ARE ANTIDEPRESSANTS AS EFFECTIVE AS CLAIMED?

NO, THEY ARE NOT EFFECTIVE AT ALL

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Moncrieff, J., et al, Can J Psych 52(2):96, February 2007

This British author challenges the tenet that antidepressant drugs specifically act on abnormal cerebral states to relieve depression. She points out that meta-analyses of the myriad of published randomized, controlled trials comparing antidepressants and placebo generally show only a small advantage of active treatment, further noting that trials with negative results are much less likely to be published. The author suggests that reported effects of antidepressant drugs might be due to nonspecific sedative effects of these agents on outcomes such as sleeping difficulties and anxiety rather than to a truly antidepressant effect. She cites the findings of naturalistic studies that have reported that patients treated with antidepressants do less well than those who are not so treated. The prevalence of depressive episodes, suicide and sickness absence due to depression has been progressively increasing in western countries, despite a profound increase in antidepressant prescribing, suggesting that the use of antidepressants has done little to reduce the consequences of depression. Addressing studies reporting relapse of depression after discontinuation of long-term antidepressant therapy, this author feels that this phenomenon does not necessarily provide evidence of the effectiveness of antidepressants but rather might reflect the occurrence of discontinuation symptoms that are mistakenly diagnosed as early signs of relapse. In support of this premise, she cites the findings of one meta-analysis of maintenance antidepressant studies reporting that relapses tended to cluster after withdrawal of treatment, with the risk declining thereafter. The author concludes that there is no reason to suppose that the diverse problems that are labeled as "depression" can be reversed by antidepressant drugs. 9 references (j.moncrieff@ucl.ac.uk)