Debate | Does current evidence support the use of antidepressants for major depressive disorder?

Date and time: 26 Mar 2022 from 11:30 to 12:30

Location: Virtual  

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:

Learning Objectives

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

 

Abstract Submission

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.

Literature References

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

1. Do you have a relationship with a for-profit and/or a not-forprofit organization to disclose?

Yes

2. All other investments or relationships that could be seen by a reasonable, well-informed participant as having the potential to influence the content of the educational activity

I am chairperson of the Critical Psychiatry Network, an informal organisation of critically minded psychiatrists.

3. Patents on a drug, product, or device

None

4. Funded grants or clinical trials

I am Chief Investigator for an NIHR (UK government) funded trial on antipsychotic reduction and a co-investigator on a trial of antidepressant discontinuation

5. Membership on advisory boards or speakers' bureaus

I am board member of the Council for Evidence based Psychiatry (CEP) a non-profit organisation

6. Any direct financial payments including receipt of honoraria

None

7. I acknowledge that the National Standard requires that any description of therapeutic options utilize generic names (or both generic and trade names) and not reflect exclusivity and branding.

Yes

8. I intend to make therapeutic recommendations for medications that have not received regulatory approval (i.e., "off-label" use of medication). Note: You must declare all off-label use to the audience during your presentation

No

9. By clicking "I agree", you are acknowledging that the information provided is accurate and that you understand that this information will be publicly available.

I agree

 

Prof Ian Anderson MRCP(UK), MD, FRCPsych.:

Learning Objectives

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

 

Abstract Submission

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.

 

Literature References

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

1. Funded grants or clinical trials

None

2. Membership on advisory boards or speakers' bureaus

None

3. Any direct financial payments including receipt of honoraria

None

4. I acknowledge that the National Standard requires that any description of therapeutic options utilize generic names (or both generic and trade names) and not reflect exclusivity and branding.

Yes

5. I intend to make therapeutic recommendations for medications that have not received regulatory approval (i.e., "off-label" use of medication). Note: You must declare all off-label use to the audience during your presentation

No

6. By clicking "I agree", you are acknowledging that the information provided is accurate and that you understand that this information will be publicly available.

I agree