Misleading Beliefs about Antidepressants Prevalent in Psychiatry

Researchers argue that academic psychiatry maintains at least two false beliefs about antidepressants that have far-reaching implications for the treatment of depression.

Madison Natarajan, MS
19
3581

A 2018 article published in Ethical Human Psychology and Psychiatry argues that there are two primary false beliefs held by academic psychiatry related to the efficacy of antidepressants. The article was written by researchers with expertise on antidepressants and suicide risk, Michael Hengartner of Zurich University in Switzerland and Martin Plöderl of Paracelsus Medical University in Salzburg, Austria.

First, they explain that physicians often attribute antidepressant effects to pharmacological action rather than placebo effects. Second, academic psychiatry maintains that physical dependence on antidepressant drugs does not exist, and therefore any withdrawal or discontinuation symptoms are benign and affect only a small minority of users. These two remain pervasive within the field of psychiatry, despite a wealth of evidence suggesting that they are untrue. Hengartner and Plöderl point to the undue influence of the pharmaceutical industry as one of the forces maintaining the popularity of these misleading beliefs about antidepressants.

“The problem is presumably less with erroneous views expressed by patients and researchers critical of psychopharmacological drugs, but rather with false beliefs held by academic psychiatry and promoted by the pharmaceutical industry,” the authors write.

For the last three decades, a neurobiological theory of depression has been the dominant viewpoint of medical professionals in academic psychiatry. Many attribute this view to the influence of the pharmaceutical industry and reporting and publication biases inflating the efficacy of antidepressant drugs. Consequently, this view has been adopted by the general population and led to increased antidepressant use. However, depression prevalence remains largely unaltered.

Many are beginning to question why, if antidepressants are effective, depression rates are not decreasing. A study by leading European psychiatrists surveying approximately 1,000 of their patients found that 57% of antidepressant users agreed that it is challenging to stop antidepressants when you have taken them over a long period, and 56% agreed that you could develop dependence. Despite these concerns, the authors of that study stated that the patients had erroneous views and lacked knowledge about pharmacotherapy. This perspective is dismissive of the lived experiences of service users as well as the scientific data.

Of further concern is the influence of the pharmaceutical industry and the overstated pharmacological drug effects of antidepressants. In a 2016 study, researchers found that psychiatrists believed that only 26% of antidepressant effectiveness was due to placebo effects. These beliefs are in contrast with the results of randomized placebo-controlled trials that suggest that 88% of antidepressants’ short-term efficacy is attributable to placebo effects and only 12% to their pharmacologic action.

“Although 96% of psychiatrists were familiar with the recent literature questioning the efficacy of antidepressants, only 23% reported that these studies had influenced their prescribing practices. These findings further raise the issue of why continuing medical education has not resulted in a more evidence-based appreciation of placebo effects, given that meta-analyses have already shown at the turn of the 21st century that the response to placebo accounts for at least 80% of antidepressants’ efficacy.”

This is not to say that antidepressants have no mental effects. They are psychoactive drugs, and the most common effects include emotional numbing, depersonalization, drowsiness, and agitation.

In addition to pharmacological effects being overstated, withdrawal effects upon discontinuation of antidepressants are severely understated and neglected.

“Although withdrawal is a bothersome problem for many long-term users, the issue is largely neglected in the scientific literature, in routine practice, and psychiatric training. It is not uncommon for patients who report antidepressant withdrawal symptoms to be dismissively told by their physicians that these symptoms have nothing to do with the drugs, but rather are signs of their underlying mental health problem.”

Research consistently shows that withdrawal symptoms occur in up to 50% of all patients, regardless of abrupt withdrawal or slow discontinuation. For a significant minority of antidepressant users, studies have shown that the withdrawal reactions are severe enough to qualify for a drug-induced persistent post-withdrawal affective disorder.  For many of these reasons, some users report they feel addicted to the antidepressants.

“The beliefs that there is no physical dependence to antidepressants and that ‘discontinuation reactions’ are a minor problem that is easy to manage are a major medical concern since so many patients seriously suffer from antidepressant withdrawal for months and even years,” the authors state.

Given the large body of scientific knowledge about withdrawal symptoms of antidepressants, there is speculation about why academic psychiatry has persistently minimized withdrawal effects while substantially overestimating the pharmacological effects and benefits.

One likely reason is due to the commercial interests of the pharmaceutical industry. Not only do companies that produce medical drugs have strong ties with academic departments, but they also have influence in medical journals and what content is created and disseminated. Research sponsored by pharmaceutical companies is more likely to yield positive results and favorable conclusions while underreporting adverse events and harm.

As long as industry ties and commercial interests of the pharmaceutical companies infiltrate medicine, training, and research, psychiatry will likely remain neglectful of both placebo effects and withdrawal reactions. The authors argue that “only when the field acknowledges that the drugs’ efficacy in attenuating depression symptoms is by and large a placebo response will alternative interventions such as psychotherapy or exercise be recommended to patients more often as first-line treatment.”

The authors also suggest that non-medical mental health experts such as nurses, psychologists, and social workers be on expert committees to have a determining influence on practice guidelines. Correcting false beliefs in academic psychiatry has implications for psychiatric training, continuing education of medical professionals, and treatment practices.

 

****

Hengartner, M. P., & Plöderl, M. (2018). False beliefs in academic psychiatry: The case of antidepressant drugs. Ethical Human Psychology and Psychiatry, 20(1), 6–16. https://doi.org/10.1891/1559-4343.20.1.6 (Link)

Previous articleThe Pandemic Claims New Victims: Prestigious Medical Journals
Next articleRCMP Officer Drags Student in Crisis, Steps on Her Head
Madison Natarajan, MS
Madison Natarajan is a master’s level psychotherapist and current doctoral student at the University of Massachusetts Boston. As a researcher, her focus is on the impact of religious trauma on female sexual development, specifically assessing the subculture of the evangelical purity movement. Madison has a family history that has been intertwined with psychiatric care, ranging from family members who were institutionalized to those practicing psychiatry, both in the US and India. Madison seeks to challenge the current structure of psychiatric care in the West and disseminate honest and empowering information to the community at large.

19 COMMENTS

  1. Well, going on antidepressants and losing your marbles two weeks or so later isn’t due to placebo effects, but inept screening, maybe with one of those company-issued “screening” sheets that doesn’t inquire about perceptual distortions.

  2. Some people claim that “Antidepressants are prescribed like sweets”. But taking these Drugs can have long term affects:-

    APPLYING TO JOIN THE ESSEX POLICE

    QUESTION
    I am taking antidepressants for depression. My depression is really well controlled. Would this affect my application?

    ANSWER
    Each decision is made after a careful consideration of the facts. The severity of the condition is reflected by the type of antidepressant, its strength and the duration of treatment in addition to many other factors.

    We would also consider the 2004 Home Office guidance which generally advises against accepting recruits whilst they are still being treated with antidepressants and for a period after stopping them. We recognise that this is guidance but guidance holds a particular status in law.

    The main goal of the assessment is to determine your mental resilience and the probability of further episodes of impaired mental health. Police work is like no other and good mental resilience and emotional stability are paramount.

  3. I’m so sorry not to be impressed by such articles. To be honest I find them boring, and insulting.
    It is dialogue that is supposed to sound “reasonable” and is supposed to show “proof”, that “some” things are not right within psychiatry.
    If those who realize that there is everything wrong with psychiatry (and really, I’m not sure if a logical person can come to any other conclusion) it would serve people much more usefully to fight with them, against psychiatry, against the whole paradigm and the complete mess and hoax it is.

    But no, “researchers” want their money too, their bit of “recognition” and so, participate completely and wholly to keep psychiatry alive and well.
    Psychiatry would now like to thank all the researchers and critics to keep the nice dialogue and conversations going. As we can all see, it keeps everyone involved in a job, while people suffer.

    No, it’s not good enough.

    • Yes.
      The entire premise of Pharma-psychiatry is that SCIENCE has proven people feel down or have weird thoughts only because of bad brain chemistry. And they have the pills to adjust it so you’ll feel normal again.

      A giant hoax. And even the non medical people who spread this lie know it’s a hoax. Pete Earley admits as much on his blog–justifying this deception by saying the drugs work. Meaning they turn “loved ones” into passive, sickly zombies who won’t annoy relatives.

      I was hoping this article would share more details on how ignorant or knowledgeable your friendly neighborhood shrink is. It doesn’t.

      • I was not expecting that of the article Rachel.
        It’s talk, like abuse was talk since mankind stirred. Of course many people know it’s a hoax. It works exactly as it is supposed to. Hoaxes catch on quickly because most of us are not awake enough to see it coming and get blindsided by whatever miracle comes along.

  4. Psychiatrists think the common symptoms of antidepressant discontinuation syndrome is “bipolar.”

    How an industry can claim to “know everything about the meds,” yet actually know nothing about the common adverse effects of the drugs they prescribe, is just criminal.

      • You can’t make sane people think they’re insane, unless you behave in an insane manner, so that’s exactly what the psychological and psychiatric do.

        They psy-op people. They call drugs that can create suicidal and homicidal thoughts “antidepressants.”

        They call the “psychosis” creating neuroleptics “antipsychotics.”

        And then they blame their clients’ so called “mental illness,” when the client suffers from the common adverse effects of the psych drugs.

        It’s a catch22, and it’s a scam.

        The situation is insane, I agree, Fiachra.

    • “How an industry can claim to “know everything about the meds,” yet actually know nothing about the common adverse effects of the drugs they prescribe, is just criminal.”

      Bingo SE. and that would be because they know nothing about the human mind or brain. Judging a person’s conversation and calling it an illness is the most ludicrous practice. Imagine I get to listen to certain styles and traits, then go into a boardroom and create a name for that style and enter it into a book as an “illness”. I then get to diagnose people based on the “illness” I created. People that discovered cancer never diagnosed people with “cancer” based on conversation. And they certainly never treated it based on what the doctor “named” it. And all cancer is cancer. It does not get a bunch of funny names. And even though they know somewhat of how cancer works, the “treatments” are nasty with lots of side effects and no one is judged for having cancer.
      No one created “cancer”. “mental illness” was created by shmucks who believe they hold the model of “normal”

  5. The “placebo” randomized control trials done by corporations may have found around 88% of the drug effect is a placebo effect. However these studies put the placebo group through withdrawal and/or have an unblinded drug group (via side effects). We should stop acting like studies with massive bias in favor of the drugs and done by corporations who’ve been fined billions for fraud are real. They are propaganda.

  6. As often happens, the authors are way too careful in their analysis. The title should not say “misleading” but “false” beliefs, and the attribution of responsibility to drug companies belies their own data that doctors who are fully aware of the science about both placebo and withdrawal effects continue to prescribe despite their knowledge. This suggests that the problem is not merely with pharmaceutical companies nor with academic interests alone, but that many individual psychiatrists are themselves corrupt, most likely receiving either direct kickbacks or gifts and perks provided for prescribing sufficient numbers of a particular drug, or else establishing some kind of prestige in their profession for supporting this kind of narrative, in contravention of the facts. It is apparent from this research that knowing the facts does not deter psychiatrists from believing whatever belief serves them best. So it is a much bigger problem than insufficient medical education. It comes down to an entire profession committed to a false narrative, and knowing on some level that backing away from full support for these beliefs that they KNOW to be false will lead to the collapse of their profession and their personal prestige and wealth.

    • Yes Steve, they are committed to their “honor”, which really is about saving face. The pressure is immense from mommy, daddy, aunts, kids and cars. Of course there is the WHOLE colleague thing, and “what would I ever do for a living”.
      THAT is what psychiatry amounts to.
      Few could face the awakening. Very “anxiety” producing, and they might get “depressed”.
      I just want a few young ones reading here or there, and be brave, gutsy enough to walk their own walk. Walk away while there is time.

LEAVE A REPLY