Criticism

The effectiveness of antidepressants continues to be questioned. Their effectiveness has been shown to increase with the severity of the depression, and to reach clinical significance only in studies involving the most severely depressed, perhaps because the very severely depressed had a decreased response to the placebo effect rather than an increased response to the medication. An editorial in the BMJ drew attention to bias in the publication of studies showing antidepressant efficacy compared to unpublished studies where the data did not support efficacy. Though these unpublished studies might have suffered methodological or other problems, the article called attention to the possibility that sponsor or journal bias might have inflated or created the apparent efficacy of antidepressants over placebo. A black box warning was introduced in the United States in 2007 on SSRI and other antidepressant medications due to increased risk of suicidality in patients younger than 24 years old. While antidepressants, specifically fluoxetine (Prozac), might be effective in adolescents, they have not been found to be beneficial in children.