Researchers Propose Study to Test Whether Antidepressants Impede Recovery

Evolutionary theorists suggest that antidepressants interfere with the adaptive function of depression and propose a test of this theory.

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An evolutionary understanding of depression as an adaptation, called the analytical rumination hypothesis (ARH), posits that depression may have evolved to allow for sustained thinking about complex social problems. This view suggests that clinical treatments that facilitate the functions that depression evolved to facilitate will be more effective than those – such as antidepressant medications – that merely relieve distress.

Further, evolutionary theory suggests that antidepressant medications may have an iatrogenic effect that prolongs the duration of the underlying episode. In other words, by masking symptoms, ADMs might actually prolong depressive episodes, leaving them unresolved. To test this theory, Steven Hollon, Paul Andrews and their colleagues have outlined a simple research study that could test whether antidepressant medications are, in fact, iatrogenic for this reason.

Researchers have suggested that ADMs may do more harm than good. They have been criticized for a variety of reasons, including correlation with long-term disability, withdrawal problems, risks in pregnancy, and the increased risk of suicidality, especially for youth. Industry-backed studies of ADM efficacy have also been criticized for the misreporting of clinical trial results. Others have raised concerns about the reasoning behind the classification of depression as an illness requiring neurochemical modifications as opposed to, for example, social or political change.

As Hollon wrote in a previous study, “any intervention that facilitates the functions that depression evolved to serve is likely to work better in the long run than one [such as ADM] that simply anesthetizes the pain.”

According to the analytical rumination hypothesis, depression evolved to keep people focused on the source of their distress until they could come up with a solution to resolve the relevant problem. … [On this view] there is reason to believe that [ADMs] have an iatrogenic effect that prolongs the life of the underlying episode and leaves patients at elevated risk for relapse whenever taken away.

Depression is the single most prevalent diagnosed psychiatric disorder worldwide, and ADMs are the most commonly prescribed interventions for the treatment of depression. Unfortunately, ADMs appear to work only for as long as they are taken. Despite safety concerns regarding long-term usage, the American Psychological Association’s guidelines call for indefinite usage for patients with chronic depression.

The authors proffer cognitive-behavioral therapy (CBT) as an alternative method of treatment that is equally efficacious as ADMs when adequately implemented, with long-term therapeutic effects not found from the use of medications. However, the bulk of evidence for the enduring effects of CBT comes from comparisons with prior ADM use, and the extent to which ADMs are iatrogenic therefore remains unclear.

As the authors argue, based on the ARH, there is a reasonable possibility that ADMs not only interfere with CBT’s enduring effect but also have iatrogenic effects. They write:

“If the goal of analytical rumination is to arrive at a solution to whatever complex interpersonal problem first triggered the distress, then any intervention that facilitates implementing that solution should facilitate the function that analytical rumination evolved to serve… There is reason to think that adding ADM may undercut CBT’s enduring effect.”

To test this hypothesis, the authors devised a randomized trial that could determine whether ADMs prevent the enduring effect of CBT.

Previous studies have simply compared results for depressed patients using CBT versus those using only ADM. The authors’ study introduces a third experimental control group, a pill-placebo group. If CBT truly has an enduring effect, then patients who recover from depression in CBT should be less likely to experience a recurrence than patients who recover on a placebo (the nonspecific control needed to determine whether CBT is enduing or ADM iatrogenic, or both). If ADM is iatrogenic, then patients who recover on ADM should do worse than either the CBT or the pill-placebo groups.

As Hollon and his colleagues conclude:

“We know that prior CBT outperforms prior ADM, but we do not yet know why… The proposed study will answer these questions and deserves to be done.”

 

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Hollon, S., Andrews, P., Singla, D., Maslej, M., Mulsant, B. (2021). Evolutionary Theory and the treatment of depression: It is all about the squids and the sea bass. Behavior Research and Therapy 143. (Link)

14 COMMENTS

  1. “According to the analytical rumination hypothesis, depression evolved to keep people focused on the source of their distress until they could come up with a solution to resolve the relevant problem. … [On this view] there is reason to believe that [antidepressant meds] have an iatrogenic effect that prolongs the life of the underlying episode and leaves patients at elevated risk for relapse whenever taken away.”

    I’m pretty certain this is what the antidepressants have, for decades, been used for. As one who was inappropriately given an antidepressant, by a PCP, under the guise of a “safe …med,” to cover up a “bad fix” on a broken bone. Which, when abruptly taken off of it, did result in the common symptoms of antidepressant discontinuation syndrome, being misdiagnosed by multiple doctors, even according to the DSM.

    Based upon my experience and research, the psychological and psychiatric industries are the systemic malpractice and child abuse covering up factions of the medical and religious industries, according to my family’s medical records. And according to reality, their primary actual societal function is apparently covering up child abuse.

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
    https://www.madinamerica.com/2016/04/heal-for-life/

    I’m quite certain, both the psychological and psychiatric industries should get out of the child abuse covering up business, since such is illegal. Not to mention, they should get out of the illegal business of covering up easily recognized malpractice, too.

    But I have no doubt, the systemic child abuse covering up psychological industry, did likely f-ck up, by totally partnering with the “bullshit” and “invalid” DSM “bible” thumping psychiatrists. Since now even the NIMH, UN, and WHO are speaking out against their systemic crimes.

    https://www.wired.com/2010/12/ff-dsmv/
    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis
    https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=21689
    https://www.madinamerica.com/wp-content/uploads/2021/06/9789240025707-eng.pdf

    And now these “mental health” industries are handing over “conservatorship” contracts, under disingenuous guises, to attempt to cover up their co-workers’ crimes, rather than utilizing their malpractice insurance, for what it is intended. Truly, the American psychiatric and psychological industries have sunk to the lowest depths of human existence.

    Dumbf-cks, your ADHD drugs and antidepressants can create the “bipolar” symptoms. And your antipsychotics / neuroleptics can create the positive and negative symptoms of “schizophrenia,” via anticholinergic toxidrome and neuroleptic induced deficit syndrome.

    https://www.alternet.org/2010/04/are_prozac_and_other_psychiatric_drugs_causing_the_astonishing_rise_of_mental_illness_in_america/
    https://en.wikipedia.org/wiki/Toxidrome
    https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome

    In as much as I’m not a believer in the “mental health” workers “genetics” / evolution based belief system. I do know their current belief system is based upon iatrogenesis, not genetics, thus it is morally deplorable.

  2. I hate to support the work of people who so clearly do not understand the basics of their subject. But if we can find some way to cancel the use of antidepressants it would be worth it.

    To take a wild guess, I would think most severe depressive episodes are triggered by severe physical or emotional pain, or some combination of the two. And this pain would most likely be coming from a psychopath in the environment, or in some cases an environmental poison or contaminant.

    Remove the physical or psychological contamination, provide adequate nutrition and rest, and the depression should subside. Then further work can be done to handle the situation more permanently.

    To describe depression as an adaptive response consisting of “analytical rumination” is a bizarre and unnecessary complication. But if a study will demonstrate that drugs make it worse, go for it!

  3. Don’t both approaches rely on the assumption that depression comes from within? Whether from a biological cause or a learned cause, the patient is the source of the illness. But if they are not the actual source, then it seems like there will be little difference between CBT and antidepressants other than the form the dependency take – whether via medication or therapy.

    I’ve have found CBT and DBT ineffective and often counterproductive. And the way mindfulness is so often involved in these therapies is concerning, given that mindfulness is entirely inappropriate even as clinical therapy in the context of certain illnesses. It’s inappropriate because instead of facilitating a function, it fails to acknowledge that function results in a mental feedback loop.

    I’m interested to hear more about the methodologies and results if this study is ever conducted.

    • I’m not so sure, first off if you believe that mental illnesses have adaptive value (as I do) then the concept of depression starts to become problematic in the first place (it is less of an illness, let alone a disease, as opposed to a coping strategy which isn’t very effective in its current form).

      So you can still locate the source of dysfunction largely outside the client while helping them find new and different ways of conceptualizing and responding to their stressor; it’s a fine line but that’s the nature of the beast; I don’t think things ever really break down into distinct categories without interplay between them (i.e., over here is your problem, over there is you, over there is your coping strategy, etc.; they all influence each other).

      • I don’t think the most important “mental illnesses” (or whatever we want to call them) have adaptive value. I don’t believe in that line of thinking. Does a broken arm have adaptive value? Something happened and you broke your arm! Get it fixed up so it can heal! That’s how I look at the more important mental problems.

        Some behaviors that are basically normal are condemned by the truly sick as being “mental illnesses.” I think that’s where the real problem lies for most people who get diagnosed as “mentally ill.”

        But I reject the premises of “evolutionary psychology” and wish psychologists would start studying the psyche instead of finding new and creative ways to avoid studying it.

        • I think it depends on how you define adaptive, yes a broken arm is not functional but the reaction of the body (swelling, bruising, sending white blood cells to kill off potential infections are adaptive even if they don’t feel or look good [in the context of so-called mental illnesses these are the things which get called symptoms and medicated away, in the same way in which anti-pyretics reduce fever whereas fever arguably restores health by increasing the body’s temperature to the point where certain bacteria can’t survive {so that by cooling the body you might make yourself feel better but it allows the illness to continue longer than it would have}]).

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