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Antidepressants for Depression: More Harm than Benefit

12/24/2019 3:00:03 PM
depressionAntidepressant medications are routinely prescribed for the treatment of major depressive disorder. Data from the National Health and Nutrition Examination Survey (NHANES) that were published in 2017 showed that 1 in 8 people over the age of 12 in the United States had taken antidepressants during the previous month. Selective serotonin reuptake inhibitors (SSRIs) are the most widely prescribed class of antidepressants and a first-line treatment for depression.
In an article published in BMJ Evidence Based Medicine, researchers asked whether antidepressants should be used for major depressive disorder. Two investigators independently searched the Cochrane Library, BMJ Best Practice, and PubMed up to June 2019 with the search terms “depression” and “antidepressants.” They included reviews that assessed the benefits and harms of any antidepressant compared with placebo in adults.

Studies examine effectiveness of antidepressants

Previously, in 2017, the authors published a systematic review that had shown that SSRIs had a statistically significant effect on depressive symptoms, but the effect size was far below what clinicians would consider to be “minimal improvement” (e.g., a 7-point change on the Hamilton Depression Rating Scale). The few trials that assessed long-term effects showed even smaller benefits than the short-term trials. They concluded that the harmful effects of SSRIs seemed to outweigh the potential benefits.
Nearly identical results were reported in a 2018 meta-analysis published in the Lancet. When compared with placebo, antidepressants reduced depressive symptoms with a statistically significant but clinically irrelevant effect.
When the researchers evaluated the risk of bias for studies of antidepressants, they found that the vast majority of studies were prone to “for-profit bias.” For example, in a systematic review of 43 trials, 39 involved industry funding and were at a high risk of bias. Studies with funding from manufacturing companies were more likely to report benefits and less likely to include negative statements. This means that the already weak evidence of antidepressant benefits  may be overestimated.

Antidepressants may not help long term, natural approaches more effective

Most trials of antidepressants have only assessed the short-term effects (approximately 4-8 weeks). There is no supporting evidence for the long-term use of antidepressants. Also, SSRIs increase the risk of adverse events, such as gastrointestinal problems, sleep disturbances, and sexual dysfunction. Moreover, when people discontinue antidepressants, they can experience withdrawal symptoms for as long as weeks or even months.
This review was funded by the Copenhagen Trial Unit, and the authors declared no conflicts of interest. The review concludes: “Based on current evidence, antidepressants seem to offer more harm than benefits.” Alternative treatment options, such as psychotherapy, exercise, smoking cessation, and a healthy diet, should be carefully considered for patients with depression.
Jakobsen JC, Gluud C, Kirsch I. Should antidepressants be used for major depressive disorder. BMJ Evid Based Med. 2019.