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The Depression Pill Epidemic

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ByProfessor Peter C. GøtzscheJune 4, 2019

In some countries, including the United States, about 10% of the entire population is in treatment with depression pills. This is a tragedy. These drugs do not have relevant effects on depression; they increase the risk of suicide and violence; and they make it more difficult for patients to live normal lives (1). They should therefore be avoided. We have been fooled by the drug industry, corrupt doctors on industry payroll, and by our drug regulators (1).

Surely, many patients and doctors believe the pills are helpful, but they cannot know this, because people tend to become much better with time even if they are not treated (1). This is why we need placebo-controlled trials to find out what the drugs do to people. Unfortunately, virtually all trials are flawed, exaggerate the benefits of the drugs, and underestimate their harms (1).

Cold turkey in the placebo group

Virtually all patients in the trials are already on a drug similar to the one being tested against placebo. Therefore, as the drugs are addictive, some of the patients will get abstinence symptoms (usually called withdrawal symptoms) when randomized to placebo, even if a wash-out period before randomization is introduced (1). These abstinence symptoms are very similar to those patients experience when they try to stop benzodiazepines. It is no wonder that new drugs outperform the placebo in patients who have experienced harm as a result of cold turkey effects.

To find out how long patients need to continue taking drugs, so-called maintenance (withdrawal) studies have been carried out, but such studies also are compromised by cold turkey effects. Leading psychiatrists don’t understand this, or they pretend they don’t. Most interpret the maintenance studies of depression pills to mean that these drugs are very effective at preventing new episodes of depression and that patients should therefore continue taking the drugs for years or even for life.

Lack of blinding

Because of the conspicuous side effects of the drugs, quite a few patients (and their doctors) know who is on the drug and who is on placebo (1). It does not take much unblinding in a trial before the small differences recorded can be explained purely through the bias in the outcome assessment on a subjective rating scale (1).

The smallest effect that can be perceived as an improvement on the Hamilton Depression Rating Scale is 5 to 6, but flawed trials attain only approximately 3 (1). Several meta-analyses have found that the effect is larger if the patients are severely depressed, but the reported effects are small and below what is clinically relevant for all severities of depression (2). Further, it is likely just a mathematical artifact that the effect seems to be slightly larger in severe depression (3). The bias caused by the lack of blinding will be greater when the baseline score for depression severity is larger.

The small effects of depression pills measured in flawed trials disappear if the placebo contains atropine, which has similar side effects to the pills—e.g., dry mouth (4).

Irrelevant outcomes

A score on a rating scale says very little or nothing about how well a patient is functioning. According to the American Psychiatric Association, major depression is present when the patient exhibits five or more of nine possible symptoms that “cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.” Given how the disorder is defined, it makes no sense that no effectiveness trials have used these stated outcomes (1).

Since these drugs have purely symptomatic effects, one highly relevant outcome is the patients’ conclusions as they weigh any benefits they have experienced against the harms, which they do when deciding whether to continue the trials to the end or drop out. Based on almost 70,000 pages of unpublished reports from drug regulators, we found that 12% more patients dropped out on a drug than on placebo, which means it is better to get placebo than a drug (5). It is remarkable that people preferred placebo even though some were harmed due to cold turkey effects.

We also wanted to study quality of life in the trials but discovered that even the clinical study reports were grossly unreliable (5). The degree of selective reporting within these reports was astounding, and drug regulators had done absolutely nothing to request the missing data from the drug companies, even though these reports are used in getting drugs approved.

There is no doubt that these drugs negatively impact the quality of patients’ lives, and we know, for example, that half of the patients experience disturbances to their sex life after starting the drugs (1).

Depression pills are also far more dangerous than people know. We found that they double the occurrence of events that can lead to suicide and violence in healthy adult volunteers (6); they increase aggression in children and adolescents by a factor of 2 to 3 (7)—an important finding considering the many school shootings where the killers were on depression pills; and they increase the risk of suicide and violence by four to five times in middle-aged women with stress urinary incontinence (8). Also, twice as many women experienced a core or potential psychotic event (8).

I have described the dirty tricks and scientific dishonesty involved when drug companies and leading psychiatrists try convincing us that these drugs protect against suicide and other forms of violence (1). Even the FDA was forced to give in when it admitted in 2007, at least indirectly, that depression pills can cause suicide and madness at any age (1, 9).

There is no doubt that the massive use of depression pills is harmful. In all countries where this relationship has been examined, the sharp rise in disability pensions due to psychiatric disorders has coincided with the rise of psychiatric drug usage (10), and depression pills are those which are used the most by far. This is not what one would expect if the drugs were helpful.

As these pills cannot cure anyone, it is immensely misleading to call them antidepressants, suggesting they are as effective as antibiotics for infections.


Professor Peter C. Gøtzsche, MD, co-founded the Cochrane Collaboration. He has published more than 70 papers in the top five general medical journals and six books, most recently, Death of a Whistleblower and Cochrane’s Moral Collapse. He recently launched the new Institute for Scientific Freedom with the goal of preserving honesty and integrity in science.


references

  1. Gøtzsche PC. Deadly psychiatry and organised denial. Copenhagen: People’s Press, 2015.
  2. Jakobsen JC, Katakam KK, Schou A, et al. Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and Trial Sequential Analysis. BMC Psychiatry (2017): 17-58.
  3. Gøtzsche PC, Gøtzsche PK. Cognitive behavioural therapy halves the risk of repeated suicide attempts: systematic review. J R Soc Med. 110(2017): 404-10.
  4. Moncrieff J, Wessely S, Hardy R. Active placebos versus antidepressants for depression. Cochrane Database Syst Rev. 1(2004): CD003012.
  5. Sharma T. Effects of selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) on suicidality, violence, and quality of life. Ph.D. thesis, defended 23 April 2019 at the University of Copenhagen. Available here.
  6. Bielefeldt AØ, Danborg PB, Gøtzsche PC. Precursors to suicidality and violence on antidepressants: systematic review of trials in adult healthy volunteers. J R Soc Med. 109(2016): 381-92.
  7. Sharma T, Guski LS, Freund N, et al. Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ 352(2016): i65.
  8. Maund E, Guski LS, Gøtzsche PC. Considering benefits and harms of duloxetine for treatment of stress urinary incontinence: a meta-analysis of clinical study reports. CMAJ 189(2017): E194-203.
  9. FDA. Antidepressant use in children, adolescents, and adults. Available here.
  10. Whitaker R. Anatomy of an epidemic. New York: Broadway Books, 2015.

Comments on The Depression Pill Epidemic

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Rachel HillJune 5th, 2019 at 12:21 pm

In the last 4-5 years that I’ve either been taking or teaching Crossfit, and in that same amount of time also reading the articles sent daily to my email, this is the first time I’ve ever truly felt compelled and somewhat disappointed with Crossfit for posting an article. I’m sure there are more that I’ve probably skimmed over in the past that are similar, but for some reason today this one just hit a chord within me in a very negative way. While I appreciate and can understand the importance of researching the differences in antidepressants vs. placebos, the side effects of some if not all of these pills, I think that it’s more harmful to post an article like this one because of both Crossfit’s Popularity and the article’s subtle implications that ALL antidepressants are “as effective for depression as antibiotics are for infections.” It really angers me that Crossfit would actually allow a post like this be associated with its brand, as someone who has battled with mental illness my entire life and has not only thrived by having an avid exercise regiment, but also taking an antidepressant daily for the last two years consistently due to depression along with PTSD/anxiety. To loop all antidepressants into a singular category of all being harmful to any given individual taking them is basically continuing to stigmatize those who are on these medications and thriving, and perpetuating the stigma on mental illness/health. Further more, for some individuals who follow the Crossfit prescriptions and recommendations to a T, how would Crossfit feel if, hypothetically, a bunch of athletes decide that, based on this article and ones before it, they no longer need their medication because they’ll “get better over time” without it? Ok. Maybe they will... but what if they don’t? What if they truly do need that medication due to their particular chemical makeup and imbalance? What happens if their mental illness gets worse? Again, I appreciate and support research for all of its results and information that it can provide us. But I encourage Crossfit to be better than this article; today you guys made me feel like it was my fault I’m “sick” because I’m continuing to take my medication. Fortunately, I’m wise enough to know that, while I may not always need it, I do for right now and that’s ok. If the author’s suggestions in this article have been misinterpreted, I do apologize. Perhaps next time think about what you’re writing a little bit more before publishing. Either way, this particular article is truly a disappointment to see being posted in my email.

Maria MaynardJune 5th, 2019 at 2:30 pm

Rachel Hill you said it perfectly! I was very much surprised at the tone and content of this piece and thought it contained information that appears reckless, if not dangerous. I also have an anxiety disorder and find that the combination of regular exercise and the use antidepressants has improved my anxiety issues, and I have no plans to stop this combination.

Olivia LeonardJune 5th, 2019 at 2:42 pm

Thank you for your thoughtful comment, Rachel. First: there should be no stigma associated with struggling with depression, or with those who take medication for its relief. Nowhere in this post or elsewhere on CrossFit.com will you find a disavowal of the realities of mental illness. The issue at hand is with the industries who profit from the real pain and difficulties experienced by those individuals who do battle depression and/or mental illness—industries that rush drugs to market, conceal or downplay side effects (including those that increase feelings of depression or suicidal impulses), or manipulate data to promise benefits that do not actually result from their products. As Marcia Angell pointed out in one of several posts previously run on CrossFit.com (which I recommend, as she has a thoughtful and expert perspective on this issue), a troubling majority of the influential psychiatrists entrusted with the care of the most vulnerable, in terms of their authority to define illness via the DSM or promote specific medications or courses of treatment, receive compensation from those same companies that profit from a rush to prescribe pharmaceutical care even in the absence of careful, accurate research. It would be irresponsible not to point out the risks and flaws of many of these treatments and the science behind them, along with the concerning conflicts of interests inherent in their development and promotion, especially with the widespread (and growing) usage of such treatments. I don’t believe, nor does Gøtzsche argue here, that all depression medication is unhealthy or wrongly prescribed, or that those who take it are weak or flawed, any more than a cancer patient is weak or flawed. Nor does this post prescribe specific individual action, such as getting off a course of medication. But in the same way that CrossFit has urged and undertaken a careful investigation into cancer research and pointed out the significant fault lines in our understanding and application of cancer’s origins and current therapeutic approaches, it seems important to turn that same critical eye toward psychiatric medicine, a field of practice and industry that has a tremendous impact on the lives of so many people. If we commit to scrutinizing the totality of the “Mess” that is the state of modern medicine—from initial research to diagnosis to prescription—and the powerful interests that act out of a desire for power or profit rather than out of concern for the wellbeing of the patient, it would be irresponsible to ignore psychiatry.

Nima AlinejadJune 5th, 2019 at 8:04 pm

Rachel, I hope no one takes this article as a "Mental Illness is all made up". Nor, that they should immediately stop their current antidepressant without consulting with a Physician first. The article points out one of the dirty secrets within Medicine, that we have evidence that shows antidepressants do not work nearly as well as we tell patients they do. There is a lot of blame and guilt in mental illness already. Patients feel it for having a diagnosis. We feel it on the provider side for not being able to do more sometimes. However, the Pharmaceuticals do not feel any guilt nor shame when their products do not work (yet market them as cures).

Rita MacleodJune 5th, 2019 at 2:43 pm

Boo CrossFit! Please don’t post polarized fear based articles about mental health. We as a community need to be able to have open conversations about our wellness. This article marginalizes and isolates people with depression, anxiety and other mental health conditions. It can be read and interpreted as ‘not only is something wrong with you, you’ve also made a bad choice is using antidepressants’

Ryan HorathJune 5th, 2019 at 5:04 pm

This is not a fair assessment. Dr. Gøtzsche is a major advocate for people with depression and mental illness. It is because of this that he is compelled to show people the scientific evidence behind these drugs is poor. Dr. Gøtzsche wants doctors to stop lying to patients. They tell them fairy tales that are not true to get them to take these drugs. For example, the commenter above mentioned "chemical imbalances". There is no such thing, and this theory has been so widely disproven that leading psychiatrists are now denying they ever supported the theory. Yet, somehow patients almost universally repeat this nonsense theory. Dr. Gøtzsche does not deny that depression is real or that some patients suffer from depression for a long time. What he says is that the scientific evidence does not support the use of these drugs - they are harmful. There is no doubt about this when you read the evidence. This article was likely posted on CrossFit because the evidence says that if anything is effective for depression, it is exercise and therapy. Neither one of those have the serious side effects associated with taking a foreign substance. Exercise comes with great positive benefits for your physical health as well as your mental health. Though again, neither exercise nor therapy are a panacea, guaranteed to cure all your mental health woes. It just does not work that way. But they do offer benefits, unlike antidepressant medication (which, as Dr. Gøtzsche notes, should just be called "depression pills").

Ryan HorathJune 5th, 2019 at 4:46 pm

The comments to the article so far are disappointing. Dr. Gøtzsche is one of the most well known members of the evidence-based medicine community. He is a co-founder of the Cochrane Collaboration - the scientific group that evaluates the efficacy and safety of medical treatments. Everything he states is supported strongly by the available scientific evidence. If you follow his references and read many of the books and papers listed, you will read some of the best scientific information available on this subject. The majority of people who take antidepressants will not be seriously harmed by them. In fact, as Dr. Gøtzsche notes, the majority of people will recover within some reasonable period of time. When they do so, they will almost without exception attribute their recovery to the antidepressant, even though the scientific data tells us this is not the case. Because depression can be such a difficult and trying experience in life, many of these people can develop very strong positive feelings about antidepressants that are not warranted, but nevertheless real. This human tendency is very much a part of the marketing of these drugs. The scientific data says they are on average harmful, yet the people who are unharmed often become emotionally invested in the myth around these drugs. They often see an attack on the drugs as an attack on their mental health, since they so strongly believe the drugs help them. I encourage anyone who reads this to follow the references and really dig into the science around antidepressants. These drugs have powerful effects on the brain. Their main effects are a result of causing dysfunction in the serotonin systems they interact with. Emotional numbing and sexual dysfunction are two of the most prominent characteristics, along with the risk of suicidal thinking - often manifested in a bizarre, compulsive manner. Some patients enjoy being emotionally numb - at least temporarily - but it does not cure or help depression. Rather, it makes you indifferent to your depression. The scientific data tells us one thing: that even if you believe the studies on antidepressants, they have shockingly low efficacy. But Dr. Gøtzsche gives some excellent reasons why we should not believe even these studies. The results are driven by biased ratings filled out by doctors who are proponents of the drugs. In the few cases where this bias has been peeled away, the (small) efficacy of these drugs disappears.

Kristen JacobsJune 21st, 2019 at 10:10 pm

You know what this article does a great job at? Making people who have had a great response to these drugs and have had to battle the stigma of mental illness feel again like they are crazy. I have had a great response to these medications and have battled a long time with the insecurities that having to take them cause. Exercise a lone will not cure depression and many people benefit from them. If Crossfit feels the need to dive into this topic they should be providing the information rather than providing click bate with half written and dangerous partial information. This is highly disappointing coming from an organization that I have in the past admired.

Shakha GillinJune 5th, 2019 at 6:41 pm

I frequently have patients (all kids) who come to me for emotional concerns. Some are depressed. I have to address the underlying causes. The stressors in these kids lives- the academic pressure, the lack of sleep, social pressures, overscheduling, nutrition, constant iPhone use, JUULing (a whole other modern day disaster), social media, and more. Starting a 15 year old who sleeps 6 hours a night, spends 4 hours on social media, and eats carbs all day on an antidepressant is bad practice. But kids are started on antidepressants everyday. Because it’s something we can do. Write a prescription. It’s easier for the doctor and patient. Maybe. Dog Prozac is on the rise. It’s seems less insensitive and more obvious to discuss SSRI’s for dogs. Dog Prozac is ridiculous. Dogs need a lawn and some love. They don’t need to be pigeon holed into a crate all day and then be medicated. There’s a major problem here. And the solution is not a pill. One factor affecting mental illness is nutrition. The common consumption of carbs and processed foods is excessive. There is long standing research and evidence that low fat/high carb diets affect mental well-being. Dr Michael Norden in Beyond Prozac discusses the direct relationship of the low fat/high carb diet to mental illness. Studies demonstrate the impact of sugar on depression. https://www.ncbi.nlm.nih.gov/m/pubmed/26109579/ We also have to evaluate the efficacy and side effects of any drug. Which Dr Gotzsche (and references) presents well in this article. While there may be a role for medical treatment in the acute stabilization of patients with severe depression, they have to be part of a multimodal plan which emphasizes lifestyle changes. It’s time to take a step back and take a better look.

Nima AlinejadJune 5th, 2019 at 7:56 pm

I am a CrossFitter. I am an Affiliate Owner. I have my CF-L2. I also happen to be a Family Physician and Psychiatrist. No one is arguing the validity or existence of mental illness, nor the burdens associated with mental illness. Dr Gøtzsche is a well respected and well pedigreed professional. This article is airing one of the dirty secrets within Medicine – that antidepressants really do not work. We have known this going back to 2008 (see Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials? by John PA Ioannidis available at https://peh-med.biomedcentral.com/articles/10.1186/1747-5341-3-14). Antidepressants separate out from Placebo (sugar pills) only in the most severe cases of Depression – yet they are the first line treatment in family practice, pediatrics, and mental health offices for everyone that walks in. The proof that they work is thin. And even in the most severe depressed patient, is not that antidepressants are more effective – it is that the statistical significance in the studies come from the placebo becoming LESS effective. Leaving the international scene alone, we currently have approximately one in nine Americans on an antidepressant (approximately 40 million people) – the original FDA studies for Fluoxetine (Prozac, the first “antidepressant”) which granted approval for Prozac as a safe and effective treatment for depression were based on 5 studies totaling 817 patients. Leaving unpublished negative studies, unregistered trails, p hacking, and the host of other manipulative things Pharma does to make profits (not cure disease) – the truth of the matter is we overestimate how well antidepressants work. We overestimate the efficacy of prescription antidepressants, increasing the profit of pharmaceutical companies – to the detriment of therapy and other modalities that have become overshadowed by the advertising campaigns of big pharma. Feel free to read up on Pharma and their adulteration of results to the detriment of public health. Start with https://en.wikipedia.org/wiki/Study_329 about Paxil (paroxetine). Again, CrossFit has never been about posting “polarized” articles as click bait. It goes back to the basic message CrossFit Headquarters has been working to promote “Let’s start with the truth”. As a Doctor, I agree wholeheartedly with Mr Glassman’s statement that “there’s something profoundly wrong with medicine… and it’s not going to get better until we acknowledge that reality.” Stop hiding the truth, as uncomfortable and shocking as it may turn out to be, as complicit as we Physicians end up being in that charade - and let us work to make medicine better for everyone.

Nicole SharpJuly 8th, 2019 at 4:52 am

Thank you for your response and investment in making our communities better.

Scott GillinJune 5th, 2019 at 9:50 pm

I for one am very grateful that CrossFit Health and Greg Glassman have decided to address the system errors that plague our current medical system leading to a rise in all sorts of chronic disease including mental illness. As Nima stated the motto of CrossFit Health is “Let’s Start With The Truth”. The truth is that mental illness and suicides are on the rise in this country. If pharmacotherapy was effective this should not be the case. Taking an antidepressant on a long term basis will not address the root cause of the depression anymore that injecting insulin will remove the effects of excess carbohydrate consumption. Every member of society needs to be a skeptic and learn to constantly question the status quo. The unfortunate reality is that most people do not know what kind of studies were performed to get a medication approved. In the modern era true scientific rigor has been neglected. Most studies are funded by the pharmaceutical industry, negative findings are not published and the leaders in the field are on the payroll of pharmaceutical companies. Dr. Gotzsche has dedicated his career to working to find the truth in medicine and has suffered personally for his dedication. It is never easy when our beliefs are called into question. However, it is important to keep an open mind and examine the arguments against the status quo that are being presented. The truth is that our current approach to treating most chronic diseases are failing. Medications address symptoms, not root cause, often with significant side effects and minimal effectiveness.

Eric BrownstoneJune 6th, 2019 at 7:11 pm

Brilliant work guys! It is a serious shame what is going on in America right now... Big Pharma is seriously doing us wrong.

shiloh pettyjohnJune 6th, 2019 at 10:09 pm

YES!!! This is a great article and it takes some real guts to spell out the truth on this topic. You guys have not only done a great job in expressing a genuine crime on the peoples effected by this but have done it in a way that is easily understood and accessible. Prescription drug use is OUT OF CONTROL. The quick fix / Magic Pill solution has resulted in the Big Pharma producing addictive drugs, that cause horrible side effects, long term damage to the health of our bodies and in most cases amplify the underlying problem. In addition to this being a problem of huge proportion for adults, its now adolescent children that are being put on these heavy drugs. Did you now that there are over 600,000 children aged 0-5 that are on depression pills in the US alone? Look it up! The data is out there. I hope that CrossFit.com produces more articles on this topic and uses its voice to create more dialog on this topic.

Scott L. RoyalJune 21st, 2019 at 6:07 pm

Thank you Professor Gotzsche for putting this in your article, "many school shootings where the killers were on depression pills". The ugly truth. We are not in the habit of peacefully living with our emotional selves, nor are we part of a society where my emotional self, really has a safe place for it's expression. Don't deal with the multi-generational emotional burden, medicate it. Add to that an emotional irresponsibility that spans many generations and the whole pill idea looks good. Until we re-read: "many school shootings where the killers were on depression pills". If one were to read from Dr. Kelly Brogan: https://kellybroganmd.com/rising-rates-of-suicide-are-pills-the-problem/?utmsource=Kelly+Brogan+MD+Newsletter&utmcampaign=c580f1f1cc-Rising+Rates+of+Suicide&utmmedium=email&utmterm=0_d0f977a8c5-c580f1f1cc-122115837 Or from Dr. Natasha Campbell McBride: http://www.doctor-natasha.com/gaps-book.php The truth is out there. Will you look at it?

Stan MillerJuly 20th, 2019 at 7:49 pm

On a broader yet critical note regarding Gotzsche's work, what's essential to see is that Gotzsche has not just exposed the corrupt pharma industry but orthodox medicine in general with their various non-drug interventions and treatments. For example, Gotzsche has been an extremely prolific opponent of mammography. Gotzsche's book "Mammography Screening: Truth, Lies and Controversy", along with the book "The Mammogram Myth" by Rolf Hefti (author's outline at themammogrammyth dot com), are the only two really extensive, independent works on the deep fraud of mammography. As such Gotzsche really exposes the business of conventional allopathic medicine and its government cronies as highly criminal. Which is backed by his ejection from Cochrane and the hospital he worked for many years, of course, for purely political reasons....