No Good Evidence That Antidepressants Prevent Relapse

Trials of antidepressants for relapse prevention are confounded by withdrawal effects caused by the drugs.

Peter Simons
15
1382

Despite evidence that the long-term use of antidepressants leads to worsening outcomes, many people continue to be prescribed the drugs for years, or even decades. One argument for long-term use of antidepressants is that even if the person taking them no longer meets the criteria for depression, the drugs may prevent relapse and the return of depressive experiences.

Now a new research article questions whether antidepressants actually prevent relapse. The evidence for relapse prevention is based on flawed data from biased trials. Real-world data shows that antidepressants do not seem to have this relapse-preventing effect.

The article was written by Michael P. Hengartner at Zurich University of Applied Sciences (ZHAW) and published in Therapeutic Advances in Psychopharmacology. Hengartner writes:

“Currently, there is no reliable evidence that long-term antidepressant treatment is beneficial and there are legitimate concerns that it may be largely ineffective or even harmful in a substantial portion of users.”

According to Hengartner, the argument that antidepressants are useful for preventing relapse comes “almost exclusively” from “discontinuation trials.” In these studies, people who respond well to antidepressants are randomly assigned to two groups: one group remains on the drug, and the other abruptly stop taking the drug.

Given the high likelihood of drug withdrawal reactions from antidepressants (which has been recently noted in the UK’s NICE guidelines on antidepressant use), people who abruptly discontinue the drug are likely to experience negative effects. The researchers in these studies then assume that these negative effects are a return of the supposed “underlying” depression, rather than drug withdrawal symptoms.

These studies do consistently demonstrate that continuing to take antidepressants is effective in preventing drug withdrawal. However, according to Hengartner, they provide no actual information about relapse, which is a different beast altogether.

“There is substantial withdrawal confounding in discontinuation trials, which renders their findings uninterpretable,” Hengartner writes.

Hengartner is not the first researcher to point out that withdrawal symptoms consistently bias the relapse-prevention literature.

On the other hand, there are large real-world studies (rather than small randomized controlled trials), such as the oft-cited STAR*D trial. According to Hengartner, these studies have not shown any indication that antidepressants are effective at relapse prevention.

In fact, in the STAR*D trial, only 6% of the participants taking antidepressants did not relapse by the end of the study—making it difficult to see how the drugs could be said to “prevent” relapse. Hengartner writes:

“To enable a thorough risk-benefit evaluation, real-world effectiveness trials should not only focus on relapse prevention but also assess antidepressants’ long-term effects on social functioning and quality of life. Thus far, reliable long-term data on these outcome domains are lacking.”

 

 

****

Hengartner, M. P. (2020). How effective are antidepressants for depression over the long term? A critical review of relapse prevention trials and the issue of withdrawal confounding. Therapeutic Advances in Psychopharmacology, 10, 1-10. (Link)

15 COMMENTS

  1. This merely demonstrates the kind of fumbling you get when you mistake a syndrome for an actual disease. Since there can be a variety of causes for “depression”, it would be foolish to presume a “one treatment fits all” approach to have much, if any value. It would be as foolish as believing that one hat size fits all or that one waist size will create pants that fit everyone (creating amusement for the spectator, but embarrassment for most wearers).

  2. Yes of course.
    They do endless research, which we of course by now know it is not “research”, but simply pretension to keep the idea of “mental illness” alive.
    I don’t think people realize the extent to which the practice that USED to be actual medical, has adopted psychiatry. It is really all the same practice now. It is what people and organizations do, mostly use each other, even if not intentionally aware of it.

    Words are created, adopted and twisted to suit. The new words, the new language all has an end point. Keep that idea alive.

    Allostatic load. New term and around it, swirls the brain theories.
    Yes, always a segment of truths and possibilities is how they keep the falsities alive.
    It’s nothing new in fact.

    The interesting thing is, when they do their rat studies, creating depressed and self injuring rats, they NEVER cure them with chemicals.
    In allostatic overload, they provided them with an “emotionally enriched environment”, and the rats behaviour and health improved.
    They also mention the effect that a feeling of safety, and not minimizing people has on health, yet these fixes are NEVER applied.

    So in one sentence they completely nullify their practice, but the next sentence brings it right back to the false paradigm. Why? just because they can.

    It’s kind of like a child singing, nana nana boo boo, we are the boss, we get the power.

    And it’s true, they do hold the ultimate power. It is not about science, so proving them wrong does nothing.
    It is illuminating that they exist by power and need.
    How they mete out their assistance is the most illuminating. I doubt anyone can justify how they are allowed to wield their power, and so we must blame politicians. Those who populated the lands with force, by force, just because they could.

  3. In the middle ages an elixir was discovered in Ireland and Scotland and it became known as the “Water of Life” or “Uisce Beatha”.

    It gave pleasure and happiness and friendliness to people who consumed it, and it also had medicinal qualities.

    But most reasonable people were aware that it should be used very carefully, as too much of it could cause harm.

    The “potion” was known for short as “Uisce”, and in English the pronunciation became “Whisky”.

    • According to the Big Book of Alcoholics Anonymous:- the end of the line for an Alcoholic comes when he can’t live with alcohol and he can’t live without it. This is known as the “Jumping off Point”, when the alcoholic feels life is no longer worth living. But if the hopeless Alcoholic is lucky his new life is just about to begin.

      Euthanasia or Government Sponsored Suicide is now available for lots of European people, even young physically fit adults who have now arrived at the “end of the line” with “Mental Illness”, Trauma, Depression Antidepressants (and other psychotropics). But it is very possible to turn this corner.

  4. “Thus far, reliable long-term data on these outcome domains are lacking.” It’s pretty sad there’s no reliable long term data on a drug class that’s been being handed out like candy, and fraudulently under the guise of “safe…meds,” for decades.

    I’m quite certain the psychologists and psychiatrists should stop lying to their clients, claiming they “know everything about the meds,” given the fact they know very little about the common adverse and withdrawal effects of the drugs they prescribe.

    For goodness sakes, the “mental health” workers didn’t even know that antidepressant withdrawal created “brain zaps” or “brain shivers,” until after the patients pointed it out 3100 times on the internet.

    https://www.researchgate.net/publication/247806326_'Brain_shivers'_From_chat_room_to_clinic

    And they’ve been systemically misdiagnosing the common adverse and withdrawal effects of the antidepressants as “bipolar” in millions of people, including over a million children, for decades.

    https://www.alternet.org/2010/04/are_prozac_and_other_psychiatric_drugs_causing_the_astonishing_rise_of_mental_illness_in_america/

    And no doubt, this massive in societal scale malpractice will only get worse, since the psychiatrists took this DSM-IV disclaimer out of their DSM5 in 2013.

    “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.”

    It’s truly a shame that the goal of the psychiatrists and psychologists is to intentionally harm their clients, with the psych drugs, for profit. But when your primary actual societal function is covering up child abuse, which is illegal. But covering up child abuse and rape is the primary actual societal function of both the psychologists and psychiatrists, and it’s by DSM design.

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
    https://www.madinamerica.com/2016/04/heal-for-life/
    https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

    You’re looking at a completely corrupted, and downright criminal, “mental health” system.

    • Lack of long-term outcome data means you have no idea if your “treatment” is actually effective. Which means from a purely scientific viewpoint, your “treatment” is not legitimate. We assume something doesn’t work until proven that it does, not the other way around. That’s how science is supposed to work. Anything else is marketing.

      • Lack of long-term outcome data means you have no idea what the “treatment” is likely to do to you and your brain!

        “….Anatomy of an Epidemic gives facts and figures on the astonishing rise in social security disability cases due to mental illness. Whitaker makes a comparison between the advent of Prozac in 1987 and the subsequent 37-fold increase in disability cases…”

        Most of these people (the “mentally” disabled) will die in treatment.

  5. If someone said alcohol was safe and effective and should be consumed all day because alcoholics taken off alcohol do worse (some can even die from the withdrawal) they’d be laughed at. Yet that is the same exact argument used for psychiatric drugs.
    Psychiatrists lie to people to get them addicted to drugs. They then use the withdrawal which is a harm caused by the drug as a reason to keep people addicted to the drugs. They even force people to get addicted to their drugs. The drug cartels are amateurs.

LEAVE A REPLY