Depressed patients who are treated with antidepressants do worse in the long run

October 25, 2017, Journal of Psychotherapy and Psychosomatics
Credit: CC0 Public Domain

In the current issue of Psychotherapy and Psychosomatics a new analysis discloses insights into the long term effects of antidepressant drugs. Major depressive disorder (MDD) is more often chronic or recurrent in clinical than in community samples. For example, perhaps 85 percent of patients but only 35 percent of persons in the community with MDD experience another depressive episode within 15 years. Nonetheless, active treatments including antidepressant medication or cognitive therapy reduce depressive symptoms and delay relapse compared to inactive controls. Follow-ups of treated and untreated persons in clinical trials have rarely exceeded 1-2 years, however.

The current analyses of a national sample with 9-year follow-ups clarified these possibilities. Using the same assessments for treated and untreated persons excluded the first possibility. Testing whether MDD severity and a wide range of demographic, psychosocial, and clinical variables accounted for long-term differences between treated and untreated persons estimated the second possibility, with remaining outcome differences more likely due to treatment. Twelve-month MDD prevalence at survey waves 1, 2, and 3 was 13.3, 10.5, and 9.9 percent, respectively. With MDD, 38.1 percent of participants received no treatment, 25.2 percent inadequate treatment including , 19.2 percent inadequate treatment without medication, 13.5 percent adequate treatment including medication, and 4.1 percent adequate treatment without medication during the past year.

Prior depressive status, treatment and their interaction, predicted subsequent depressive symptom levels. Among persons with , symptoms were higher after inadequate treatment, adequate treatment, treatment without medication, or treatment including medication compared to no treatment, and symptoms were higher after treatment including medication versus treatment without medication. In addition, among persons with major depressive disorder, symptoms were higher after inadequate treatment, adequate treatment, or treatment including medication compared to no treatment, and symptoms were higher after treatment including medication versus treatment without medication.

These findings show that symptoms were more sharply elevated 9 years following treatment including medication than treatment without medication, and major depressive disorder severity plus other covariates did not account for increased depression after medication. Patient characteristics accounted for symptoms after treatment without medication, however. This pattern suggests possible long-term iatrogenic effects of antidepressants.

Explore further: Mindfulness may help more if no antidepressants are used

More information: Jeffrey R. Vittengl. Poorer Long-Term Outcomes among Persons with Major Depressive Disorder Treated with Medication, Psychotherapy and Psychosomatics (2017). DOI: 10.1159/000479162

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not rated yet Oct 27, 2017
There are many different classes of Antidepressants that act on different chemicals/receptors in the brain. To lump all of them together and say people suffering from Major Depressive Disorder are better off essentially pulling up their bootstraps and getting on with it is dangerous. Suicide due to MDD is a leading cause of death. People need to feel there's hope - even if it's placebo. That said this sorta metaanalysis needs to break down targets. SSRIs, from Tricyclics, from Lithium, from MAOis, from etc etc etc. This is a dangerous thing to share w/ someone suffering from major depression. These medicines have helped me & others I love. Some would not be here w/o at least the hope of medical intervention.

Pushing the antidepressants don't work narrative makes pharm companies weary about investing in development of new novel treatments (like NMDA receptor agonists / ketamine based drugs). Careful w/ the blanket assessment Mr. Truman state university Pdoc(After Revsion?)

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