Kirsch Irving
Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Z Psychol. 2014;222(3):128-134. doi: 10.1027/2151-2604/a000176.
Antidepressants are supposed to work by fixing a chemical imbalance, specifically, a lack of serotonin in the brain. Indeed, their supposed effectiveness is the primary evidence for the chemical imbalance theory. But analyses of the published data and the unpublished data that were hidden by drug companies reveals that most (if not all) of the benefits are due to the placebo effect. Some antidepressants increase serotonin levels, some decrease it, and some have no effect at all on serotonin. Nevertheless, they all show the same therapeutic benefit. Even the small statistical difference between antidepressants and placebos may be an enhanced placebo effect, due to the fact that most patients and doctors in clinical trials successfully break blind. The serotonin theory is as close as any theory in the history of science to having been proved wrong. Instead of curing depression, popular antidepressants may induce a biological vulnerability making people more likely to become depressed in the future.
抗抑郁药被认为是通过纠正化学失衡来发挥作用的，具体来说，是纠正大脑中血清素的缺乏。事实上，它们所谓的有效性是化学失衡理论的主要证据。但是，对已发表数据以及制药公司隐藏的未发表数据的分析表明，大部分（如果不是全部）益处都归因于安慰剂效应。一些抗抑郁药会提高血清素水平，一些会降低血清素水平，还有一些对血清素根本没有影响。然而，它们都显示出相同的治疗效果。即使抗抑郁药和安慰剂之间微小的统计学差异，也可能是增强的安慰剂效应，因为在临床试验中，大多数患者和医生都成功地打破了盲法。血清素理论几乎是科学史上最接近被证明错误的理论。流行的抗抑郁药非但不能治愈抑郁症，反而可能引发一种生物学上的易感性，使人们未来更易患上抑郁症。
