By Robert Whitaker
August 13, 2022
Source: Mad in America
Photo / Image Source: Unsplash,
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Such is the risk-benefit equation that emerges from studies of real-world patients. Perhaps 25% will respond to an antidepressant, and perhaps 15% or so respond to treatment and stay well. There is also reason to believe that the one-year recovery rate for untreated patients is much higher than that.
Long-term outcomes
The industry-funded trials provide a risk-benefit equation at the end of six weeks on the drug. The clinical studies in real-world patients provide information about the percentage of people diagnosed with major depression who, at some point during studies of longer duration (typically six months to a year), will respond to an antidepressant and still be well at the end of the study. The third question that needs to be assessed is this: How do patients treated with antidepressants fare over longer periods of time—two years or more?
This question harkens back to the same one that arises in the clinical studies of one year in length: what is the natural long-term course of the illness? For an antidepressant to be effective over the long term, it would need to improve on that natural recovery rate.
Unfortunately, there is abundant evidence that antidepressants, on the whole, increase the risk that a person will become chronically depressed and functionally impaired. I reviewed that collection of evidence in Anatomy of An Epidemic; a summary of that research can be found here on Mad in America.
In the mid 1990s, Italian psychiatrist Giovanni Fava raised this concern in a series of papers. He wrote:
“Antidepressant drugs in depression might be beneficial in the short term, but worsen the progression of the disease in the long term, by increasing the biochemical vulnerability to depression . . . Use of antidepressant drugs may propel the illness to a more malignant and treatment unresponsive course.”
In his articles on this topic, Fava noted that antidepressants induce changes in the serotonin system the opposite of their intended effect, and reasoned that this might be the mechanism that “sensitized” the brain to depression.
In 2012, American psychiatrist Rif El-Mallakh, an expert in mood disorders, concluded that SSRIs could induce a chronic “tardive dysphoria.” He noted that up to 40% of patients initially treated with an antidepressant end up “treatment resistant,” and up to 80% maintained on the drugs suffer a recurrence of symptoms.
“A chronic and treatment-resistant depressive state is proposed to occur in individuals who are exposed to potent antagonists of serotonin reuptake pumps (SSRIs) for prolonged periods. Due to the delay in the onset of this chronic depressive state, it is labeled tardive dysphoria. Tardive dysphoria manifests as a chronic dysphoric state that is initially transiently relieved by—but ultimately becomes unresponsive to—antidepressant medication. Serotonergic antidepressants may be of particular importance in the development of tardive dysphoria.”
Such is the gap between what depressed patients—and society at large—have been told about antidepressants for the past 30-plus years and the story told in the scientific literature. The public was led to believe that antidepressants fixed a chemical imbalance in the brain and thus could be considered an antidote to the pathology that caused depression, and that clinical studies have shown that these drugs “work.” In fact, the research literature told the following story:
Depression is not caused by a known chemical imbalance in the brain
An antidepressant causes the brain to begin functioning in a manner that is both “qualitatively and quantitatively different” than normal
In industry-funded trials, only one in eight patients could be said to benefit from the treatment
Studies in real-world patients found that only a minority of patients respond to an antidepressant and relatively few remain well at the end of one year
Long-term outcomes for treated patients are particularly poor, and there is evidence that their use increases the risk that a person will become chronically ill
This, of course, is information that would enable patients to make an informed choice about whether to take an antidepressant. Yet—and this is an example of how the APA continues to misinform the public—here is what the APA currently tells the public about the efficacy of antidepressants:
“Between 80% and 90% of people with depression eventually respond well to treatment. Almost all patients gain some relief from their symptoms.”
How can such practices impact your health? Why? What is your experience?
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