Antidepressant Use Leads to Worse Long Term Outcomes, Study Finds

Results from a 30-year prospective study demonstrated worse outcomes for people who took antidepressants, even after controlling for gender, education level, marriage, baseline severity, other affective disorders, suicidality, and family history of depression.

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A new study by Michael P. Hengartner, Jules Angst, and Wulf Rossler found that those who took antidepressants were more likely to have worse depression symptoms after 30 years. This finding was independent of illness severity as well as a large number of other potential confounding factors.

The authors, from Zurich University of Applied Sciences and the University of Zurich, published their findings online this month in the journal Psychotherapy and Psychosomatics. The study followed 591 Swiss adults from the age of 20/21 until they were 49/50 years old. Antidepressant use at some point in the study was associated with worse depression symptoms at the end of the study—even when controlling for initial symptoms and other factors.

“These findings are in line with a growing body of evidence from several naturalistic observational studies suggesting that (long-term) antidepressant use may produce a poor long-term outcome in people with depression,” Hengartner writes.

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The evidence that antidepressants worsen long-term outcomes mostly comes from research that charts real-world outcomes. For instance, a one-year study in a community sample found that only 5% enjoyed a “sustained remission,” which is a much lower remission rate than is typically found in studies of unmedicated depressed patients. Similarly, in the large STAR*D trial, only 108 of the 4041 (3%) patients who entered the study remitted and then stayed well during the one-year followup. All of the others either never remitted, relapsed, or dropped out of the study. Another study in real-world patients published last year found that antidepressant use was associated with worse outcomes after 9 years.

The prevailing theory on why antidepressants might make depression worse is receptor sensitization—the idea that long-term use modifies the ways that neuroreceptors work, causing the medication to become ineffective, and potentially making people vulnerable to worsening depression.

This new contribution to the literature presents the results of 591 adults in a community sample. The participants were assessed by trained psychologists and psychiatrists with a semi-structured interview. Assessments began in 1979 (baseline assessment) when participants were all 20-21 years old, and assessments were conducted again in 1981, 1986, 1988, 1993, 1999, and finally in 2008 (when they were 49-50 years old). At each assessment, the primary outcome was the severity of depressive symptoms within the previous year. Also at each assessment, participants reported whether they had been prescribed antidepressants within the previous year.

In order to create their predictive model, the authors tested whether being prescribed antidepressants at one assessment (e.g. 1988) increased the likelihood of more severe depressive symptoms at the next time point (e.g. 1993). The authors stratified the participants into several groups: no depressive symptoms; few depressive symptoms that did not last for more than 2 weeks; “subthreshold” depression that did not quite reach diagnostic criteria; and major depression as defined by meeting criteria as specified in the Diagnostic and Statistical Manual (DSM).

Averaged across time-points, 6% of those with few depressive symptoms were taking antidepressants; 7% of those with “subthreshold” symptoms were taking antidepressants, and 22% of those with major depression were taking antidepressants.

After controlling for numerous factors—including gender, education level, marital status, any affective disorder at baseline, suicidality at baseline, family history of depression, subjective distress, childhood adversity, and low parental income—the researchers found that antidepressant use was associated with an 81% increased likelihood of depression severity increase. For example, this means that people who had “subthreshold” depression but took an antidepressant were 81% more likely to worsen to major depressive disorder than those who had “subthreshold” symptoms but did not take an antidepressant.

Because the researchers in the current study could not randomize people to antidepressants or a control group, this limits causal conclusions. There is always the possibility that some other factor accounted for the poor long-term effect that the researchers found, e.g. some trait shared by people who sought medication that led to worse outcomes. However, when the researchers controlled for all the usual risk factors—such as depression severity, subjective distress, baseline symptoms, demographic traits (e.g. gender, education level) and even childhood adversity—they still found that antidepressant use was associated with a worse long-term outcome.

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Hengartner, M. P., Angst, J., & Rössler, W. (2018). Antidepressant use prospectively relates to a poorer long-term outcome of depression: Results from a prospective community cohort study over 30 years. Psychotherapy and Psychosomatics. doi: 10.1159/000488802 (Link)

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Peter Simons
Peter Simons
Peter Simons was an academic researcher in psychology. Now, as a science writer, he tries to provide the layperson with a view into the sometimes inscrutable world of psychiatric research. As an editor for blogs and personal stories at Mad in America, he prizes the accounts of those with lived experience of the psychiatric system and shares alternatives to the biomedical model.
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32 COMMENTS

  1. It certainly does. The ultimate outcome can be longterm psychiatric illness, or “invisible” death through suicide.

    What this study indicates, is that exposure to Psychiatric Drugs creates longterm mental illness even in well people.

    This can be seen with drugs like Valium, that create anxiety conditions in well people. But with other drugs like antidepressants and *neuroleptics the development has been medically denied.

    *(Neuroleptic Dopamine Supersensitivity Syndrome leading to longterm dependency and organic psychosis).

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  2. The solution for large scale discontent and unhappiness is not a pill.

    Duh!

    I imagine, in part, that it must be the atomistic nature of a society fostered by corporate capitalism that has produced this kind of miasma. Blame the individual, and nobody is going to be able to see the forest for the trees.

    I wonder about these people who get into the therapist business. Thirty, forty, fifty years of listening to the same people describe how poorly they feel? Okay, here’s a pill. It won’t make you feel any better, but it might make you feel better about not feeling any better. After all, if life were smooth sailing for you, I’d be up against the reefs of unemployment and impoverishment, or. at least. a imminent career change, and facing a pretty depressing situation myself. As is, I have got this job as a professional “healer” so long as I don’t actually “heal” anybody, and an increasing number of bodies (according to the WHO) at that.

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  3. The pros and cons of my external world have been more or less the same for the past 40 years. The only thing that’s “changed for the better” has been what goes on inside my head.

    So conceivably a therapist could help “improve a person’s happiness” (through “psychotherapy”).

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    • I would put it that a person could USE a competent therapist as a catalyst to improve his/her OWN happiness. The operative word here is “competent”. I was fortunate enough to hit upon a very competent therapist in my 20s and was much the better for the experience. However, the number of therapists who actually know how to play that “catalyst” role (who were never in the majority even back in 1980) appears to have decreased dramatically since the introduction of the DSM III and the push for biological explanations. More and more appear to have become handmaidens of the psychiatric industry, and such “therapists” are more than dangerous, as they not only harm the individual but give the idea that there is no real help out there except for drugging up your brain.

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    • So could a life coach. Or anyone who actually cared. (Not all Certified therapists do.)

      Tony Robbins swears he’s stopped people from committing suicide. Someone was angry at his heresy, saying that only “mentally ill” people thought of suicide. And the only way to prevent this was to lock them up, stigmatize them, and damage their brains with drugs and shocks.

      My guess is Robbins is better medicine than a shrink any day. If I’m depressed again, I’ll listen to his free motivational pap instead of telling a shrink or any legitimate medical professional. Beats a trip to the psychiatric jail!

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      • I was prescribed antidepressants for a number of years. They made no difference at all to me emotionally.

        I wasn’t clinically depressed – the antidepressants came with a mood disorder diagnosis, to explain my suicidal tendencies (which stopped when the long acting neuroleptic injection stopped).

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  4. How many more studies like this will it take before reality undermines the psychiatric myth of the ‘chemical cure?’ This looks like as well-controlled a naturalistic study as could possibly be arranged, and it comports with the data from every other naturalistic study on the subject already published. How many does it take before the industry is held accountable for promoting ineffective and destructive “solutions” that don’t even identify the real problem, let alone solve it?

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    • The psychiatric drugs are given to people to make people ungodly ill, in order to distract people from their real life concerns, such as easily recognized malpractice or medical evidence of child abuse. The antidepressants are called such because they created depressive symptoms (and worse), and the antipsychotics are called such because they create psychosis (via anticholinergic toxidrome, and worse).

      Today’s “mental health” industry is one gigantic, fraud based, primarily child abuse covering up, multibillion dollar, iatrogenic illness creation system. Historically and today, covering up child abuse has always been, and still is, the primary function of both the psychologists and psychiatrists.

      https://en.wikipedia.org/wiki/The_Freudian_Coverup
      https://www.madinamerica.com/2016/04/heal-for-life/

      Despite the fact that both the psychologists and psychiatrists are mandatory reporters of child abuse. The psychologists and psychiatrists break the mandatory reporter law on a regular basis. Given the reality that over 80% of those mislabeled as “depressed,” “anxious,” bipolar,” or “schizophrenic” are child abuse victims. And over 90% of those mislabeled as “borderline” are child abuse victims. And all this psychiatric and psychological misdiagnosis of child abuse victims, is by design.

      No “mental health professional” may EVER bill ANY health insurance company for helping ANY child abuse victim EVER. Unless they first misdiagnose the child abuse victim with one of the other billable DSM disorders, which they always do, since they want to be paid. Today, child abuse is classified in the DSM as a “V Code,” and the “V Codes” are NOT reimbursable by the insurance companies.

      https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

      Our society should really be asking ourselves whether our society as a whole is actually benefitted by having fraud based “mental health” industries, whose primary actual function within our society is, and has always been, covering up child abuse. Which, of course, also functions as a paternalistic, pedophile protection and empowerment system.

      Personally, I know our society as a whole would be better off if we got rid of these criminal child abuse covering up industries, and started arresting the child molesters instead. As our laws actually state should be done.

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    • I was sitting here asking myself the very same question. I suspect that the general public doesn’t see most of these studies and instead get their information from those damned web sites that the drug companies control. I was in a small meeting with some of the administration people where I work and made the statement that there is no such thing as a chemical imbalance. One of the administrators stated that they didn’t think any of the doctors in the “hospital” believed that anymore. I then asked that if this is true, if the doctors no longer believe in chemical imbalances, why do all of the so-called doctors still keep drugging people with the drugs that supposedly correct chemical imbalances? All I got was stares and no reply. So they know the truth but they do nothing to change anything.

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    • Totally. I wonder this myself all the time. The evidence is there, that isn’t the problem. The problem is that the evidence being there doesn’t seem to affect clinical practice, and therefore doesn’t seem to ever trickle down to “everyday people.”

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      • Sadly, it could take many more studies, but maybe not if the information is shared in many ways, including social media. For my part, will do my share on the facebook pages I run for the french speaking community. Cultural and, ultimately, political change is often a long run, or marathon, in the face of economic forces that resist as long as many dollars are involved. Just consider how long it took to counter the cigarette lobbys, gun sellers, pesticide etc. But let’s not sink into apathy and helplessness. After all, most here are not on antidepressants (or, any more) !

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    • But Steve, people don’t want reality. We need “mental illness” because it gives us the hope of happiness in a bottle. Plus it explains bizarre, evil behavior away as a diagnosis allowing “doctors” to prevent crimes before they happen. Just like Tom Cruze in The Minority Report. 😀

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  5. Long-term efficacy studies are the ultimate weapon against psychiatry. Indeed, the side effects are easy to prove; so if the drugs are not effective, consumers ask themselves: “all this for nothing?”

    And we can answer them:

    “Not quite for nothing: your condition has become much worse, and some people have gained a lot of money thanks to you. So, everyone was not losing.”

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  6. KANYE IS NOW TAKING “MEDICATIONS”: While the fuss has been over his rambling rants about slavery, lost in the furor have been the interviews in which Kanye West is heard talking about having a “nervous breakthrough” which is being assisted by unspecified “medications” (this after having detoxed from opioids). He thinks he’s doing better than ever. Someone needs to warn him what he could be in for. Even Dr. Oz has expressed concern about this, having recently hosted two shows featuring discussions of “antidepressant” fueled violence and suicidality.

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  7. Pretty compelling even thought the findings are correlational and thus, inconclusive in terms of causality. But still, this study challenges the medical community with a possibility that goes contrary to the common belief that antidepressants may have to be taken for life. This is not trivial but very critical. Doctors, psychiatrists, pharmacists and all other healers involved in prescribing will eventually have to face the fact that they could be doing harm. If more studies keep pointing in the same direction, it will gradually lead to a major change in prescribing habits. The prescriber will eventually have to “guess” on the best time frame for antidepressant use and also at what point the symptoms are either induced or not. That will be a very hard riddle … But then, by shifting the liability of prescribers in the direction of having to be prudent, they will have to change. I’m am very happy to see such research, independent of the industry and of a (very) long term prospective nature.

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  8. For what it’s worth I took a “bipolar” test. My score was 7. According to the site I need to get checked since I have some of the “symptoms” of depression. How about if I don’t and say I did?

    Frankly I don’t feel that unhappy. Just physically sick. Developed a bad case of candida with mouth moss, really bad psoriasis, and itching all over. Wish Bcharis would offer some advice. Keep having this problem since my Effexor went below 75 mg or half the original dose.

    Btw, if “depression” were a brain disease as shrinks claim–unhappiness itself would be a symptom of the disorder. Not the other way around.

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  9. This looked like the best current thread to report this in: I saw a Parkland student (I think) talking about “mentally ill” students TAKING MEDICATIONS and having access to guns. The message I think I was hearing was that “medications” were being implied to be the problem more than the “mental illness.” It sounds like the word on psych drugs & violence may be trickling out, though not yet in a well-informed way. Keep our fingers crossed.

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