A couple of attempts to defend SSRIs. First an editorial from The Times:
What is not warranted is a rush to judgment that these drugs are no good: policymakers and doctors should have sharply in mind that the people most likely to say that pills are pointless are the people who most need them.
Huh? Is this supposed to be a serious argument?
The answer reveals a key flaw of randomized clinical trials and meta-analyses: when you are looking at aggregated data, huge individual differences can be washed out. For example, let’s imagine a drug that causes people with one genetic variation to have a profound positive effect– but causes those with another to get dramatically worse and has little effect on everyone else.
Some people are strong responders to one drug– but give them another in the same class, and they become actively suicidal. Most people have a slight positive effect; some have a slight negative effect. In aggregate, a drug that is a home run for one person and potentially fatal to another looks inert.
This question isn’t whether these drugs are of any value. The relevant questions include whether, based on the evidence, there should be 40 million people on Prozac? Should 4.5 million people have been on it in the drug’s first 5 years? Has acceptance outpaced the evidence? If the evidence for widespread use does not exist, how did we get here? Should it be a first line treatment, especially in light of our growing understanding of the withdrawal syndromes that these drugs can cause? Who are they effective for? Are there older (and cheaper) drugs that are more effective? Are there other treatments that are more effective? How can we reduce profit motives for overstating the effectiveness of drugs like this? How can we mitigate the influence of professional biases in what treatments are adopted as evidence-based?