The medicalised context of bereavement
The medicalised context of bereavement

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The medicalised context of bereavement

4.3 How effective are antidepressants in general?

Despite the rapidly expanding use of antidepressants, to date there is very little evidence that they are effective for the treatment of bereavement or in mild to moderate types of depression. Recent meta-analyses (a technique for combining the results of a number of studies) reported by Joanna Moncrieff and Irving Kirsh, a British psychiatrist and psychologist respectively, show that selective serotonin re-uptake inhibitors (SSRIs), such as paroxetine (Seroxat) and fluoxetine (Prozac), have no clinically meaningful advantage over placebo tablets (Moncrieff and Kirsch, 2005). They similarly found little evidence in support of the claim that these drugs are effective in more severe types of depression. Findings that appear to show a positive effect for antidepressant medication when compared with a placebo are probably therefore the result of methodological defects in the research.

Supporting these arguments, Canadian psychiatrist Corrado Barbui made an analysis of unpublished as well as published research, and concluded that SSRI antidepressant medication is not superior to placebos (Barbui et al., 2008). Indeed, for paroxetine, complete analysis of unpublished and published research demonstrated that the use of this medication is associated with a significant increase in the risk of suicide. Recent analysis by Irish psychiatrist and researcher David Healy and colleagues has also linked modern antidepressant use to increases in violent behaviours (Healy et al., 2006).

So how do antidepressant drugs compare in effectiveness with other possible types of treatment for bereaved people? The evidence, at the time of writing in 2008, does not look wholly convincing. Charles Reynolds, an American psychiatrist (Reynolds et al., 1999), conducted a placebo-controlled trial that compared antidepressant drug treatment with interpersonal psychotherapy for bereaved people. Although the drugs were shown to reduce some of the symptoms of depression, they had no effect on the intensity of the grief experienced by the bereaved people in the trial.

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