Prof. Dr. Joanna Moncrieff & Prof Ian Anderson MRCP(UK), MD, FRCPsych. | Debate | ‘'Antidepressants don't clinically benefit most patients with MDD.'
Prof. Dr. Joanna Moncrieff:
Objective #1 To understand limitations of antidepressant trials and meta-analyses
Objective #2 To understand the psychoactive effects of antidepressant drugs
Objective #3 To understand how psychoactive effects and mental symptoms may interact
In my presentation I will argue that antidepressant trials show marginal differences from placebo that are clinically irrelevant and likely
to be explained by residual biases. I will argue that antidepressants are psychoactive drugs and that we need to understand their
psychoactive effects to understand how they are likely to influence symptoms of mental disorders, along with overall quality of life and
social functioning. I will suggest they are not useful, and we need an alternative approach to treating depression.
Moncrieff, J., & Cohen, D. (2005). Rethinking models of psychotropic drug action. Psychotherapy and Psychosomatics, 74(3), 145- 153. doi.org/10.1159/000083999
Moncrieff, J. (2018) What does the latest meta-analysis really tell us about antidepressants? Epidemiol Psychiatr Sci. 2018 Oct; 27(5): 430–432. doi: 10.1017/S2045796018000240
Raed, J. & Moncrieff, J. (2022) Depression: why drugs and electricity are not the answer. Psychological Medicine, in press
Disclosure of Conflict of Interest
I am chairperson of the Critical Psychiatry Network, an informal organisation of critically minded psychiatrists.
I am Chief Investigator for an NIHR (UK government) funded trial on antipsychotic reduction and a co-investigator on a trial of antidepressant discontinuation
I am board member of the Council for Evidence based Psychiatry (CEP) a non-profit organisation
Prof Ian Anderson MRCP(UK), MD, FRCPsych.:
Objective #1 Being aware of the issues involved in the debate about the clinical usefulness of antidepressants in MDD
Objective #2 Knowing how the efficacy of antidepressants compares with that of psychological treatment in MDD
Objective #3 Understanding limitations in the assessment of MDD using current depression rating scales
Whether or not antidepressants confer clinical benefit for most patients with major depressive disorder (MDD) continues to be a matter
of debate. This is in spite of broad agreement about the evidence provided by randomised controlled trials, which have been
predominantly undertaken by the pharmaceutical industry for commercial purposes. The disagreement lies in its interpretation.
In arguing for the clinical benefit of antidepressants in MDD I will first discuss their comparison with psychological treatments in terms
of benefits and harms, before taking a closer look at the assessment of depression, arguing that depression rating scales provide at
best a partial measure of the lived experience of depression (and benefit from treatment). I will show that non-commercial clinical trial
evidence supports the use of antidepressants as a first-line treatment for MDD.
Jakobsen et al (2020). Should antidepressants be used for major depressive disorder? BMJ Evid Based Med. 25:130
Kappelmann et al (2020) Psychotherapy or medication for depression? Using individual symptom meta-analyses to derive a Symptom- Oriented Therapy (SOrT) metric for a personalised psychiatry. BMC Med. 18:170.
Duffy et al (2019) Antidepressant treatment with sertraline for adults with depressive symptoms in primary care: the PANDA research programme including RCT. Southampton (UK): NIHR Journals Library; 2019 Dec.
Lewis et al (2021) Maintenance or Discontinuation of Antidepressants in Primary Care. N Engl J Med. 385:1257-1267.
Disclosure of Conflict of Interest