17.3 million American adults (7.1% of the adult U.S. population) and 3.2 million adolescents (13.3% of U.S. population aged 12 to 17) suffered at least one major depressive episode in 2017. Antidepressant drugs, the most widely used therapy for depression, are also among the least effective, and often make the situation worse, especially in the long term. Studies have repeatedly shown antidepressants work no better than placebo for mild to moderate depression. A 2017 systematic review of 131 placebo-controlled studies found that “all trials were at high risk of bias” and that clinical significance was questionable. Antidepressants are neurotoxic and possible side effects include worsening depression, self-harm, violence and suicide, increased risk for diabetes, heart disease, heart attack, stroke and dementia, and depletion of various nutrients (depending on the type of drug you take).
Depression can interfere with personal and work relationships, reduce work or academic performance and affect physical health by impairing your ability to properly care for yourself and make good health decisions, including decisions about nutrition and sleep. Imbalances in nutrition, weight fluctuations and poor sleep habits may in turn compromise your immune function.2
The condition can also be lethal, as depression is a contributing factor in up to 70 percent of all suicides.3 In 2016, 44,965 Americans committed suicide.4 Depression can also lead to self-harming behaviors such as drug or alcohol abuse,5 and 90 percent of people who struggle with suicidal thoughts experience a combination of depression and substance abuse.6
Unfortunately, antidepressant drugs — the most widely used therapy for depression — are also among the least effective. In fact, statistics suggest that far from being helpful, psychiatric drugs are making the situation worse.
According to research7,8 published in February 2017, 16.7 percent of the 242 million U.S. adults (aged 18 to 85) included in the survey reported filling at least one prescription for a psychiatric drug in 2013.
Twelve percent reported using an antidepressant; 8.3 percent used anxiolytics, sedatives and hypnotics; and 1.6 percent used antipsychotics. With nearly 17 percent of the adult population in the U.S. taking psychiatric drugs, it would be prudent to evaluate the larger ramifications of these types of medications. Sadly, statistics overwhelmingly fail to support their use, yet they continue to be the leading form of treatment.
In a March 2019 segment of Full Measure (above), award-winning investigative journalist Sharyl Attkisson interviewed psychiatrist and director of the International Center for Patient-Oriented Psychiatry, Dr. Peter Breggin. He is known to many as “the conscience of psychiatry,” as he was instrumental in preventing the return of lobotomy as a psychiatric treatment in the early 1970s.
Breggin is also the author of “Medication Madness,” in which he details the many hazards of psychiatric drugs. In his 50 years of practice, he has never placed a patient on drugs. In fact, he specializes in getting people off them, and wrote a book on psychiatric drug withdrawal, “Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients and Their Families.”9
When asked what he thinks people don’t know about psychiatric treatment, and ought to, Breggin responds, “They don’t know that all psychiatric drugs are neurotoxins. They don’t know that they aren’t correcting biochemical imbalances, they are causing biochemical imbalances.”
Prozac was the first selective serotonin reuptake inhibitor (SSRI), approved by the U.S. Food and Drug Administration (FDA) in 1987.10 Over the years, Prozac became the target of a number of lawsuits, as patients suffered all sorts of ill effects, from birth defects to suicide and serotonin syndrome, a condition caused by excess serotonin in the brain, leading to agitation, confusion, high blood pressure and more.11
Already by 1996, 35,000 complaints about the drug had been lodged with the FDA.12 In the early 1990s, Breggin was appointed by a federal court as the medical and scientific expert for the plaintiffs in all combined lawsuits facing Eli Lilly with regard to Prozac, a role that gave him access to corporate records.13 Breggin tells Attkisson:14
“Prozac … had amphetamine affects. The chief investigators said and wrote, ‘this drug has amphetamine like effects. We need to put this into the label. It can make depression worse, can make people agitated, make them angry, might increase the suicide rate,’ but the FDA wouldn’t allow onto the label what it’s chief investigator into adverse effects was telling them.
So, from the beginning, it was all a house of cards. And, as for it’s being useful, I looked it over, carefully analyzed the statistics and said the drug actually doesn’t work. It’s about as good as placebo.
Now, placebo will help anywhere between 40 and 80 percent of people, so it’s a huge effect and that especially with depression, because depression is not about a biochemical imbalance. It’s about hopelessness. Depression is part of the human experience.”
In Breggin’s view, “There is no promising medical treatment and probably there never can be,” for the simple reason that depression is primarily rooted in the complexity of human emotions and experiences. He believes one needs to avoid numbing and escapist behaviors such as drug and alcohol use, and implement strategies to support healthy brain function instead, in order to “be able to deal with your issues.”
Dr. Breggin lays out the facts on his website:
The antidepressant drugs have no specific impact on depression and instead are used off label to treat everything imaginable from physical pain to anxiety and ADHD. People often experience euphoria after starting an antidepressant, but it is short-lived, leaving the individual to try one and then another antidepressant in the hope of re-experiencing this artificial, chemically induced “happiness.” This initial “feeling great” is in reality a danger sign, often signaling the start of an antidepressant-induced manic episode that can ruin lives. Antidepressant-induced mania is largely indistinguishable from spontaneous mania, and varies in intensity from mild to psychotic. It can include bizarre destructive behaviors, impulsivity, sexual acting out, callousness, grandiosity, and very bad judgment. Antisocial behavior is common. Extreme irritability can lead otherwise loving people to become hateful and violent. Loss of judgment can cause ethical people to act like criminals (See Scientific Sections 1-7).
With or without mania, antidepressants often cause a worsening of the individual’s condition, with “crashing” into depression and suicide. Suicidality in children and young adults has been demonstrated in short-term clinical trials conducted by drug companies for FDA approval. (Scientific Section 6, see Black Box Warnings at top of Full Prescribing Information for all antidepressants). These very short, drug-company manipulated studies are poor indicators for suicide or violence, and other clinical and epidemiological studies have confirmed that antidepressants cause suicidality and violent behavior in all age groups (Scientific Sections 3 and 4).
The harmful mental and behavioral effects of antidepressants are especially prevalent and severe in children and youth with up to 50% afflicted with reactions such as motor restlessness, sleep disturbance, social disinhibition or a subjective sensation of excitation. (See Science Section 5, including Riddle et al., 1990, for 50% figure, and King et al. 1991 for severity of cases). A great deal of behavior described as “bad” or “antisocial” is in reality driven by antidepressants.
Detailed descriptions and analyses of these unfortunate outcomes are presented in my book, Medication Madness: the Role of Psychiatric Drugs in Cases of Violence, Suicide and Crime. In the book, I review 50 real-life cases based on extensive information on each individual drawn from my forensic work and clinical practice. Additionally information about these tragic antidepressant adverse drug reactions is provided in dozens of individual scientific articles made available on this resource center.
The official American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM) in the descriptions of manic episodes affirms in every recent edition that antidepressants can cause the full range of mania, from a few symptoms to gross cases. The DSM-IV-TR (2000) states, “Symptoms like those seen in a Manic Episode may also be precipitated by antidepressant treatment such as medication, electroconvulsive therapy, or light therapy” (p. 361). The latest edition, DSM-V (2013), has a more lengthy discussion of mania and manic-like symptoms caused by antidepressants (p. 129). In both editions, the sections on diagnosing mania and bipolar disorder require differentiating these syndromes from the identical symptoms caused by antidepressant drugs.
The official Full Prescribing Information (also called the ‘label’ or the ‘package insert’) for antidepressants describes multiple adverse effects in the sections on Warnings, Precautions and Adverse Effects. The material in the Warnings and Precautions section is part of the class label for all antidepressants and therefore appears in almost identical language in the Full Prescribing Information section of every antidepressant drug label (see Scientific Sections 6 & 12). The 2014 Lexapro Full Prescribing Information (see Scientific Section 12), for example, states:
All patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases.
The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric. p. 6
Note the enormous range of symptoms and disorders caused by antidepressants. Most of the above symptoms are related to and can lead to mania, violence or suicide. That these adverse drug reactions can occur in nonpsychiatric patients confirms that the drug is the culprit and not that patient’s own emotional problems. They are commonly mistaken for the patient’s emotional problems instead of being correctly identified as adverse drug reactions. They can occur in mild or severe forms. Note that the highest risk is around the time of the starting the drug or dose changes, up or down.
In the long-run, antidepressants, like almost all psychiatric drugs, lead to apathy, indifference, and lack of caring. Emotional life is dulled and relationships lack empathy and love. Some patients become so dulled that they develop a gross apathy syndrome (See Scientific Section 4). Long term, antidepressants also produce a dysphoria syndrome, with varied painful emotions that the doctors and patients mistakenly attribute to the patient’s “mental disorder” (El-Mallakh et al. in Scientific Section 4). These drugs suppress both sexuality and love, often without full recovery when the drugs are stopped (See Scientific Section 11).
Most people continue to take antidepressants because they fail to perceive their loss of quality of life (see Breggin, 2006d, on medication spellinbinding in Scientific Section 7). Also, when many patients try to stop taking their drugs, the withdrawal syndrome produces such torture-like emotional and physical reactions that they think they need to keep taking the medication to control their “mental illness.” In reality, they need a slow tamper with careful, experienced supervision (See Scientific Section 10, and my book Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients and their Families).
Antidepressants Are Ineffective, and Do More Harm than Good
All the citations that follow are in Scientific Section 8.
According to FDA regulations, drug companies only need to produce two studies to demonstrate the effectiveness of a drug; but they can try as many times as they wish. This is an unscientific methodology that corrupts the research process. If a drug fails to help in six studies and succeeds in two, it has not been proven effective; but the FDA will call it effective. Kirsch et al. (2008) reviewed all the antidepressant double-blind placebo-controlled clinical trials conducted during the FDA approval process, not just those that were cherry-picked to gain approval. In addition, the studies are totally controlled by the drug companies with little or no oversight by the FDA and they are very short in duration, typically 3-8 weeks long. On the basis of evaluating all the studies, Kirsh et al. concluded that antidepressants are ineffective (also see Antonuccio et al., 1999; and Jureidini 2004 for children).
The largest antidepressant trials ever conducted, the government sponsored STAR*D study, found that only 2.7 percent of patients (108 of 4041) had an initial remission that lasted or could be followed up for 12 months (Pigott, 2015; Pigott et al., 2011). The study demonstrated an overall lack of effectiveness..
Thomas Insel, the former Director of the National Institute of Mental Health (NIMH), in December 2011 confessed in his official government blog that antidepressants are virtually useless: ‘‘The bottom line is that these medications appear to have a relatively small effect in patients broadly classified as having depression.’’ He meant a small therapeutic effect. By contrast, the adverse effects are numerous and potentially devastating and even deadly.
There are many therapeutic interventions and real-life alternatives for helping people overcome depression, spanning the spectrum from running and healthy eating to mindfulness training and psychotherapy. I have reviewed these in some of my other articles (e.g., Breggin, 2016, in Scientific Section 7). I am not focusing on better alternatives in this resource center, because overall, antidepressants do far more harm than good in children and adults, and therefore should not be prescribed. Even if more effective treatments or approaches did not exist, antidepressants, by doing more harm than good, are too dangerous for clinical use. My best book for helping overcome stressful circumstances and negative, self-defeating emotions is Guilt, Shame and Anxiety: Understanding and Overcoming Negative Emotions.
In 2010, Dr. Mercola interviewed medical journalist and Pulitzer Prize nominee Robert Whitaker about the use of psychiatric drugs, as he has written two books on this topic. I’ve included that interview again for your convenience. In it, Whitaker details the science showing antidepressants don’t work — and what actually does.
The available science has also brought Jacob Stegenga, a philosophy of science lecturer at the University of Cambridge and author of “Medical Nihilism,” to the same conclusion. In a recent essay, he notes:15
“Diving into the details of how antidepressant data are generated, analyzed and reported tells us that these drugs are barely effective, if at all … The best evidence about the effectiveness of antidepressants comes from randomized trials and meta-analyses of these trials.
The vast majority of these studies are funded and controlled by the manufacturers of antidepressants, which is an obvious conflict of interest. These trials often last only weeks — far less than the duration that most people are on antidepressants.
The subjects in these trials are selected carefully, typically excluding patients who are elderly, who have other diseases, or who are on several other drugs — in other words, the very kinds of people who are often prescribed antidepressants — which means that extrapolating the evidence from these trials to real patients is unreliable.
The trials that generate evidence seeming to support antidepressants get published, while trials that generate evidence suggesting that antidepressants are ineffective often remain unpublished …
To give one prominent example, in 2012 the U.K. pharmaceutical company GlaxoSmithKline pleaded guilty to criminal charges for promoting the use of its antidepressant Paxil in children (there was no evidence that it was effective in children), and for misreporting trial data … When analyzed properly, the best evidence indicates that antidepressants are not clinically beneficial.
What Does the ‘Best Evidence’ Say About Antidepressants?
According to a 2022 British study by the University College London, depression is not a chemical imbalance in the brain. While all prescribed medications act by maintaining serotonin levels, the study suggests low serotonin levels do not cause depression. Instead, the study suggests depression may be more strongly correlated with adverse life events, which lower mood. Since the 1990s, antidepressant use has grown alongside the theory that drugs establish correct levels of chemicals in the brain. However, researchers say that is unfounded.1
“I think we can safely say that after a vast amount of research conducted over several decades, there is no convincing evidence that depression is caused by serotonin abnormalities, particularly by lower levels or reduced activity of serotonin,” said Joanna Moncrieff, a professor of psychiatry at UCL who authored the study.
“Many people take antidepressants because they have been led to believe their depression has a biochemical cause, but this research suggests this belief is not grounded in evidence,” she noted. “The popularity of the ‘chemical imbalance theory of depression has coincided with a huge increase in the use of antidepressants,” she continued.
Moncrieff also pointed out that “thousands of people suffer from side-effects of antidepressants, including the severe withdrawal effects that can occur when people try to stop them, yet prescription rates continue to rise.”
“We believe this situation has been driven partly by the false belief that depression is due to a chemical imbalance.”
Moncreiff then said, “It is high time to inform the public that this belief is not grounded in science.”
Researchers in the report reviewed studies regarding serotonin and depression and found no difference in levels between thousands of people diagnosed with the condition and healthy control participants. They also looked at studies where serotonin levels were artificially lowered in hundreds of people by depriving their diets of the amino acid required to make serotonin. The study surprisingly found that it did not make them depressed.
The researchers say that patients should not be told a chemical imbalance causes depression. They also noted that patients should not be informed that SSRIs can correct the problem. However, antidepressants can work but must do so through a different route. It is worth noting that experts have warned people against stopping their medication. (TGP)
While some psychiatric drugs may be helpful for a small minority of people with very severe mental health problems, such as schizophrenia, it’s quite clear that a vast majority of people using these drugs do not suffer from the type of psychiatric illnesses that might warrant their prudent use.
Most are struggling with sadness, grief, anxiety, “the blues” and depression, which are in many ways part of your body’s communication system, revealing nutritional or sunlight deficiencies and/or spiritual disconnect, for example.
The underlying reasons for these kinds of troubles are manifold, but you can be sure that, whatever the cause, an antidepressant will not correct it. In fact, as noted by Breggin, studies16,17,18 have repeatedly shown antidepressants work no better than placebo for mild to moderate depression.
Irving Kirsch, associate director of the Program in Placebo Studies at Harvard Medical School, has conducted several meta-analyses of antidepressants in comparison to placebo, concluding there’s virtually no difference in their effectiveness. According to Kirsch, “The difference is so small, it’s not of any clinical importance.”19 For example:
In a 1998 meta-analysis20 that looked at 19 double-blind studies, Kirsch and colleagues noted that:
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| Research published in 2008 found major discrepancies between published and unpublished research makes antidepressants appear far more beneficial and effective than the sum total of the research actually reveals them to be. Of 74 FDA-registered studies, 31 percent were never published. As noted by the authors, “According to the published literature, it appeared that 94 percent of the trials conducted were positive. By contrast, the FDA analysis showed that 51 percent were positive … Selective reporting of clinical trial results may have adverse consequences for researchers, study participants, health care professionals and patients.” |
| A 2010 meta-analysis21 concluded that “The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms.” |
| In a 2011 paper,22 Kirsch notes that six-week trials have a higher success rate than eight-week trials — 55 versus 42 percent — which suggests long-term use of antidepressants is likely ineffective. |
| In a 2014 paper,23 Kirsch notes that “analyses of the published data and the unpublished data that were hidden by drug companies reveals that most (if not all) of the benefits are due to the placebo effect.” In this paper, he notes that two of his earlier meta-analyses24,25 actually revealed that when both published and unpublished trials were included, the placebo response accounted for a whopping 82 percent of the beneficial response to antidepressants. A major benefit of evaluating FDA trial data was that all of the trials used the same primary measure of depression, which made the drug-to-placebo effects very easy to identify and compare. The primary measure of depression used in these studies was the Hamilton depression scale, a 17-item scale with a possible score of 0 to 53 points. The higher your score, the more severe your depression. Importantly, the mean difference between antidepressants and placebo was less than 2 points (1.8) on this scale. To illustrate just how insignificant of a difference this is, you can score a 6-point difference simply by changing sleep patterns without any reported change in other depressive symptoms. Simply fidgeting less results in a 4-point decrease in your depression score, so as noted by Stegenga in his essay,26 “a drug that simply made people sleep better and fidget less could lower one’s depression score by 10 points.” What’s more, clinical guidelines in the U.K. require antidepressants to lower depression scores by a mere 3 points, 27 and this too reveals why and how the benefits of antidepressants have been overestimated and oversold. |
| Most recently, a 2017 systematic review with meta-analysis and trial sequential analysis of 131 placebo-controlled studies found that “all trials were at high risk of bias and the clinical significance seems questionable. SSRIs significantly increase the risk of both serious and non-serious adverse events. The potential small beneficial effects seem to be outweighed by harmful effects.” None of the trials, even when reporting a positive result, met the threshold for clinical significance of 3 points on the depression score. |
Long-Term, Antidepressant Users Fare Much Worse
What’s more, research has shown that patients who do not take antidepressants fare better in the long term compared to those taking drugs,28 and research29 comparing exercise and drug treatment for depression suggests those not taking drugs have a lower risk of relapse. This risk is also addressed in Kirsch’s 2014 paper30 on antidepressants and the placebo effect.
“The serotonin theory is as close as any theory in the history of science to having been proved wrong. Instead of curing depression, popular antidepressants may induce a biological vulnerability making people more likely to become depressed in the future,” Kirsch writes.
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