The Council for Evidence-based Psychiatry
22 February 2018
For immediate release:
Cipriani’s et al’s new research on whether antidepressants work has generated much excitement in the news media as well as the psychiatric community. The study has been represented by the Royal College of Psychiatrists as “finally putting to bed the controversy on anti-depressants“.
This statement is irresponsible and unsubstantiated, as the study actually supports what has been known for a long time, that various drugs can, unsurprisingly, have an impact on our mood, thoughts and motivation, but also differences between placebo and antidepressants are so minor that they are clinically insignificant, hardly registering at all in a person’s actual experience.
But even these differences can be accounted for. Most people on antidepressants experience some noticeable physical or mental alterations, and as a consequence realise they are on the active drug. This boosts the placebo effect of the antidepressant, helping explain these tiny differences away.
Furthermore, the trials only covered short-term antidepressant usage (8 weeks) in people with severe or moderate depression. Around 50% of patients have been taking antidepressants for more than two years, and the study tells us nothing about their effects over the long term. In fact, there is no evidence that long-term use has any benefits, and in real-world trials (STAR-D study) outcomes are very poor.
Lastly, and perhaps most importantly, the study does not bury the controversy around the damage caused by unnecessary long-term prescribing, the costs lost to the NHS, and the associated harms and disabling withdrawal effects these drugs cause in many patients, which often last for many years.
Overall, the study’s findings are highly limited, and do not support increasing antidepressant usage. Antidepressants are already being prescribed to around 10% of the UK population, and current guidelines do not even support their use by at least one-third of these patients.
This study, and the media coverage that has accompanied it, will unfortunately do nothing to help reduce this level of unnecessary prescribing and the consequent harms.