention away from the fairy tale and toward the reality of more effective treatment strategies for depression.”
David D. Burns, author of
Feeling Good: The New Mood Therapy
“A beautifully written, profoundly important book.”
Druin Burch, author of Taking the Medicine
“A terrific account of how optimism, greed and scientific incompetence have misled us about the nature of depression and the drugs we throw at it.”
Psychology Today
“[The Emperor’s New Drugs] absolutely dismantles the case for antidepressants as a pharmacologically effective treatment.”
Publishers Weekly
“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.”
St. Petersburg Times
“Measured and laserlike in focus…The Emperor's New Drugs dismantles the case for antidepressants as a pharmacologically effective treatment.”
Charlotte Observer
“Kirsch…uses clear no-nonsense prose to marshal the extraordinary and convincing evidence needed to support his position.”
About the Author
Product details
- Publisher : Basic Books; Reprint edition (March 8, 2011)
- Language : English
- Paperback : 241 pages
- ISBN-10 : 0465022006
- ISBN-13 : 978-0465022007
- Reading age : 13 years and up
- Grade level : 11 and up
- Item Weight : 8.5 ounces
- Dimensions : 5.5 x 0.61 x 8.25 inches
- Best Sellers Rank: #187,917 in Books (See Top 100 in Books)
- #58 in Medical Psychopharmacology
- #68 in Popular Psychology Psychopharmacology
- #1,116 in Medical General Psychology
- Customer Reviews:
About the author

Irving Kirsch is Associate Director of the Program in Placebo Studies and a lecturer in medicine at the Harvard Medical School. He is also Emeritus Professor of Psychology at the Plymouth University (UK), University of Hull (UK) and the University of Connecticut (USA). He has published 10 books and more than 200 scientific journal articles and book chapters on placebo effects, antidepressants, hypnosis, and suggestion. He originated the concept of response expectancy. His 2002 meta-analysis on the efficacy of antidepressants influenced official guidelines for the treatment of depression in the United Kingdom. His 2008 meta-analysis was covered extensively in the international media and listed by the British Psychological Society as one of the “10 most controversial psychology studies ever published.” His book, The Emperor’s New Drugs: Exploding the Antidepressant Myth, has been published in English, French, Italian, Japanese, Turkish, and Polish, and was shortlisted for the prestigious Mind Book of the Year award. It was also the topic of 60 Minutes segment on CBS and a 5-page cover story in Newsweek. In 1974, Kirsch co-produced a record album titled "The Missing White House Tapes," which was nominated for a Grammy Award as Best Comedy Recording of the year.
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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. If he tells his doctor about the side effects, then the doctor will also know that he's been assigned the treatment. The doctor may have a different attitude toward the patient if he knows that he's been assigned the treatment. So the supposedly double-blind study isn't really double-blind. That's the reason why the other drugs also were effective for depression. Any drug that causes side effects will make both the patient and doctor more confident and hopeful, since the side effects make them know that the patient is receiving the actual treatment. The placebo effect, not the chemical action of the drug, treats the depression.
As part of his research project, Kirsch used the Freedom of Information Act to obtain unpublished clinical trial studies from the FDA. Combining this data with the published studies, Kirsch found that the drug effect was less than 20%. By contrast, the drug effect for pain medication is about 50%. Kirsch also found that the therapeutic effect of antidepressants, unlike most other medications, is not dose dependent. Higher doses of antidepressants produce more side effects, but don't reduce the symptoms of depression more than lower doses.
These above-mentioned results were well known by researchers, regulatory agencies, and drug companies, but not by most doctors and patients. Pharmaceutical companies have used some tricks to keep this "dirty little secret" from the general public, including:
1) Withholding negative studies from publication
2) Publishing positive studies multiple times
3) Publishing only some of the results from multi-site studies
4) Publishing data that was different from what they submitted to the FDA
Why were the drugs approved, when they show so little benefit over placebo? Regulators only require two clinical trials having positive results. Negative trials don't count. Drug companies can conduct as many trials as they want until they find two with positive results. Kirsch calls this "voodoo science." It makes things too easy for drug companies.
In the last three chapters, Kirsch discusses at length the placebo effect. Placebo effects are examples of how suggestion can change how people feel and behave. Expectancies are important in placebo effects. If people expect to get better, depending on how strong they believe this, and what kind of disorder they have, there's a chance that they will get better. Depression and pain are two disorders that respond well to placebos.
Since placebos work so well for depression, why not prescribe placebo pills to depressed patients instead of medications? Placebo pills are cheaper and don't have any side effects. Kirsch argues that this is wrong because it involves deception. A better alternative is psychotherapy, especially cognitive-behavioral therapy. Therapy is the "quintessential placebo," a treatment that utilizes the placebo effect (i.e. the relationship between therapist and client, and the client's expectancies of getting better), but does so without deception. Psychotherapy has a number of advantages over medication, including no side effects, reduced likelihood of relapse, and less long-term cost.
One problem with this book is that Kirsch seems to think that placebos will effectively treat all kinds of depression, including the more severe kinds. He acknowledges that the placebo response is reduced for the most severe types of depression. In other words, medications are more effective relative to placebos for the most severely depressed. He explains this by saying that because the severely depressed patients are more likely to have been on antidepressant medication before, and have higher dosages prescribed, they can more easily recognize whether they are on the actual drug or placebo. This will reduce the placebo effect for those assigned the sugar pill, which means that the drug effect is really a placebo effect in disguise. I don't agree with this explanation. I think that some of the severe types of depression are biologically based, not responsive to placebos, but responsive to antidepressant medication.
In conclusion, "The Emperor's New Drugs" is an excellent account of the ineffectiveness of antidepressants, written by a pioneering researcher. It makes one wonder how so many people were fooled for so long into thinking that antidepressants treated patients by correcting chemical imbalances. Its weakness is that the author doesn't distinguish between the majority of cases of mild to moderate depression in which drugs are no more effective than placebo, and the small number of biologically-based more severe cases in which placebos aren't effective, but drugs are.
Pseudoscience on full display. I was able to learn more about mental illness and myself within the first 6 months of reading books and materials online than all the Dr's. I was seeing combined. I saw the truth and I ignored it over the last 20 years seeking a pill, an easy answer, a single answer to a much simpler set of problems that I was having. I was struggling with anxiety, depression, and OCPD (official diagnosis after being institutionalized). It took 20 years, 27 drugs and one trip to an inpatient facility to get that final diagnosis, which is pointless because the treatments have never worked for me and it's all based around the same categories of drugs I have already tried. So no matter how many times the diagnosis changes I am stuck trying the same classes of drugs.
The simple answer is modern psychiatry has no answers, they don't know how it works or why it works (when it does). They have no tests to figure out what they should try etc. I have a few genes that predispose me to have anxiety, depression, and oppositional defiant disorder. None of the mutations I have are the big genes linked to depression and anxiety. I have had these test results for a decade not one Dr. would ever listen to me, no Dr. would take genetic expression into consideration evidence, tests, proof of any kind means nothing to the Dr's. I have had experiences with. It was always a new diagnosis a new explanation, I might as well have been stuck in a revolving door.
My point is not to say the drugs will not work for you, I know a few people that the drugs have helped but those people had very different life experiences from mine. My anxiety issues had been present since the age of 3-4 and I had developed OCD behaviors as coping mechanisms and developed a very rigid OCPD way of thinking as a way to control my own inner world. Because I could not control the chaos around me. The whole nature vs nurture argument, basically the drugs caused me personally to feel worse. I have the liver enzyme mutations that cause me to poorly metabolize these drugs which leads to auto-intoxication, and to akathisia induced impulsivity. In my experience the drugs made me much sicker than I actually was, I didn't need the drugs. I needed a better diet, more frequent bowel movements, exercise, friends, a significant other, a part-time job, a dog etc.
Top reviews from other countries
Great book.











