Saturday, July 13, 2019

Stopping antidepressants may cause more problems than it’s worth

Vasco M Barreto defends antidepressants in his Aeon essay. Although he may have some doubts about the serotonin theory of depression, he still believes in the neuronal basis of depression and antidepressant effects, and has no doubt antidepressants work better than placebo, even though clinical trials may be biased. I’m not convinced he’s right (see eg. previous post) and do not see depression as a neuronal disease.

I can't prove it, and I guess Barreto will never believe me, but I think any apparent antidepressant effect may be due to placebo. I'm not saying that antidepressants are inert, but if they help depression, this may be because of the placebo effect. Despite what Barreto says, I'm also sceptical about the claimed benefits of aspirin (see BMJ eletter).

Barreto describes his own history of depression, which returned on stopping  antidepressants, and led to him making the decision to persist with treatment. I agree people should not be shamed for taking antidepressants (see previous post). Discontinuing antidepressants may well cause more problems than it's worth. All the more reason why guidelines should be followed to warn people, when they first start antidepressants, of the risk of discontinuation problems. Stopping antidepressants, if only because of withdrawal symptoms (see previous post), may cause more problems than it's worth.


cobweb said...

Duncan could you clarify a bit more please? It seems as though you are suggesting anti depressants should be prescribed to deal with withdrawal effects rather than depression - wouldn't that cause the continuation and increased severity of the adverse effects of the drug and these actually lead to causing depression? susanne

DBDouble said...

Continuing antidepressants may be a way of dealing with withdrawal symptoms. Not sure why you think antidepressants may cause depression.