Stop using antidepressants for all but the most severe depression, experts say

in a new article British Medical Journal (BMJ), More than 30 leading figures in key psychiatry are calling on the UK government to acknowledge evidence that antidepressants are no better than placebo for most patients and increase funding for social and psychological interventions while reducing drug prescribing .

They wrote that multiple meta-analyses showed that antidepressants, in addition to placebo, did not provide any clinically meaningful benefit for all but the most severely depressed patients.

The list of more than 30 authors reads like a veritable who’s who of critical psychiatry. The lead author is James Davies, co-founder of the Committee for Evidence-Based Psychiatry (CEP), senior lecturer in social anthropology and psychotherapy at the University of Roehampton, and a practicing psychotherapist in the UK.The second author is John Read, President of the International Institute of Psychiatric Drug Withdrawal, Professor of Clinical Psychology at the University of East London, and Editor of the Journal mental illness, Expert in ECT and psychiatry.

Other notable authors include Joanna Moncrieff (Professor of Critical and Social Psychiatry at University College London and founder of the Critical Psychiatry Network) and Mark Horowitz (Clinical Research Fellow in Psychiatry at North East London NHS Foundation Trust), whose 2022 paper The final word is in the coffin of the serotonin theory of depression; Lucy Johnstone, a clinical psychologist who helped launch the Power Threat Meaning Framework, a non-diagnostic alternative to the DSM; Joe Watson Jo Watson, psychotherapist and founder of Drop the Disorder; Peter Kinderman, psychologist; Luke Montagu, who co-founded CEP with Davies; Sam Everington for his work on improving primary care For his work, he was knighted and awarded an Order of the British Empire (OBE). The article also profiles psychiatrists, general practitioners, members of parliament and advocates with lived experience.

They write: We, a group of medical professionals, researchers, patient representatives and politicians, are calling on the UK government to commit to reversing the prescribing rates of antidepressants.

We must reduce the use of antidepressants

Clinical practice guidelines outside the United States, such as the NICE guidelines in the United Kingdom, have suggested that antidepressants are not the best first-line intervention for the treatment of mild to moderate depression. NICE guidance suggests that watchful waiting, guided self-help, various psychotherapies, exercise and mindfulness/meditation are better options for reducing severe depression as they have the same effect but with a much lower risk of adverse effects. For example, a recent meta-analysis found that exercise was as effective as antidepressant drugs in treating mild to moderate depression, and that adding drugs to the treatment regimen did not improve outcomes.

The World Health Organization (WHO) has firmer guidelines on the treatment of depression: Mild depression does not require antidepressant drugs, the WHO said.

Even for severe depression, multiple studies have found that adding antidepressants to cognitive behavioral therapy does not lead to better outcomes, and that psychotherapy alone is equally effective in the short term.and treat alone beat When it comes to long-term results, medications.

In addition, psychotherapy does not produce the harmful effects of antidepressant drugs, including sexual dysfunction, weight gain and metabolic problems, emotional numbness, etc. that occur in up to 88% of people taking antidepressant drugs. Likewise, withdrawal is common after stopping taking antidepressant medications and can be severe and last for years. Drug withdrawal effects can include anxiety, depression, brain damage, fatigue, and even stroke-like symptoms.

Still, prescriptions for these drugs are increasing. Davies and his co-authors note that antidepressant prescription rates have nearly doubled in the UK over the past decade.

However, increases in antidepressant prescriptions were not associated with improvements in population mental health outcomes, and by some measures, mental health outcomes have worsened as antidepressant prescriptions have increased, the authors wrote.

Most people who experience mild depression or even vague discomfort that cannot be diagnosed will still take medication.A US study found that only 2% of people taking antidepressants actually suffered from severe depression, and more than half of them did not meet the criteria for depression. Similarly, a British study found that more than half of people taking antidepressants did not meet criteria for any psychiatric diagnosis. A 2015 study found that more than two-thirds (69%) of patients taking antidepressants did not meet diagnostic criteria for depression.

Davis and his co-authors add that disproportionately those receiving antidepressants are those living in poor areas, women and the elderly, which, they write, raises questions about how much we are getting it wrong The adverse and depriving effects were treated and treated effectively.

The use of antidepressants to treat mild depression and nonpsychiatric distress must be discontinued, the authors write. Additionally, funding must be provided for recovery-focused centers to assist those struggling to recover from addiction. Finally, funding should be directed towards social prescribing, focusing on isolation, poverty and marginalization most associated with symptoms of depression, and supported by the World Health Organization.

As James Davis said in a speech to the British Parliament:

Medications can’t save a broken marriage; they can’t erase a painful past or build community. They can’t bring back their loved ones. They do not address poverty or poor housing, nor correct the wrongs of inequality or discrimination, nor address any of the other obvious social determinants of poor health. They are who they are; they have their place. But they also need to stay where they are.

Is there evidence of antidepressant efficacy?

For decades, countless studies have questioned the efficacy of antidepressant drugs. A 2010 analysis found that, on average, the benefits of antidepressants may be small or nonexistent for patients with mild or moderate symptoms; however, this leaves open the possibility that for patients with severe depression Symptoms, these medications can really help.

However, researchers found in 2008 that although antidepressant drugs appeared to be more effective in severe depression, the difference wasRelatively small even for people with severe depression.The researchers went on to suggest that this benefit was due to a diminished placebo effect in patients with severe depression, rather than an increase in the drug’s efficacy.

To make matters worse, in another study, researchers found that those with more severe depression, those with comorbid anxiety disorders, and those who were suicidalleast likelyBenefit from medicine.

These drugs are known to make people feel suicidal, rather than preventing it: A recent study found that antidepressants tripled suicide rates among children and teens and increased suicide rates among 18- to 24-year-olds Doubling, even among older patients, did not reduce suicide rates.

This is consistent with previous research, which has repeatedly shown antidepressants increase the risk of suicide, especially in children and adolescents, with some studies finding more than a doubling and at least one analysis finding a six-fold increase.

Since the 1990s, researchers have warned that antidepressant treatments can disrupt the brain’s natural functions, worsening outcomes. These warnings have been borne out in multiple studies: Researchers have repeatedly found that people who take these drugs long-term have worse outcomes, even after controlling for baseline levels of depression severity.

Even all these negative findings and warnings can be considered optimistic because negative studies are much less likely to be published due to publication bias.For example, a study New England Journal of Medicine 2008 examined published and unpublished studies on the efficacy of antidepressant drugs. They found that half of the trials of antidepressants found no beneficial effects compared with placebo. The only problem is: almost no negative studies are published, and those that do end up being twisted into positives.

But depression is naturally self-limiting. if you No With treatment, you actually have a good chance of recovering on your own. A 2006 NIMH study found that 85% untreated People with depression recover naturally within a year.

Compare it with the result treated Depression: In one study of more than 1,000 people with depression who received rigorous treatment, starting with antidepressants (more than half used multiple medications) and including psychotherapy and hospitalization, less than 25 percent Or even respond to treatment, let alone recover.Unfortunately, the study did not have a placebo group to compare this effect with, but in clinical trials, the placebo effect averages about 31%, which meansMore people are expected to benefit from placebobenefited from aggressive drug treatment than in studies.

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Davis, J., Reed, J., Kruger, D., Crisp, N., Lamb, N., Dixon, M.,. . . & Marshall-Andrews, M. (2023). Reversing antidepressant prescription rates: Politicians, experts and patient representatives are calling on the UK government to reverse antidepressant prescription rates. British Medical Journal, 383,2730. doi: https://doi.org/10.1136/bmj.p2730 (link)

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