Charles Medawar - Do antidepressants Work?

Charles Medawar, has this great paper on antidepressants that can be downloaded here.

"There are no conclusions in this paper, but something of a hypothesis emerges from it: "depression" is fast developing as an iatrogenic disease and that, however much they are part of the solution, antidepressant drugs seem much more implicated in the problem of depression than is supposed. Moreover, the public's opinion that antidepressants are drugs of dependence seems much closer to the reality than the exactly opposite orthodox view." (emphasis mine)

"The long-term efficacy of benzodiazepines proved largely an illusion, but only after more than 20 years of extensive use. The reason most people stayed on these drugs turned out to be they couldn't readily stop taking them. They had become dependent on them, in rather the same way that people get dependent on alcohol: usually very subtly and sometimes to disastrous effect. It is a long, sad story, perhaps not over yet."

"If history were to be repeating itself, it would be both because and in spite of authoritative denials that any risk is involved. If antidepressants were in some sense drugs of dependence, but not recognised as such, it would increase the element of risk and lead naturally to an over-estimation of their effectiveness as well"

"The greatest mistakes are probably made not because doctors don't know enough, but because too often they behave as if they do." Lewis Thomas (1979) [Medawar, 1996].

Source:
Medawar C: The Antidepressant Web - Marketing depression and making medicines work, International Journal of Risk & Safety in Medicine, 1997, 10, 2, 75-126