THE GREAT ANTIDEPRESSANT CON
by Steven Goldsmith MD
THE GREAT ANTIDEPRESSANT CON
by Steven Goldsmith MD
If you seek treatment for depression from a psychiatrist, what are the chances you will fully recover from your problem, that you will become well? Hint: What are the chances you will pitch the New York Mets to a pennant next year?
The vast majority of psychiatrists these days treat depressed patients with antidepressants. That is partly because most of them, unlike their forebears decades ago, no longer can practice competent psychotherapy sufficient in itself to heal depression. Some may be capable of that but instead choose the more remunerative and less time-intensive path of medication visits every 15 minutes. A chief of service under whom I worked said unapologetically that he did not know how to do psychotherapy. In bygone days that would have been a shocking admission. A cause for disbelieving stares from colleagues. (What is the point of our profession if we don’t know how to help people to change by talking with them?) The equivalent of an attorney’s admission that s/he does not know how to craft contracts, or a cleric’s that s/he cannot deliver sermons. But no longer.
All right, so the interpersonal dimension of healing has largely vanished from psychiatry. And, granted, because of the formulaic nature of psychiatric prescribing, contemporary psychiatry seems ripe for a takeover by AI. But if the drugs work, what is the problem? How effective are they really? (I set aside here the major problems of side effects and cost so as to focus on efficacy issues, though I recognize that is like talking about JFK’s 11/63 visit to Dallas without mentioning the assassination.)
Antidepressants have existed about 75 years. According to the CDC in 2018 about 13 percent of American adults were taking antidepressants, with 240.7 million antidepressant prescription fills recorded. All indicators point to an increase in these statistics since then. But this trend affects all ages. The American Psychological Association reported that in 2024 about 1/4 of American college students were taking these drugs.
If your psychiatrist prescribes an antidepressant, what are your chances of feeling substantially improved while taking these drugs? About 40 percent, give or take. Not insignificant, and certainly good for those 40 percent, but not great overall.
What then are your chances of becoming completely well so that you have no residual symptoms of depression and are able eventually to stop the medication and remain well? The most noteworthy research study evaluating the efficacy of antidepressants is known as the Star*D trial, completed in 2006. It studied 4041 depressed individuals who received antidepressants in several potential stages, i.e. if the first one prescribed did not help, the subjects received another medication or combination of medications, and if those didn’t help they received a third medication, then a fourth if necessary. This trial was sponsored for once not by a pharmaceutical company but by the National Institute of Mental Health. Its results startled many people.
A lead author of the study, Dr. Ed Pigott, upon discovering a major methodological flaw in the study’s design, reanalyzed the data. They showed the likelihood of sustained benefit from antidepressants to be only 2.7 percent. In other words, if precisely 4000 depressed individuals were treated, only 108 of them would become fully and lastingly well with treatment.
Dr. Pigott was not alone. Dr. Mauricio Fava, a Star*D trial investigator and prominent academic psychiatrist at the Massachusetts General Hospital in Boston, remarked about this study that “there’s been a failure of the field to demonstrate robust advantages of antidepressants over placebo.” In other words, there appeared no sizeable difference between the efficacy of antidepressants and of inert sugar pills that act only through the hopeful expectations of the recipient.
Other studies reported modest improvements over the Star*D statistics, but nothing to write home about. Moreover, even if you belong to the 40 percent who seem to have recovered from depression with drugs, you are not home free. If you are doing well on an antidepressant and decide eventually to stop it, research documents that you have a 40-80 percent chance of relapse within the first 6 to 12 months of drug discontinuation.
Suppose a medication resolves your depression but you decide to continue the medication indefinitely? You still are not immune from relapse. A significant percentage of individuals become tolerant to the benefits of the medication. As a consequence the dose may need to be ratcheted up periodically, with an attendant greater risk of side effects at the higher dosages. Eventually, previously effective medications no longer work at all. Then new medications must be prescribed and the same process starts anew. I have witnessed this phenomenon many times.
What becomes of the overwhelming majority of depressed individuals who are not cured? Even the more fortunate of these exist in the twilight domain of the medicated but chronically ill, the MBCI, who limp through compromised lives, hobbled by side effects and chains of illness that do not chafe as painfully because of the emollient of chemical suppression.
None of this information is controversial. The front page of the October, 2011 issue of the Psychiatric Times, a newsletter for psychiatrists, blared in large bold print the headline of an article, “Antidepressants: Lifesavers—or Active Placebos?”
In short, after more than 7 decades of antidepressants, each one touted like automobiles or deodorants as better than the others, more than 43 million Americans remain depressed and/or dependent upon these drugs. No wonder psychiatry considers depression to be a chronic and incurable illness, the definition of which is an illness that they cannot cure.
B-b-but, some might counter, since a chemical imbalance causes depression, don’t we need to take a chemical drug that corrects said imbalance? As noted in my previous post about the myth of chemical imbalance, no evidence exists that implicates any biochemical abnormality as the cause of most depression, including serotonin deficiency, which is B.S promoted by Big Pharma to sell SSRI antidepressants.
Consider contemporary psychiatry’s failure, despite its pretensions, to deal with depression, one of the two major problems it faces (the other is anxiety, with comparable results). Psychiatry’s inadequacy in this regard compares with that of a Japanese chef who can’t cook rice or with a color-blind painter.
Buckminster Fuller said, “You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.” We need a new model to replace the fraudulent and ineffectual enterprise that is contemporary, pharmaceutically-based psychiatry.
Be well.
Another terrific article that hits home. Years ago, I met a psychologist who worked for the VA with the tough PTSD patients. I was struggling with some things and started seeing him as a private patient. We talked (actually I did the talking) and without any drugs. W ith a commitment of several years, I was like brand new. Drugs are a band-aid. It's amazing what you don't even know you are thinking, until you have someone sitting across from you and just looking at you. The silence makes you talk. Facing your own reality by talking is the cure.
I always appreciate rebel Psychiatrists, and add you to my growing list. As for alt treatment models, I follow Dr James Greenblatt who attends to all underlying nutritional imbalances and gut health, in conjunction with traditional BigPharma meds. I have believed for decades that all our clients should be treated for their nutritional deficiences at commencement.