New Study Concludes that Antidepressants are “Largely Ineffective and Potentially Harmful”

Peter Simons
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A new study published in Frontiers in Psychiatry concludes that “antidepressants are largely ineffective and potentially harmful.” The researcher, Michael P. Hengartner at the Zurich University of Applied Sciences in Switzerland, conducted a thorough literature review focusing on randomized, controlled trials—the gold standard of evidence-based recommendation.

According to Hengartner, “Due to several flaws such as publication and reporting bias, unblinding of outcome assessors, concealment and recoding of serious adverse events, the efficacy of antidepressants is systematically overestimated, and harm is systematically underestimated.”

Photo Credit: Wikimedia Commons

Hengartner questioned why the “massive increase in antidepressant prescription rates over the last three decades did not translate into measurable public health benefits” in the treatment of depression. Although meta-analyses tend to find a small difference between placebo and antidepressant effect, Hengartner argues that it comes nowhere near the “clinically significant” threshold of at least 7 points on the Hamilton Depression Scale. Instead, a difference of 1 or 2 points is a meaningless numerical difference that would not be considered an improvement to a clinician or the person diagnosed with depression.

Additionally, even this small difference could be due to the side effects of antidepressants effectively unblinding researchers or research participants, which casts doubt on the conclusions of any study that does not use an active placebo.

Further, Hengartner argues that “Naturalistic long-term studies suggest that maintenance therapy has no clear benefit, and non-drug users do not show increased recurrence rates.” That is, there is no benefit to continuing antidepressant use. The research demonstrates that those who discontinue the medication are not at higher risk of relapse than those who continue.

In fact, Hengartner cites evidence that likelihood of relapse is correlated with duration of treatment. That is, the more one takes an antidepressant, the likelier one is to have another episode of depression. Hengartner writes that neurochemical sensitization could make someone who takes antidepressants more susceptible to relapse. He cites the STAR*D trial, which is usually cited as evidence of antidepressant efficacy. At 12-month follow-up, he writes, “only 5.8% of all patients who entered continuation therapy were still in remission.” That is, almost every single patient on medication had relapsed within a year.

Hengartner also questions financial conflicts of interest and the bias of industry-supported research.

“The estimated efficacy of pharmaceutical products is significantly higher when the research was funded by the industry compared to non-industry funding, but this difference is not attributable to differences in the study quality.”

According to Hengartner, research funded by the National Institute of Mental Health found no differences between antidepressant efficacy and placebo—and this was despite robust research design using randomized controlled trials, the gold-standard method. Hengartner calls attention to industry-supported research biases in which trials that showed no effect were never published and studies that inaccurately described negative findings as positive. He also notes that harms are systematically not reported or underreported in industry-supported publications.

Regarding harms, Hengartner writes:

“A growing body of evidence from hundreds of randomized controlled trials suggests that antidepressants cause suicidality, but this risk is underestimated because data from industry-funded trials are systematically flawed. Unselected, population-wide observational studies indicate that depressive patients who use antidepressants are at an increased risk of suicide and that they have a higher rate of all-cause mortality than matched controls.”

Also, antidepressants increase the risk of death from other sources as well. Hengartner writes that “In a study with over 60,000 patients with MD aged 65 years and older, it was shown that over a mean follow-up of 5.0 years, prescription of tricyclics increase the relative mortality rate by 16%, SSRI by 54%, and other antidepressants (mostly SNRI) by 66%.”

Hengartner concludes that “As concerns treatment recommendations, my reading of the literature is that some patients may benefit from acute pharmacotherapy, but on average clinical benefits are debatable and should be weighed against adverse side effects. Continuation and maintenance therapy is not recommended due to an apparent lack of clear clinical benefits, coupled with a possibly increased vulnerability to chronic depression, increased suicide risk, and, in particular in older adults, higher all-cause mortality.”

 

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Hengartner, M. P. (2017). Methodological flaws, conflicts of interest, and scientific fallacies: Implications for the evaluation of antidepressants’ efficacy and harm. Frontiers in Psychiatry, 8(275). https://doi.org/10.3389/fpsyt.2017.00275 (Link)

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Peter Simons
MIA-UMB News Team: Peter Simons comes from a background in the humanities where he studied English, philosophy, and art. Now working on his PhD in Counseling Psychology, his recent research has focused on conflicts of interest in the psychopharmaceutical research literature, the use of antipsychotic medications in the treatment of depression, and the general philosophical and sociopolitical implications of psychiatric taxonomy in diagnosis and treatment.

6 COMMENTS

  1. Thank you Peter,

    I was prescribed “antidepresssants” in the 1980 s. Emotionally:- going on them made no difference, being on them made no difference, and coming off them made no difference.

    I wasn’t clinically depressed to begin with, but I did suffer “Melancholy”. My happiness levels improved a lot with the practice of Buddhist Breathing Meditation, and I suffer from very little melancholy now.

  2. Do you mean to say that antidepressants don’t “unmask bipolar?” Millions of people have already had “bipolar unmasked” with the antidepressants, including hundreds of thousands of children. Despite the fact this is a blatant misdiagnosis, even according to the DSM:

    “Note: Manic-like episodes that are clearly caused by somatic antidepressant
    treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count
    toward a diagnosis of Bipolar I Disorder.”

    And adding the antipsychotics to “cure” that completely iatrogenic form of “bipolar” can make people “psychotic,” via anticholinergic toxidrome poisoning, which is conveniently missing from the DSM.

    https://en.wikipedia.org/wiki/Toxidrome

    What a great business model, psychiatry. But can you say, “We have less than zero ethics.” “We use our medical training to intentionally harm people, instead of help them, after promising to ‘first and foremost do no harm.'” Which makes you hypocrites of the highest order. Can you say, “Our primary actual function on this planet today is aiding, abetting, and empowering pedophiles, by turning millions of child abuse victims into the ‘mentally ill’ with our psychiatric drugs.”

    https://www.madinamerica.com/2016/04/heal-for-life/

    Definitely, the antidepressants are “Potentially Harmful.”

  3. These articles are becoming more frequent which is nice to see. I’ve been diagnosed with Neurotoxicity because of Lexapro. I’m permanently disabled after an adverse reaction. It took two years to find a doctor to admit it. Now I can qualify for disability to support my family. My hope is to see them banned one day. Doctors need to also stand behind their patients not betray them.

  4. I believe I have Malabsorption Syndrome after more than 20 years on SSRI’s. I seem to have all the symptoms.

    My doctor notes things like heart arrhythmia, digestive problems, etc. but is close-mouthed when I ask her why these things are happening. This makes me very cynical of the medical profession as a whole.

    And you thought lawyers were a dishonest bunch!