A newly released study examines the quality of information presented on popular websites about antidepressants. The researchers, Maryanne Demasi and Peter C. Gøtzsche, found that a majority of the sites they reviewed promoted the disproven “chemical imbalance” theory of depression, and the risks and benefits presented were not consistent with the scientific evidence, as they minimized risks and overstated the benefits. The authors write:
“We found that the information about the benefits and harms of antidepressants on 39 popular websites contained information that conflicted with the scientific evidence.”
Informed consent, or being provided with information regarding the risks and benefits of a particular treatment, is crucial in the medical and mental health fields. Although the treating professional is responsible for providing this information, many prospective patients do their own research online before deciding whether to follow through with treatment. This research often impacts how the individual views or understands a particular treatment. When it comes to information about medical and mental health treatments, it is crucial that accurate information is provided online.
In an attempt to assess whether there is accurate information available online about antidepressant treatment, researchers reviewed search results related to “depression,” “antidepressants,” and “depression therapy,” on the most popular websites in ten English or Nordic-speaking countries, which included Australia, Canada, Denmark, Ireland, New Zealand, Norway, South Africa, Sweden, UK, and the USA.
Thirty-nine websites were ultimately included in the researchers’ analysis, all of which mentioned the benefits and consequences of antidepressant use. Yet, most of the sites analyzed did not accurately portray the potential costs of antidepressant treatment.
A shocking twenty-nine or 74% of websites describe depression as being caused by a “chemical imbalance,” or suggest that antidepressants are effective in repairing said imbalance. Yet, there is no research evidence to support that depression can be attributed to a chemical imbalance in the brain. The myth that depression is the result of a chemical imbalance was widely promoted by Eli Lilly, the creators of Prozac, which was one of the first most predominantly utilized medications to treat depression.
Unfortunately, although this has been disproven, the chemical imbalance myth appeared on the majority of the websites reviewed, and is also reflected in the beliefs in the general population as well – 88% of participants in an Australian study were found to believe that chemical imbalance in the brain is the cause of depression.
This misinformation is problematic as it can encourage individuals to continue taking antidepressants, as these persons are operating under the assumption that their experience of depression is something that needs to be “managed” for the rest of their lives, just like diabetes must be managed through insulin.
This idea that antidepressants are required as lifelong treatment was a claim made by some of the websites reviewed in the current study. Some suggested that antidepressants may need to be taken across a lifetime, which is particularly concerning considering there are no current research studies that provide evidence that lifetime antidepressant use is necessary. There is no good evidence even to support that patients require antidepressants for 6-9 months, which is the standard timeframe for treatment as referenced by 56% of the websites reviewed.
Moreover, contradictory evidence was found throughout the website review. One UK website, in particular, claims that antidepressants can help improve life through improving one’s mood, one’s ability to take care of oneself, improving relationships, and increasing satisfaction in sexual relations. Yet, this same website also warns that potential side effects include decreased sex drive and a potential negative impact on relationships with friends and loved ones.
In addition to contradictory evidence, the researchers found that most websites neglected to clearly outline significant risks associated with antidepressant use. Only 13% mentioned the experience of emotional numbing, or a sense of dulled emotional experience, as being attributed to antidepressant use.
Most (29) of the websites failed to mention the potential harms of antidepressants use in pregnancy or suggested that pregnant women consult with their doctor. The majority of sites (59%) did, however, mention the negative impact that antidepressant use can have on sexual functioning, such as reduced sex drive, difficulty orgasming, and erectile issues in men.
Although twenty-five websites addressed the increased risk of suicidal thoughts associated with antidepressant use, most of them (92%) presented inaccurate information related to suicidality. While the Food and Drug Administration (FDA) has warned that suicide risk is increased for individuals of all ages who are taking antidepressants, only two websites mentioned this. One site even falsely claimed that the FDA has still not yet determined if there is a relationship between suicide risk and antidepressant use.
The Mayo Clinic misleadingly suggested that antidepressants can be used as a buffer against suicide and downplayed the harms associated with suicidal and homicidal thoughts or behavior, suggesting that they aren’t as concerning as suicide. The authors write:
“One argument for softening warnings is to avoid deterring people from taking their medications. Such paternalism in lieu of honest information is common.”
In addition to downplaying suicide risk, several websites suggested that fluoxetine (Prozac) is safer than other antidepressants for use in children. However, research has challenged the effectiveness of antidepressants in children.
Others have written about how diagnoses of depression in children and adolescents increased significantly following the introduction of Prozac in 1988. Prior to this, depression was thought to be highly uncommon in children, pointing to how mental health professionals have over time, pathologized normative childhood and adolescent experiences, such as moodiness.
Moreover, the researchers found inaccurate information on the effects of antidepressant withdrawal to be present on 46% of the websites reviewed. Most sites shied away from or explicitly denied the addictive nature of antidepressants, explaining away antidepressant withdrawal as merely being the body needing to “adjust.” Yet, withdrawal reactions to selective serotonin reuptake inhibitors (SSRIs), used in the standard treatment of depression, are comparable to benzodiazepines such as Xanax.
Although all websites suggested that antidepressants are effective in treating depression, all of them failed to explain what the results of antidepressant research mean. The authors describe how the results of randomized trials, which are used to assess the effectiveness of antidepressants, might have effects so small that they are clinically insignificant, or the effects might not exist at all as the trials have not been appropriately blinded.
Antidepressant research is conducted using randomized controlled trials (RCTs) wherein some participants receive an antidepressant, whereas others receive a placebo or sugar pill. Participants must remain blind to what group they are in, as their expectations can influence the outcome of the study. However, as described elsewhere, participants were demonstrated to “break blind” or identify whether they belong to the treatment or placebo group in 78% of antidepressant RCTs in the most extensive study conducted on this matter.
Further, researchers in the current study identified that the benefits of antidepressants were highly exaggerated, claiming that antidepressants relieve symptoms of depression in more than half of individuals who take them. The authors write:
“It is misleading to write that two-thirds of the patients taking antidepressants will recover or feel better because this reflects the spontaneous remission that would have occurred in any case, also in untreated patients.”
Finally, while 95% of the websites mentioned psychotherapy as an alternative or addition to antidepressant treatment, the information on it was inconsistent. Some sites touted psychotherapy as useful, whereas others claimed that it was effective only when used alongside antidepressants.
The authors point to research evidence that psychotherapy for the treatment of depression is superior, especially long-term, in the treatment of depression. Another study provides similar evidence, demonstrating that antidepressants are not more effective than psychotherapy in depression treatment.
The researchers in this study assert that psychotherapy should be the primary treatment for depression of all severity levels, citing how psychotherapy has been shown to reduce suicide attempts. In contrast, antidepressants have been shown to increase suicide risk in individuals across the lifespan.
The results obtained by researchers bring to light the large swath of misinformation present on popular websites regarding antidepressant treatment for depression. As discussed, this is of concern as individuals interested in learning more about antidepressant medication are provided with an inaccurate portrayal of the benefits and harms associated with antidepressant use.
Demasi, M., & Gøtzsche, P. C. (2020). Presentation of benefits and harms of antidepressants on websites: A cross-sectional study. International Journal of Risk & Safety in Medicine, 1¸ 1-13. (Link)