Are SSRI‘s Superior to Placebo for Mild to Moderate Depression? A Critical Evaluation of Some Research Articles

Abstract

In the pharmacologic treatment of depression, the introduction of selective serotonin reuptake inhibitors (SSRI s) has been advantageous in that they have less adverse effects than older classes of

antidepressants. It has been commonly concluded in studies and review articles alike that SSRI‘s have similar efficacy as tricyclic antidepressants (TCA's) such as imipramine, and that both classes of drugs are superior to placebo. Because of large placebo effects and various methodological issues regarding clinical trials, the present paper will critically assess three representative studies of SSRI efficacy versus placebo. Areas of focus include evaluation of study design and bias, execution of the studies, and the interpretation that was offered in each paper. It will be concluded that SSRI‘s are useful in severe depression. However, strongly designed studies of efficacy in mild and moderate depression are lacking, and the studies that do exist show zero or very slight advantages of pharmacologic treatment over placebo. Some serious adverse reactions such as anorgasmia, definitely offset these modest benefits in many patients with major depression of a mild to moderate severity.