Fava: Antidepressants in Severe Cases, Short Duration Only

Rob Wipond
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Giovanni Fava has published an integrative analysis of the different sources of scientific research into antidepressants in Psychotherapy and Somatics. “The use of antidepressant drugs exemplifies the discrepancy between different sources of information,” he writes. Discussing tolerance, efficacy, paradoxical effects, withdrawal, and effects of antidepressants on different psychological conditions, Fava ultimately argues that a rational use of antidepressants “consists in targeting their application to only the most severe and persistent cases of depression, limiting their use to the shortest possible duration and reducing their utilization in anxiety disorders…”

Fava acknowledges his recommendations “may seem to be radically different from current guidelines such as those of the American Psychiatric Association.”

Rational Use of Antidepressant Drugs, (Fava, G.A. Psychother Psychosom 2014;83:197-204
DOI:10.1159/000362803)

4 COMMENTS

  1. Does that mean they will some day stop handing these dangerous antidepressants out under the guise of “safe smoking cessation meds,” ever? Because the antidepressant withdrawal effects get misdiagnosed as “bipolar” in non- “mentally ill” people, whose desire it is to quit smoking, too.

    I think the doctors need to go back to understanding that their drugs are all poisons, and actually presume adverse reactions are the result of the drugs, rather than assuming all adverse reactions to their precious “wonder drugs” are “mental illnesses” in their patients. Especially since the current approach has resulted in doctors and their drugs becoming, at least, the third leading cause of death in the US.

    • I think there should be better regulation for the “off-label” prescriptions. It may be appropriate in some cases but it’s overused like crazy and psychiatry is the main culprit (since these drugs anyway don’t do much in terms of “treating mental illness” so they’re basically interchangeable: if SSRI doesn’t work a good doctor will write you an anti-psychotic or an anti-convulsant or whatever).

  2. I’ve just returned from a neuroscience conference and although psych drugs and “disorders” are not my professional interest I did go and take a look at research on this topic. One impression was that actually the scientific community seems to agree with the prevalent view o MIA, that is “mental illness” is caused primarily by chronic stress and trauma, especially social stress and stress experienced in childhood and adolescence. Moreover, any susceptibility alleles are tightly linked to stress response pathways and people with the “mental illness” versions can live happy and carefree life if there is no significant trauma involved.
    As for antidepressants – the only consistent biological effect I’ve seen documented is one enhancing brain plasticity – that is the process of adaptation to the environment by growing new neuronal connections, adult neurogenesis, etc. This process is not very well understood but I’ve seen a nice poster on a study on mice. It involved 4 groups of animals in which “depression” was induced by stress and then “treated” with either placebo or antidepressant of an SSRI class in either positive environment (to further recovery) or remaining stressful conditions. Results should not be very surprising: mice on antidepressants in a recovery-promoting environment did slightly better than the placebo, at least on some tests, although both groups improved as compared to stressful conditions but they did abysmally worse than placebo in the stressful environment. That would be in essence an explanation for the “paradoxical effect” – if you dump drugs on people without changing their circumstances first you’re only making them significantly worse. It must be said that the study was short term (a few weeks) as it is usually with rodents and may explain why the antidepressant may be seen as helpful for some (though it seems that simply changing environment may already “cure” you).
    So much for the basic science, apparently the clinicians didn’t get the memo…