Depressing News

About antidepressants.

Some years ago, I was at a psychiatry conference and sat through a lecture by one of the big beasts of the psychiatric jungle, on his favourite obsession, how everybody should be taking antidepressants. He ended with the usual mantra: “Psychiatry is making enormous progress in understanding the neurobiology of depression. We stand on the cusp of dramatic improvements in our ability to provide rapid, lifelong protection against this, the biggest cause of disability in the world.” The audience burst into animated applause but the speaker didn’t bother with questions. Obviously fired up by what I felt was just propaganda, the happy throng filed out for morning tea. While waiting to leave, the chap next to me said: “That’s very exciting, isn’t it. I already prescribe antidepressants to 80% of my new cases, what about you?” I hadn’t really thought about it: “Maybe 1-2%,” I replied. He gave me the sort of look you would give your neighbour’s mangey dog and edged away.

Since then, the rate of prescription of antidepressants has gone up and up, currently about 16% of the adult population in this country, with rapidly rising rates among teenagers and children. This week, these drugs are back in the news but not in a way that would thrill the renowned speaker mentioned above. Over the past few years, prescription rates among adolescents for the biggest group, SSRIs, have risen by no less than 67%, mostly in girls, with no sign that this is likely to reduce. The trouble is, as critics have been saying for years, the evidence that these drugs are safe and effective for this group simply isn't there. First, as publicised a few years ago, the so-called “chemical imbalance model” of depression has been shown to be a myth. Second, the evidence on which they were approved in the first place was shown to be seriously deficient. Third, as mentioned, they aren’t doing the job they’re supposed to do: the more the drugs are prescribed, the higher the rates of depression and of suicide. Next, while 40% of people prescribed them soon stop them because of side effects or no response, the remaining 60% take them for years, if not decades. This matters because, 35 years ago, they were approved on the basis of mostly eight week trials.

This leads to the next point, side effects, short term and long term. For twenty years, prescribers have been warned that these drugs increase suicidal ideas and/or impulses among adolescents, but they also induce “manic states,” i.e. intense agitation with various other symptoms in about 10-15% of people. These appear to be associated with homicidal thoughts or actions in some cases. However, many serious side effects don’t emerge until months or even years later. Everybody who has taken them knows about the weight gain and the sexual side effects. Weight gain starts after about 2-3 months (conveniently after the drug trials have ended) and continues relentlessly. It always seemed to me that they didn’t just stimulate the appetite, even forcing people to get up at night and gorge, but they altered the body’s metabolism such that it was nearly impossible to lose weight while taking them.

The sexual side effects, however, were immediate: near-total loss of interest and arousal, with diminished or even failed orgasm, and impotence and ejaculatory failure for men. Finally, while there is still some argument over whether these drugs are actually “addictive,” there is no doubt that they provoke a fearsome state of dependency, such that many people simply can’t stop them. Their defenders say they aren’t addictive as they don’t induce a state of euphoria but tobacco, the most addictive drug of all, doesn’t make smokers drift off in bliss either, so we don’t take that seriously. What counts is that coming off them can be very uncomfortable/dangerous so people have to taper them very slowly. Now, however, 35 years after they were introduced, the evidence for serious long-term side effects is piling up.

A detailed study from Britain a few years ago showed that long-term use of antidepressants is significantly associated with cardiovascular disease and early death from all causes. This directly contradicts the usual cry of the drug pushers that “antidepressants save lives.” They don’t. A healthy lifestyle saves lives, and these drugs don’t promote it. We know that exercise has a powerful antidepressant effect, so that should always be tried first. It never is. There is also a possibility that these drugs provoke sudden cardiac deaths, but this is a fairly uncommon event so it would only be revealed by a large-scale, long-term study, which drug companies never undertake. Is it a direct drug effect, or do the drugs cause another effect, such as diabetes, that then precipitates the heart disease? There was a large-scale, long-term study of the effects of diabetes in the US but, after about 30 years, the DOGE mafia have chopped it. The drug company people will be happy about that, the last thing they want is anybody looking closely at their chemicals, especially after they’ve taken such efforts to conceal the side effects.

One potential side effect that definitely takes a long time to emerge is the risk of dementia. As the population ages, so the rate of dementia rises: since people aren’t dying young of infections, heart disease and treatable cancers, they enter the age group where dementia becomes more common. For dementia sufferers and their families, it’s a terrible condition but for the community, it is a huge and rapidly growing cost burden. Anything that could possibly prevent it or delay it needs to be examined very closely. We know that regular steady exercise slows age effects on the body and the brain, while regular mental stimulation and exercises can retard cognitive decline, but what about drugs? Can avoiding drugs delay the onset of dementia? Oh yes, people reply, alcohol is a potent brain toxin, and all the others, weed, amphetamines and so on, terrible things. Actually, we’re looking at prescription drugs, such as antidepressants and antipsychotics. A Swedish study published a month ago showed that dementing patients prescribed antidepressants decline faster than those who weren’t taking them (Scandinavians are very good at this sort of research). This is a dose-related effect: the longer people take them, and the higher the dose, the more they will decline cognitively. Also, the more severe the dementia when they are first prescribed, the faster they decline. Antidepressants contributed to other causes of death such as pneumonia, or injury such as fractures which are often fatal in the elderly.

Perhaps I missed something because I would never prescribe antidepressants for a dementing person. I may have mentioned an event years ago in a Veterans Affairs hospital, where our patients were almost all elderly. A new resident doctor arrived who made it fairly clear he didn’t think much of psychiatry. After a month or so, he burst out: “I don’t get this. We have all these confused and depressed patients come in, you do nothing, all you do is stop their drugs and they get better.” “Yes,” I said, “that’s right.” Keep them occupied, keep them in company, physical exercise, regular diet and sleep, hide the drugs, and they got better. The risk of a confusional state or a fall with antidepressants was too high to be worth the slight benefit of a marginal improvement in mood. Anyway, does long-term use of psychiatric drugs actually contribute to dementia? We don’t know. It would need a very big, long-term, controlled study with heaps of brain scans, psychology tests and autopsy reports, and that isn’t going to happen any time soon. As a question of physiology, there’s no reason why they shouldn’t, but too many psychiatrists have invested too much of their careers and egos to have a landmine like iatrogenic dementia explode under their feet.

As for sexual side effects, one way I was able keep my prescribing rate for antidepressants low was simply to tell people the side effects: “First, they cause weight gain. You will gain weight, sometimes a huge amount, and it will be almost impossible to lose it while you’re taking the drugs.” About half the people immediately said “No way, I’m not taking them. My self-esteem is bad enough without looking like a beached whale.” Some shrugged so we moved on: “Next, they can cause drowsiness or slow reactions, so if you’re driving trucks or operating fast machinery, you have to notify your employer.” That knocked out another 20% of the candidates (I worked in a working class area). Finally, we pull out the big gun: “They will cause a reduction in your sexual interest and performance, which can range from mild to severe, meaning essentially no interest, and even if you stop the drugs, it can persist for years. There’s no treatment.” That was it: “Are you kidding me? Why are they allowed to sell them? No way. Show me the couch, I’ll talk, I promise.” Adverse sexual side effects are one of the main reasons people stop the drugs within a few months. Unfortunately, stopping them doesn’t always relieve the side effects.

People who are given a full list of the side effects of antidepressants will mostly refuse them. David Healy, a psychiatrist in Wales, has produced a video on what is now called Post-SSRI Sexual Dysfunction, or PSSD. In a brief paper from a few years ago, he looked at the history of adverse sexual side effects of these drugs, in particular, how any suggestions of problems were suppressed for decades (well worth reading). This wasn’t an accident: since people generally won’t talk about sexual side effects unless specifically asked, nobody counted them. Also, it was normal to blame the depression, not the drugs. And so we come to the latest and probably scariest news but first, a brief excursion into medical history.

In 1950, two young statisticians with the UK Medical Research Council, Richard Doll and Bradford Hill, published a paper on the dramatic rise in deaths due to bronchogenic cancers. Previously, it had been uncommon but their figures showed that as the consumption of tobacco rose during the first half of last century, so, a decade or so later, the incidence of lung cancer began to rise, and rise:

… in the quarter of a century between 1922 and 1947 the annual number of deaths recorded increased from 612 to 9,287, or roughly fifteenfold … rate per 100,000 in 1901-20, males 1.1, females 0.7 ; rate per 100,000 in 1936-9, males 10.6, females 2.5 [1].

Initially, they thought this might be due to the spread of motor vehicles and tarred roads but it soon became clear that smoking was the culprit. Their methods are still regarded as models for epidemiology but – I’m tempted to say “remarkably” but that’s not true, the correct adverb is “predictably” – predictably, the medical establishment, 80% of whom smoked, was hostile to their conclusions:

The (1950) paper obtained much less publicity than we had expected. Senior clinicians and cancer research workers advising the Ministry of Health were, for the most part, unconvinced of the causal relationship and they advised against publicizing the findings for fear of scaring people …That chronic bronchitis was not then thought to be related to smoking is now almost incomprehensible; but the cough that smokers so often had was called a (benign) “smoker’s cough” and patients with chronic bronchitis used to light a cigarette first thing in the morning, in the absence of contrary medical advice, to help clear their chest. [2, p5; emphasis added].

That’s true, I remember people saying it. History shows that the tobacco industry fought back tenaciously, leading to what is still known as the “tobacco industry playbook” which other industries have adopted, especially asbestos and fossil fuels. But back to the present. The point here is that the first evidence of the relationship between smoking and lung cancer was just a couple of lines on a graph [1, p746]:

Now wouldn’t it be interesting if somebody could show the same sort of graph associating the rise in consumption of antidepressants and a sudden rise in a condition that was previously rare? Well, it’s happening. The association is between SSRIs and … wait for it … the explosion in the numbers of teenage girls and young women who report themselves as experiencing “gender dysphoria.” The first two articles (here and here) in a summary by Roger McFillin, a well-known psychologist in the US, indicate very clearly that this has to be taken very seriously as, just as the tobacco industry did, the drug industry will fight tooth and nail to prevent anybody concluding that psychiatric drugs could have this sort of effect. McFillin sets out his case neatly so I won’t try to summarise it. He concludes:

Given what we now know about SSRI-induced sexual dysfunction, emotional blunting, and identity disruption, continuing to prescribe these drugs to adolescents represents an ethical failure. We wouldn't accept such risks with other medical interventions for non-life-threatening conditions in children. Why do we make an exception for psychiatric medications? The time has come for a moratorium on SSRI prescriptions for children and adolescents. Simultaneously, we must require research that focuses on:

Understanding the long-term effects of early SSRI exposure on identity development

Investigating the potential link between SSRI use and gender dysphoria

Developing protocols to safely taper adolescents off these medications.

I totally agree: at this stage, even if there’s only one chance in a thousand that this is true, a major international study is mandatory. However, as Doll and Hill discovered, the perverse resistance of the medical profession should not be underestimated. Fortunately, as Doll recounts in his commentary from 2000, they found an ally: the editor of the BMJ. At the time, they were planning a second study of regional England:

Before the second phase of the study could be completed, however, Wynder and Graham reported similar findings in the United States, the findings in the second phase were pointing in the same direction, and there was no reason to wait any longer. With the willing help of the editor, our London results were consequently published in the British Medical Journal two months later [2, p5].

What are the chances of finding a helpful journal now? I don’t think they’re good at all. The psychiatric publishing industry has a poor record of self-criticism, plus it’s heavily dependent on the drug industry for advertising revenue so, if antidepressant (and other drugs) do contribute to gender dysphoria, any help they offer would be very unwilling. A small example from a few months ago is relevant.

Some years ago, the RANZCP published a set of clinical guidelines relating to treatment of mood disorders [3]. Predictably, it was heavily oriented toward drugs, which provoked a big argument over the role of long-term psychotherapy in managing these conditions. After a great deal of bickering, the College commissioned a review by the Anna Freud Centre, in London (don’t ask). Some years later, the review came back but (equally predictably), two of the authors of the original guidelines didn’t like it. Seeing one of them was a former editor of the Australian and New Zealand Journal of Psychiatry, their critique of the Freud Centre report was published as an editorial in the journal, which gives it a weight it would not otherwise have. They made a claim which I thought was not just wrong, but dangerously so, so I knocked out a letter to the editor. After several months of to and fro, it was rejected. Their editorial is now firmly part of the psychiatric literature, as my objections are unrecorded:

In an editorial objecting to the process and conclusions of the review by the Royal Australian and New Zealand College of Psychiatrists (RANZCP) into long-term psychodynamic psychotherapy (LTPP) for mood disorders, Kisely and Malhi concluded: “In the 21st century, facts should be established through rigorous scientific enquiry, not popular vote” (Kisely and Malhi, 2025: 7). This is a little surprising as psychiatry’s nosological process is routinely determined by votes in the many committees involved. At the back of the current version of the Diagnostic and Statistical Manual are about twenty pages, each with two columns of names of the people involved, thousands in all. Each of these has a vote in what is an intensely political process. Notoriously, homosexuality was a considered a mental disease until, after a series of acrimonious meetings, a vote by the APA Board of Trustees determined that it wasn’t. This is not surprising: since psychiatry lacks biomarkers for the conditions it manages, what else is there beside the opinion of practitioners? Voting determines everything in psychiatry.

As for “rigorous scientific enquiries,” Position Statement No. 80 of the RANZCP, currently in force, states:

Medical expertise: Psychiatrists apply their medical knowledge, specialist clinical skills and acumen in the provision of person-centred care. They understand the impact of ‘biological’, ‘psychological’ and ‘social’ factors on mental health and the causation of mental illness. This ‘bio-psycho-social’ model is a holistic approach that recognises the impact of social adversity and physical health on mental well-being (RANZCP, 2013).

In a letter, the current president stated: "... the biopsychosocial model (is) ...the predominant theoretical framework underpinning contemporary psychiatry ... a relevant and useful component of training and practice ... " (Moore, E. correspondence, Nov. 20th 2023).

This is important: backed by the authority of the board of directors, this essentially defines psychiatrists as people who study and practice according to a particular model. There has, however, been no formal enquiry, rigorous or otherwise, by the RANZCP into the status of their favourite model. The only enquiry to date shows that it does not exist and that continued use of this spurious model as self-justification probably amounts to scientific fraud (McLaren, 2024: Chap. 5). The Position Statement was adopted by a vote without appropriate investigation, and attempts to rectify this have since been resisted, quite bitterly at times, by successive boards of directors and editorial boards.

In my view, the editorial shows another tendency of institutional psychiatry: to spin a false narrative that psychiatry has an adequate scientific basis when, as a matter of demonstrated fact, it lacks the essential element of any field of science, a model of its subject matter (McLaren, 2024). (references at end)

Psychiatrists are masters at spinning false narratives (see Andrew Scull’s commendable history [4]) but this takes the cake. What they’re saying is that their opponents have to follow “rigorous scientific enquiry” but they don’t, they can lay down the law by a vote, very often conducted in secret by an essentially self-appointed cabal, yet complaints about their methods will not be published. In my view, and in the view of most non-psychiatrists, the mere mention of the word “fraud” should throw the entire field into panic, leading to a meticulous, impartial investigation, but nothing happens. Like the tobacco companies, and the asbestos miners and fossil fuel floggers, their attitude is “We’re experts, who are you to question us?” Perhaps they believe they follow “rigorous scientific enquiry, not popular vote,” but self-delusion is no defence. The evidence is there, all they have to do is find the courage to pick it up.

35 years ago, when SSRIs were introduced, governments should have insisted on proper studies to determine long term side effects, but nothing was done. Apart from showering money on their “key opinion leaders” in psychiatry (aka influencers), the drug companies took their monstrous profits and ran. If and when the question of gender dysphoria and antidepressants becomes public, we should not expect the drug companies and their (very willing) captive academics to tell us whether they’re safe or not (they’ll probably say “There’s no evidence,” but that’s because they chose not to collect it). If this statistical association turns out real, just as smoking and cancer did, then it could easily spell the end of psychiatry as we know it. Nobody could ever trust again.

References to main text:

1. Doll R, Hill AB (1950). Smoking And Carcinoma Of The Lung: Preliminary Report. Brit. Med Journal, 2, (4682): 739-748.

2. Doll R (2000) Smoking and lung cancer. Am J Respir Crit Care Med 162: 4–6.

3. Malhi GS, Bell E, Bassett D, et al. (2021) The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust NZ J Psychiat. 55: 7–117.

4. Scull A (2022) Desperate Remedies: Psychiatry and the mysteries of mental illness. London: Penguin.

References to quoted letter:

1. Kisely S, Malhi G (2025): Concerns over the process and outcomes of the review by the Royal Australian and New Zealand College of Psychiatrists into long-term psychodynamic psychotherapy. Aust NZ J Psychiat. Published online Dec 24, 2024; https://doi.org/10.1177/00048674241308371.

2. RANZCP (2013). Position Statement No. 80: The role of the psychiatrist in Australia and New Zealand. RANZCP Website. Accessed Nov 3rd 2023.

3. McLaren N (2024). The Biopsychosocial Model: the Claytons model for psychiatry. Chap. 5 in Theories in Psychiatry: building a post-positivist psychiatry. Ann Arbor, MI: Future Psychiatry Press