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Previous antidepressant use increased depression recurrence by three times in a new study on depressives.

Those who had been on long term antidepressant or lithium therapy for depression were the worst off

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A new study was just released in the Journal of Clinical Psychopharmacology details how antidepressants and Lithium may increase the risk of recurrent depression in patients who are on maintenance therapy for depression.

In the study the authors Amsterdam and Jay conclude: “These findings support prior evidence of a negative influence of the number of prior antidepressant treatment trials on the likelihood of response and suggest that the number of prior antidepressant trials may also be associated with a greater odds of depressive relapse and a shorter time to relapse.”

The study also showed that taking Lithium had a higher incidence in relapse of depression than those taking SSRIs, one of the most common mood stabilizers, described by some as a penicillin for bipolar.

Their study had 148 people with the Bipolar II diagnosis and who had recovered from a major depressive episode. They were randomly assigned to groups: one group took fluoxetine (Prozac) after recovery, one group took lithium, and one group took a placebo (fake pill).

SSRIs are typically given to bipolar 2 patients (but not bipolar 1 patients) as well as common mood stabilizers like Lithium. Bipolar 2 is characterized by extreme depression and only mild and infrequent hypomania.

In the study, half the patients on placebo relapsed back into depression, as well as about half the patients taking Lithium.

Recurrent antidepressant trials are common in psychiatry, as the newest practice is to simply shop the patient to different antidepressants until non-anhedonic symptoms lessen. Particularly after the STAR*D trial which argued that repeat antidepressant trials per patient was the best mode of antidepressant therapy, in order to find the best drug for the patient.

The researchers also found that those who did not take antidepressants were about three times less likely to have recurrent depression than those who took antidepressants.

Were those who took less antidepressants simply less depressed?

The researchers controlled for previous mental health history and baseline depression severity (as well as many other factors), meaning these results can not be explained away by saying that those who did not take antidepressants in the study were less depressed, because they were not.

The study suggests iatrogenic damage caused by long term use of anti-depressant drugs

The study stated that the evidence was “particularly disturbing” as it suggested anti-depressants caused harm to the brain over time. As those who took more antidepressants were more likely to have recurrent depression. The largest predictor of recurrent depression they found were those who had been on antidepressants before the study began. The word iatrogenic means, “illness caused by conventional medical treatment”, and is something researchers are constantly on the lookout for.

Amerstam and Jay in the study conclude that “some cases of resistant depression may be iatrogenic in nature and result from repeated or long-term antidepressant use.” This is not something the average psychiatric patient is told about, nor are there any societally sanctioned support centers or financial compensation available for such damage.

Long term use of antidepressants is common, suggesting widespread iatrogenic harm

More than a quarter of people on antidepressants have been on them for more than 10 years. According to the APA, 12% of the US population over the age of 12 has taken an antidepressant in the previous month. Given other studies with corroborate that long-term antidepressant use results in negative mental health outcomes compared to those with the same previous baseline depression severity who do not take antidepressants, we can estimate the amount of people currently being harmed by the drugs is enormous.

15.5 million Americans have been on antidepressants for at least five years.

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3 Comments

3 Comments

  1. reads the context

    August 25, 2019 at 2:30 pm

    You quote the paper as: “These findings support prior evidence of a negative influence of the number of prior antidepressant treatment trials on the likelihood of response and suggest that the number of prior antidepressant trials may also be associated with a greater odds of depressive relapse and a shorter time to relapse.”

    But the full quote is: “These findings support prior evidence of a negative influence of the number of prior antidepressant treatment trials on the likelihood of response and suggest that the number of prior antidepressant trials may also be associated with a greater odds of depressive relapse, and a shorter time to relapse, during antidepressant maintenance therapy in recovered depressed subjects with bipolar II disorder.”

    This actually isn’t surprising – it’s why mood stabilizers (such as lithium), not antidepressants (such as fluoxetine), are recommended for bipolar depression. But that doesn’t fit your narrative.

    • Marissa Bianchi

      August 25, 2019 at 3:36 pm

      In the study, it showed Lithium as having a higher depressive relapse rate than Prozac. Thank you for reminding me about that. I will add this to our article.

    • Marissa Bianchi

      August 25, 2019 at 3:57 pm

      You are incorrect about SSRIs and Bipolar 2. The study was on Bipolar 2 patients, and SSRIs are typically recommended in a clinical setting for Bipolar 2 patients due to extreme depression and only mild hypomania. Compared to Bipolar 1 which is characterized by depression and often *severe mania*.

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