Antidepressants: the Forever Drugs
Just get used to it.
These posts examine modern psychiatry from a critical point of view. Unfortunately, mainstream psychiatrists usually react badly to any sort of critical analysis of their activities, labelling critics as “anti-psychiatry,” whatever that is. Regardless, criticism is an integral part of any scientific field and psychiatry is no different. As it emerges, there is a lot to be critical about.
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In the post on November 11th, I described how the local college of psychiatrists have decided they need to do something to improve the average psychiatrist’s thought processes. A course on “critical thinking” will make them compassionate, rational, balanced and unbiased, and prepared to challenge the status quo, the implication being that these qualities are somewhat lacking now. I saw lots of problems with their little course and have submitted a paper to one of the journals pointing out some of them. They’ll reject it, of course, they like to talk about criticising the party line but are hostile to anybody actually doing it. Anyway, it keeps me busy but I think the timing of this little exercise is interesting. After decades of telling everybody that they’ve got mental disorder cornered, all they need is a bit more time and money and they’ll roll out the definitive cure, it seems they may be having second thoughts.
We’ve already seen how the narrative of “psychiatry unlimited” has been crafted by drug companies manipulating their research to give the results they need in order to sell their chemicals [1,2], and how psychiatrists have aided them by actively minimising the adverse effects of these very powerful drugs, including their addictive properties [3,4]. The end result is more and more people taking more and more drugs for more and more of their lives, suffering more and more side effects and dying earlier. It is entirely based in the narrative that mental disorder is brain disorder and therefore needs a physical cure. There is no proof of this idea, it has no basis in science and no more substance than an aspiration [5]. However, it’s the sort of simple and uncluttered notion that soothes the general population, elevates psychiatrists in public esteem and comforts politicians who need somebody to reassure the public that all the insane axe murderers roaming the streets are under control.
Perhaps we could get used to the idea of organic mental disorder if the actual disorders were precisely defined, but they’re not. The entire diagnostic system is based on a false concept: that all mental disorders fall into discrete categories that can be reliably classified in such a way as to determine both treatment and the research program. The plan is that each clinical entity will map down to the genome to yield a unique genetic fault to be corrected by specific drugs or physical treatment such as ECT. Life experiences are of little or no significance in the causation of mental disorder [6]; while they may concern the patient, they don’t alter treatment.
If this were true, life would be pretty good. We could quickly work out the incidence of each disorder in the community and make proper provision for it, just as we make provision for say amputations, cancers or infections. There is, however, another factor that isn’t taken into consideration: capitalism. Each of the markets for prostheses, cancer surgery and antibiotics is strictly limited by the numbers of cases. People may try to stretch it to their advantage but in general medicine, that ploy rarely works. Psychiatry, however, differs in that the size of any particular drug market isn’t determined by biology, but by the players. These include the general public, the psychiatry and drug industries, and the political class. Two of those players stand to make lots and lots of money if they can convince the others to let them loose.
We can dispense with the last one fairly easily: apart from making sure it doesn’t hit the evening news, politicians have no interest whatsoever in mental disorder. They don’t want to know about it so anybody who promises to keep things quiet will get the contract. Second, there’s the general public who can be easily swayed into acting against their own interests. They don’t know anything about mental disorder except that it’s scary, so anybody who says they do know how to deal with it will get their vote. This means that, armed with their heavy-duty drugs, the endless flow of money from the drug companies and their long history of “dealing firmly with the insane,” psychiatrists are in pole position in that race. Regardless of what they may have to offer, nurses, psychologists and social workers can do little more than sit enviously on the sidelines and pick up the crumbs.
Given these factors, the race is to the swift. Because their diagnostic criteria are so loose and subjective and can be endlessly stretched to rope in more and more of the population, psychiatrists are off to a flying start. Acting in what neoliberalism calls their “rational self-interest,” and actively encouraged by the drug companies, existing diagnoses are expanded more or less without limit. The market for drugs inevitably gets bigger and bigger, that’s what capitalism does. So-called ADHD is a case in point. This started life decades ago as a rare condition of childhood called “minimal brain damage” or “hyperactivity.” That led to a sizeable market for ambitious psychiatrists, under-employed paediatricians and the watchful drug industry, and has now pulled in up to 15% of children. Aware that they had reached the natural limits for the diagnosis – there are many parents who don’t want their children on drugs – they took the predictable step of extending the diagnosis to adults.
That opened up vast new markets, to the extent that there is now a shortage of ADHD drugs in Australia (most of them are made in India and China). However, it’s again bumped into a limit in that there aren’t enough psychiatrists to satisfy the demand for the diagnosis. Perhaps that has something to do with the outrageous fees they are charging, over $3000 for a couple of questionnaires and a brief chat, so Queensland has taken the next step in authorising general practitioners (GPs) to diagnose ADHD in adults and start a lifetime of treatment with highly addictive drugs. That means people can walk in with the results of an on-line questionnaire and demand the drugs. And they will get them, if not from the first GP, then from the second. The final step will be to put them in vending machines on street corners, then we can have half the population wandering around high. Which is more or less what is happening with antidepressants.
The clinical impression is that people are taking these drugs for much longer than is justified, up to 25yrs or more. They have a lot of side effects, including weight gain, sexual dysfunction and general emotional numbing, but possibly the most damaging is addiction. We know that because of side effects or lack of effect, about 40% of people who are prescribed them don’t continue beyond a few months. However, once they go beyond about 6 months, they find that attempts to stop them result in strange and very unpleasant symptoms. As a result, and urged on by their doctor, they resume them to “prevent the illness coming back.” The study by psychologist John Read and his group [3] found about two thirds of people trying to stop the drugs experienced withdrawal effects which could be severe and lasted several years, so they often had no choice but to resume them.
A study published last week used the Australian Pharmaceutical Benefit Scheme’s (PBS) huge database to analyse who is getting these drugs and for how long [7]. Ranwala and team took figures on antidepressants for 10 years starting in January 2014, covering everybody from age ten up. Long-term use was defined as twelve months. Naturally enough, there are big problems trying to work out who has been taking what using prescription data only. The ideal would be a prospective study, i.e. enrolling everybody who is commenced on the drugs for a period (say one year) and following them for 10 years but people want quick results. Anyway, they extracted a lot of important figures that need to be widely known.
About 13% of the population had a prescription dispensed at any stage. Their first finding was that, over the ten year period, the numbers of people taking the drugs long term rose from 66 per thousand population to nearly 86 per thousand, about 30% increase. Nobody can claim there was a 30% increase in depression in that time. Females took the drugs long term at almost twice the rate of males, nearly 110/1000, or 11% of the population, while males peaked at 6%. The highest proportion of long-term users was among the elderly, 75% of them had taken antidepressants an average of three years. This is despite all the evidence to say that psychiatric drugs and the elderly don’t mix at all well. Of more concern was the figure for young people, aged 10-24, who showed sharp increases in the numbers taking them and of those taking them long term. More young people are taking antidepressants, and more of them are having difficulty stopping them to the point where they give in and just take them. And, of course, more and more are finding that the sexual side effects of SSRI drugs, ranging from inconvenient to disabling, don’t wear off [8]. While that probably doesn’t bother a 70 yr old, at twenty, it can be devastating (for a recent biological account, see here at MIA).
The great majority of these drugs were started by GPs; most patients had not seen a psychologist or psychiatrist; and a lot of them weren’t even prescribed for depression. The market just keeps growing and growing, which is great for the drug companies but everybody overlooks three important warnings. First, almost all of these drugs were approved on the basis of studies lasting 6-12 weeks, many of which were seriously flawed, if not frankly manipulated to give the results the drug companies wanted [9]. Second, we have no idea what effect they will have on the human brain over 30, 40 or 50 years, especially where they were started as a young teenager when the brain is still developing. What happens if they predispose to dementia, which is perfectly feasible? It took a hundred years for people to realise smoking was dangerous. Will the drug companies pay compensation? Fat chance of that.
Finally, the idea that 15% of the population needs to be taking these drugs in the first place is absurd. Thirty years ago, it was about 3%; twenty years before that, it was zero. What’s happened to the suicide rate since then? Well, it’s gone up, as has the rate of people on disability pensions for depression. If the drugs were any good, if they actually reduced depression, those figures should have gone down, not up. Why are drugs seen as the first line of treatment? The authors concluded:
Existing research has identified significant barriers to the wider implementation of non-pharmacological interventions in mental health, including inadequate funding, limited human resources, negative attitudinal barriers and insufficient awareness.
In English, that means it’s cheaper to prescribe drugs than to see a psychologist; there aren’t enough people trained to deal with it, and, more to the point, attitudes and ignorance. Everybody now thinks that whatever the problem, drugs are the answer. That didn’t happen by chance, it’s the outcome of decades of propaganda such as the signs in public toilets: “Feeling depressed? Go and see your doctor” (who will give you drugs that make you fat and limp). Manifestly, there is something seriously wrong with the model of mental disorder that has been sold to governments and to the general population, and it’s just this: there isn’t a model. Mark Horowitz, co-author of the Maudsley Deprescribing Guidelines [4], was perfectly clear:
It’s not an evidence-based statement to say that depression is caused by low serotonin; if we were more honest and transparent with patients, we should tell them that an antidepressant might have some use in numbing their symptoms, but it’s extremely unlikely that it will be the solution or cure for their problem.
The whole notion that (a) depression is the result of a physical disease of the brain for which (b) physical treatments are both necessary and sufficient as cures, is simply made up. It has no standing in an articulated model of mental disorder [5]. It is the result of clever marketing by drug companies and an arrogance overlying intellectual insecurity in psychiatrists. I think we’ll be paying for this for a long, long time.
References:
1. Le Noury J et al (2015) Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence. BMJ 2015; At: https://www.bmj.com/content/351/bmj.h4320
2. Gotzsche P (2013) Deadly Medicines and Organised Crime: How Big Pharma has corrupted healthcare. London: Radcliffe Publishing.
3. Read J, Cartwright C, Gibson K (2018). How many of 1829 antidepressant users report withdrawal effects or addiction? International Journal of Mental Health Nursing. doi: 10.1111/inm.12488
4. Taylor D, Horowitz M (2024). The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs.London: Wiley-Blackwell.
5. McLaren N (2024). Theories in Psychiatry: building a post-positivist psychiatry. Ann Arbor, MI: Future Psychiatry Press. Amazon.
6. Crouse J et al (2024). Patterns of stressful life events and polygenic scores for five mental disorders and neuroticism among adults with depression. Molecular Psychiatry (2024) 29:2765–2773; https://doi.org/10.1038/s41380-024-02492-x
7. Ranwala A et al (2025). Increasing Prevalence of Long-Term Antidepressant Use in Australia: A Retrospective Observational Study. Pharmacoepidemiology and Drug Safety; 34:e70267 1 of 10 https://doi.org/10.1002/pds.70267
8. Healy D (2020). Antidepressants and sexual dysfunction: a history. J Roy Soc Med, 113(4): 133–135. DOI: 10.1177/0141076819899299
9. Doshi P (2025). Notorious GSK paroxetine adolescent depression trial is slapped with expression of concern amid legal action. BMJ;391:r2279 http://doi.org/10.1136/bmj.r2279
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My critical works are best approached in this order:
The case against mainstream psychiatry:
McLaren N (2024). Theories in Psychiatry: building a post-positivist psychiatry. Ann Arbor, MI: Future Psychiatry Press. Amazon (this also covers a range of modern philosophers, showing that their work cannot be extended to account for mental disorder).
Development and justification of the biocognitive model:
McLaren N (2021): Natural Dualism and Mental Disorder: The biocognitive model for psychiatry. London, Routledge. At Amazon.
Clinical application of the biocognitive model:
McLaren N (2018). Anxiety: The Inside Story. Ann Arbor, MI: Future Psychiatry Press. At Amazon.
Testing the biocognitive model in an unrelated field:
McLaren N (2023): Narcisso-Fascism: The psychopathology of right wing extremism. Ann Arbor, MI: Future Psychiatry Press. At Amazon.
The whole of this work is copyright but may be copied or retransmitted provided the author is acknowledged.