Relapse more frequent with antidepressants, "Blue again" study finds

[Altostrata]

Another statistical analysis of research on antidepressants finds people treated with medication relapse into depression twice as often as those given placebos. There's a discussion of the journal article here.

 

Patients Who Use Anti-Depressants Are More Likely to Suffer Relapse, Researcher Finds

 

ScienceDaily (July 19, 2011) — Patients who use anti-depressants are much more likely to suffer relapses of major depression than those who use no medication at all, concludes a McMaster researcher.

 

In a paper that is likely to ignite new controversy in the hotly debated field of depression and medication, evolutionary psychologist Paul Andrews concludes that patients who have used anti-depressant medications can be nearly twice as susceptible to future episodes of major depression.

 

Andrews, an assistant professor in the Department of Psychology, Neuroscience & Behaviour, is the lead author of a new paper in the journal Frontiers of Psychology. (See topic and full text here.)

 

The meta-analysis suggests that people who have not been taking any medication are at a 25 per cent risk of relapse, compared to 42 per cent or higher for those who have taken and gone off an anti-depressant.

 

Andrews and his colleagues studied dozens of previously published studies to compare outcomes for patients who used anti-depressants compared to those who used placebos.

 

They analyzed research on subjects who started on medications and were switched to placebos, subjects who were administered placebos throughout their treatment, and subjects who continued to take medication throughout their course of treatment.

 

Andrews says anti-depressants interfere with the brain's natural self-regulation of serotonin and other neurotransmitters, and that the brain can overcorrect once medication is suspended, triggering new depression.

 

Though there are several forms of anti-depressants, all of them disturb the brain's natural regulatory mechanisms, which he compares to putting a weight on a spring. The brain, like the spring, pushes back against the weight. Going off antidepressant drugs is like removing the weight from the spring, leaving the person at increased risk of depression when the brain, like the compressed spring, shoots out before retracting to its resting state.

 

"We found that the more these drugs affect serotonin and other neurotransmitters in your brain -- and that's what they're supposed to do -- the greater your risk of relapse once you stop taking them," Andrews says. "All these drugs do reduce symptoms, probably to some degree, in the short-term. The trick is what happens in the long term. Our results suggest that when you try to go off the drugs, depression will bounce back. This can leave people stuck in a cycle where they need to keep taking anti-depressants to prevent a return of symptoms."

 

Andrews believes depression may actually be a natural and beneficial -- though painful -- state in which the brain is working to cope with stress.

 

"There's a lot of debate about whether or not depression is truly a disorder, as most clinicians and the majority of the psychiatric establishment believe, or whether it's an evolved adaptation that does something useful," he says.

 

Longitudinal studies cited in the paper show that more than 40 per cent of the population may experience major depression at some point in their lives.

 

Most depressive episodes are triggered by traumatic events such as the death of a loved one, the end of a relationship or the loss of a job. Andrews says the brain may blunt other functions such as appetite, sex drive, sleep and social connectivity, to focus its effort on coping with the traumatic event.

 

Just as the body uses fever to fight infection, he believes the brain may also be using depression to fight unusual stress.

 

Not every case is the same, and severe cases can reach the point where they are clearly not beneficial, he emphasizes.

 

Story Source:

 

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by McMaster University.

 

Journal Reference:

 

Michael C. Neale, Charles O. Gardner, Lisa J. Halberstadt, Susan G. Kornstein, Paul W. Andrews. Blue Again: Perturbational Effects of Antidepressants Suggest Monoaminergic Homeostasis in Major Depression. Frontiers in Psychology, 2011; 2 DOI: 10.3389/fpsyg.2011.00159 See topic with full text here.

 

 

http://www.sciencedaily.com/releases/2011/07/110719121354.htm

[Altostrata]

This study is making waves. Here's another article on it:

Do antidepressants cause depression? What new study says

 

By David W Freeman CBS News July 20, 2011 12:32 PM

 

(CBS) What causes depression? Scientists have identified all sorts of things, from emotional stress and substance abuse to having the wrong genes. And now a provocative new study suggests a cause of depression that few may have suspected:

 

Taking antidepressant medication.

 

The study, published in the journal Frontiers of Psychology, showed that depressed people who use antidepressants are far more likely to suffer a relapse of major depression than those who avoid antidepressants.

 

For the study, McMaster University evolutionary psychologist Dr. Paul Andrews and his colleagues analyzed dozens of previously published studies to compare outcomes for patients who used antidepressants to those for patients who used placebos.They found that antidepressant users have a roughly 42 percent chance of a relapse, as compared with a 25 percent chance for those who shun antidepressant pills.

 

In other words, the pill poppers are almost twice as susceptible to future bouts of depression - a problem that an estimated 40 percent of all people experience at some point in their lives.

 

Why would drugs doctors prescribe to alleviate depression cause it to recur? Dr. Andrews told CBS News that antidepressants of all types interfere with the brain's regulation of two neurotransmitters, serotonin and norepinephrine. And once an individual stops taking antidepressants, the brain "overcorrects," triggering new depression.

 

"These drugs do reduce symptoms, probably to some degree, in the short-term," he said in a written statement. "The trick is what happens in the long term. Our results suggest that when you try to go off the drugs, depression will bounce back. This can leave people stuck in a cycle where they need to keep taking antidepressants to prevent a return of symptoms."

 

....

"I am not a clinician," he said. "But if it were me, I would certainly avoid antidepressant medication if at all possible. Talking therapies work just as well if not better than antidepressants, and they don't have this increased risk for relapse."

....

 

http://www.cbsnews.com/8301-504763_162-20081076-10391704.html

[cinephile]

Just posted this comment on the cbs article:

 

Betcha a bag of chips psychiatry FINALLY comes around and admits that most of these studies coming to the alarming conclusion that antidepressants cause relapse of depression are mistaking relapse for withdrawal. By saying this, they will save the antidepressants' reputation (such as it is) and convince people that those on ADs aren't stuck being depressed, but instead they just have withdrawal symptoms when they get off the meds.

 

Now, of course, if they say this they'll have to contend with what some of us have known for years: a huge portion of the efficacy studies have been contaminated by this mistaking of withdrawal for relapse, and that will cast huge doubt on the ultimate efficacy of the meds (that is, reinstating the medication doesn't remit the depression, it just stops the withdrawal symptoms which can APPEAR to be depression but are a completely different, pharmacologically induced pathology). And then the public (and psychiatry, secretly) will come to the conclusion that for as long as these pills have been around (about 25 years), only about 1% of the population (that is, the most severely depressed) should have ever been on them in the first place, as studies have time and time again shown that only the most severely depressed respond to SSRIs better than placebo. All the others who were put on these meds for the thinnest of reasons will then be seen as what they are: guinea pigs and VICTIMS.

 

And to rwsmith: I'm glad the medication is working for you, but please don't draw false medical analogies. There is no scientific evidence that mental illnesses are due to a chemical imbalance or a "malfunctioning brain" in general. Psychiatry doesn't know much more about the cause of mental disorders than it did before the SSRIs and atypicals came out. Your heart malfunction most likely has a clearly defined pathology; your mental illness doesn't. Better to say, "I take my medication and it works. I don't know why it works -- and neither does psychiatry -- but it seems to work."

[summer]

"These drugs do reduce symptoms, probably to some degree, in the short-term," he said in a written statement. "The trick is what happens in the long term. Our results suggest that when you try to go off the drugs, depression will bounce back. This can leave people stuck in a cycle where they need to keep taking antidepressants to prevent a return of symptoms."

 

I know this was written with me in mind! This is exactly what I've always done... kept taking ADs because I didn't want the depression to return.

[Altostrata]

Antidepressants cause relapse says study

21/07/2011 British Psychological Society

 

People who take antidepressants could be more likely to experience episodes of major depression in later life than those who use no medication whatsoever. This is the suggestion of a new study published in the journal Frontiers in Psychology, which found such individuals could be nearly twice as prone to relapses.

 

Evolutionary Psychologist Paul Andrews, an Assistant Professor in the Department of Psychology, Neuroscience and Behaviour at McMaster University - an institution based by Lake Ontario in Hamilton, Canada - demonstrated that those who have taken, but then gone off, such tablets are at a 42 per cent risk of going through a bout of serious depression once again.

 

This compares to just a 25 per cent risk calculated for those who have never used antidepressants for their condition.

 

Mr Andrews explained that relapses become more commonplace the more tablets affect serotonin and other transmitters in the brain, adding: "All these drugs do reduce symptoms, probably to some degree, in the short-term. The trick is what happens in the long-term."

 

Dr Lucy Johnstone, Chartered Psychologist, commented: "This overview suggests that anti-depressants may disrupt the brain's ability to keep neurotransmitters in balance, thus leaving people who are suffering from severe depression more vulnerable to relapse. The implication is without anti-depressant interference, the brain would use its naturally evolved mechanisms to achieve resolution of major depression after an average of three months or so.

 

"We already know that there is little evidence that anti-depressants work better than placebo in milder cases of depression. If the same is true in more severe cases - and moreover if anti-depressants leave these people worse off in the long run - we should be extremely concerned.

 

"We also know that all types of depression are linked to life events - bereavement, relationship difficulties, trauma and so on. It is becoming increasingly apparent that evidence-based psychological therapies are the preferred way forward if we do not want to make a difficult situation even worse.

 

"As a clinician, I am told by clients every week: 'I know the pills are just papering over the cracks.' We need continued investment in psychological interventions if we are to offer people the help they really need."

 

 

http://www.bps.org.uk/news/antidepressants-cause-relapse-says-study

[Altostrata]

And here's another article on the same study, from PsychCentral.com:

 

Antidepressants May Up Risk of Relapse

 

By Rick Nauert PhD Senior News Editor

Reviewed by John M. Grohol, Psy.D. on July 20, 2011

 

....

The provocative paper is sure to add to the controversy over depression treatment. Dr. Paul Andrews, an evolutionary psychologist, believes that patients who have used antidepressant medications can be nearly twice as susceptible to future episodes of major depression.

 

....

Researchers performed a meta-analysis combining the results from similar studies.

 

From the compilation, they found that people who have not been taking any medication are at a 25 per cent risk of relapse, compared to 42 per cent or higher for those who have taken and gone off an antidepressant.

 

The investigators reviewed dozens of previously published studies comparing the use of placebo to antidepressants.

 

They analyzed research on subjects who started on medications and were switched to placebos, subjects who were administered placebos throughout their treatment, and subjects who continued to take medication throughout their course of treatment.

 

Andrews said antidepressants interfere with the brain’s natural self-regulation of serotonin and other neurotransmitters, and that the brain can overcorrect once medication is suspended, triggering new depression.

 

Andrews believes antidepressants disturb the brain’s natural regulatory mechanisms, which he compares to putting a weight on a spring.

 

The brain, like the spring, pushes back against the weight. Going off antidepressant drugs is like removing the weight from the spring, leaving the person at increased risk of depression when the brain, like the compressed spring, shoots out before retracting to its resting state.

 

“We found that the more these drugs affect serotonin and other neurotransmitters in your brain — and that’s what they’re supposed to do — the greater your risk of relapse once you stop taking them,” Andrews said.

 

“All these drugs do reduce symptoms, probably to some degree, in the short-term. The trick is what happens in the long term. Our results suggest that when you try to go off the drugs, depression will bounce back. This can leave people stuck in a cycle where they need to keep taking antidepressants to prevent a return of symptoms.”

 

Andrews takes a contrarian view of depression, viewing the condition as a natural and beneficial — though painful — state in which the brain is working to cope with stress.

 

“There’s a lot of debate about whether or not depression is truly a disorder, as most clinicians and the majority of the psychiatric establishment believe, or whether it’s an evolved adaptation that does something useful,” he said.

 

Long-term studies cited in the paper show that more than 40 per cent of the population may experience major depression at some point in their lives. Most depressive episodes are triggered by traumatic events such as the death of a loved one, the end of a relationship or the loss of a job.

 

According to Andrews, the brain may cope with this trauma by enacting coping mechanisms altering other functions such as appetite, sex drive, sleep and social connectivity.

 

Just as the body uses fever to fight infection, he believes the brain may also be using depression to fight unusual stress.

 

Not every case is the same, and severe cases can reach the point where they are clearly not beneficial, he said.

 

Source: McMaster University

 

 

 

 

 

http://psychcentral.com/news/2011/07/20/antidepressants-may-up-risk-of-relapse/27903.html

[Altostrata]

The study this article refers to is 2011 Blue again: Perturbational effects of antidepressants -- see the discussion.

[Barbarannamated]

Just got to read this. EXCELLENT! EXCELLENT!

[Barbarannamated]

Cinephile,

I tried to find your post on CBS but found blog article only. Which link will take me there?

Great response!

B

[cinephile]

Barbara --

 

You should be able to access the comments by clicking on the "9 comments" button just below the headline. Hope this helps.

 

Link below to article:

 

http://www.cbsnews.com/8301-504763_162-20081076-10391704.html