Particularly troubling is the lack of critical analysis that can be found regarding Kirsch's book. Googling for it reveals tons of links from various magazines and news sites with sensationalistic headlines, feeding into an emotion that is easy to tap, which is the discomfort many people have with the entire concept of antidepressants. "Going on antidepressants? Read this first!" that kind of thing.

As for a formally written challenge to Kirsch, I could only find this times editorial http://www.nytimes.com/2011/07/10/opinion/sunday/10antidepre... which makes the argument that someone in my position has already suspected, that the studies being cited are flawed - that it is exceedingly difficult to identify bona-fide "mildly or moderately depressed" people to participate in a study, not to mention that measuring depression is a completely subjective affair:

> Often subjects who don’t really have depression are included — and (no surprise) weeks down the road they are not depressed. People may exaggerate their symptoms to get free care or incentive payments offered in trials. Other, perfectly honest subjects participate when they are at their worst and then spontaneously return to their usual, lower, level of depression.

Without an objective means of measuring depression, measuring the effect of drugs objectively is not straightforward.

Kirsch has, like everyone else, approached this study with a definite bias, a career based on raising the prominence of the placebo affect. I'm not sure you can read a few books and declare "the truth" as case closed here, all ideas are subject to challenge. In this case I think there's a lack of interest in challenging this idea as the drug companies are obviously doing quite well (and I am no fan of drug companies) and probably don't want to raise more attention to it. It's an extraordinary claim that the millions of people who insist that SSRIs are very effective for them are being deceived en-masse, and one under-critiqued meta-study might not be enough to prove that claim.

Interesting comment on that article as well:

> "Papers showing that antidepressants work had found their way into print; unfavorable findings had not." The point is, that there are any number of ways a clinical trial can be run such that an "effective" drug will not be able to demonstrate a level of statistical significance. While there is no way you can run a clinical trial so that an "ineffective" drug will demonstrate a level of statistical significance. If you run nine clinical trials that fail to show a drug is active, and one clinical trial that shows that it is active; when presented with this kind of data, most people in the general public would wrongly conclude that the drug is not active. In fact, the correct conclusion is that the drug is active. That is why it is the job of qualified experts at the FDA, and not the public, to examine the information generated from clinical trials and pass judgment as to whether or not a drug has been proved to be "safe and effective".

If it were possible to make an ineffective drug demonstrate a level of statistical significance, then we'd have tons of studies proving the efficacy of homeopathy, wouldn't we ?