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Hengartner, 2017 Methodological Flaws, Conflicts of Interest, and Scientific Fallacies: Implications for the Evaluation of Antidepressants’ Efficacy and Harm


andy013
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I recently came across this mini-review that I thought others might find interesting.

 

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5725408/

doi: 10.3389/fpsyt.2017.00275

 

Methodological Flaws, Conflicts of Interest, and Scientific Fallacies: Implications for the Evaluation of Antidepressants’ Efficacy and Harm

Michael P. Hengartner

Abstract

Background

In current psychiatric practice, antidepressants are widely and with ever-increasing frequency prescribed to patients. However, several scientific biases obfuscate estimates of antidepressants’ efficacy and harm, and these are barely recognized in treatment guidelines. The aim of this mini-review is to critically evaluate the efficacy and harm of antidepressants for acute and maintenance treatment with respect to systematic biases related to industry funding and trial methodology.

Methods

Narrative review based on a comprehensive search of the literature.

Results

It is shown that the pooled efficacy of antidepressants is weak and below the threshold of a minimally clinically important change once publication and reporting biases are considered. Moreover, the small mean difference in symptom reductions relative to placebo is possibly attributable to observer effects in unblinded assessors and patient expectancies. With respect to trial dropout rates, a hard outcome not subjected to observer bias, no difference was observed between antidepressants and placebo. The discontinuation trials on the efficacy of antidepressants in maintenance therapy are systematically flawed, because in these studies, spontaneous remitters are excluded, whereas half of all patients who remitted on antidepressants are abruptly switched to placebo. This can cause a severe withdrawal syndrome that is easily misdiagnosed as a relapse when assessed on subjective symptom rating scales. In accordance, the findings of naturalistic long-term studies suggest that maintenance therapy has no clear benefit, and non-drug users do not show increased recurrence rates. Moreover, a growing body of evidence from hundreds of randomized controlled trials suggests that antidepressants cause suicidality, but this risk is underestimated because data from industry-funded trials are systematically flawed. Unselected, population-wide observational studies indicate that depressive patients who use antidepressants are at an increased risk of suicide and that they have a higher rate of all-cause mortality than matched controls.

Conclusion

The strong reliance on industry-funded research results in an uncritical approval of antidepressants. Due to several flaws such as publication and reporting bias, unblinding of outcome assessors, concealment and recoding of serious adverse events, the efficacy of antidepressants is systematically overestimated, and harm is systematically underestimated. Therefore, I conclude that antidepressants are largely ineffective and potentially harmful.

December 2010: 10mg Citalopram

April 2011: 5mg for 2 weeks then cold turkey withdrawal - Extremely bad depression / no emotions

June 2011: Reinstated 10mg - After 3 weeks started getting impulsive suicidal thoughts

July 2011: Cold turkey - Withdrawal hell begins...

 

January 2021: Reinstated 0.1mg Citalopram as last resort

February 2021: 0.2mg Citalopram for 2 days had bad foggy head so went back down to 0.1mg

Upon reducing I experienced low mood, suicidal thoughts, burning up, low appetite, very bad insomnia, mild diarrhoea

22 Feb 2021: Stopped all Citalopram after panic / depression attack and crying similar to when I reinstated back in June 2011.

 

4 April 2022: Reinstated 0.1mg Citalopram - Anxiety + foggy head

5 April 2022: Stopped Citalopram.

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On 2/23/2018 at 4:47 PM, andy013 said:

This can cause a severe withdrawal syndrome that is easily misdiagnosed as a relapse when assessed on subjective symptom rating scales.

 

I've been saying this for years.

 

Thanks for posting this, andy013.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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