Debunking the debunkers on the "myths" of antidepressants

By Maryanne Demasi, PhD and Peter C Gøtzsche, DrMedSci MD

Recently, The Conversation ran an article which claimed to “debunk” a range of myths about antidepressants such as selective serotonin reuptake inhibitors (SSRIs).

Natalina Salmaso, a clinical psychologist at Carleton University in Canada, highlighted five common myths that make people hesitant to take antidepressants.

Salmaso said hesitancy is often “unfounded” and “may not be grounded in science” and that “debunking the myths surrounding antidepressants is critical to permitting educated treatment decisions for those who suffer.”

However, Salmaso’s article was full of omissions and falsehoods, so we decided to debunk the debunker.

Myth 1 - I am stronger if I do this without meds

Salmaso says that a person with depression is like an athlete with a broken leg.

An athlete cannot compete effectively with a broken leg, in the same way a person with depression cannot function effectively, because their brain “is no longer responding to everyday life.”

She adds that a person’s brain needs to “heal” before they can expect it to function like they did pre-depression and implied antidepressants can help.

This is grossly misguided. This feeds into the false narrative that depression is a brain disease that can be cured by antidepressants.

Antidepressants don’t cure people with depression and their symptomatic effects are so small that they lack clinical relevance.

Studies show that patients actually do better with psychotherapy, which has enduring effects. Further, psychotherapy halves the risk of suicide whereas antidepressants double this risk, in people of all ages.

Myth 2 - I will be dependent on antidepressants to be happy

Salmaso says that antidepressants won’t make people ‘happy’ per se, but they “allow people to experience all emotions in an appropriate and balanced way.”

However, this is not what patients report. SSRIs tend to make people feel “numb” and unable to experience emotions. Some describe it as an inability to feel love, attachment or sexual excitement.

Some experience sexual dysfunction, which can continue long after the drug is discontinued.

Salmaso says that antidepressants “are a long-term (typically at a minimum for a year) and (hopefully) curative treatment, much like chemotherapy for certain types of cancer.”

This is also misguided. Most people become depressed because they have stressful or depressing circumstances, which no drug can cure.

People have been misled to believe that antidepressants can “correct” a chemical imbalance in the brain. A systematic review in 2022 thoroughly debunked the hypothesis that depression is caused a serotonin imbalance.

Salmaso even says that “most studies show that if you take antidepressant medications for a year before coming off of them, the majority of people will not relapse.”

This is also incorrect. The majority of studies on relapse are flawed because they involve subjects already on antidepressants and when they suddenly stop them for the trial they experience withdrawals, which interferes with the assessment of relapse.

Also, the longer someone takes an antidepressant, the higher the probability of that person experiencing withdrawal effects.

Myth 3 - Meds will change who I am, I will be different or feel high

Salmaso says that antidepressants won’t change you, but rather “allow you to view things from a more balanced perspective.”

However, Danish psychiatrists have reported that half of the patients on antidepressants agreed that the treatment could alter their personality and that they had less control over their thoughts and feelings.

Far from rebalancing the brain, antidepressants alter the normal functioning of the brain and disrupt biological processes with potentially devastating consequences.

As far as “changing who you are,” there have been ample reports of out-of-body experiences (including akathisia) where people became suicidal or homicidal on antidepressants, even in people with no history of this behaviour.

A systematic review found that taking antidepressants increased aggression three times more than taking a placebo, in children and adolescents.

Myth 4: I will become addicted

Salmaso says that antidepressants “are generally not addictive and have a low potential for misuse.”

This is not correct. Antidepressants can lead to dependency. Many people experience withdrawal symptoms, which are very similar to those that people experience when they try to come off benzodiazepines.

Salmaso claims that some patients get headaches and other withdrawal symptoms when the stop taking antidepressants “suddenly” but says they are “generally short-lived and can be minimised by tapering off treatment slowly.”

However, it is well-documented that about half of patients on antidepressants cannot stop them without experiencing withdrawals symptoms, which for some, can persist for many years. These symptoms are very difficult to “minimise” even with slow tapering.

Myth 5: Meds should only be used as a last resort

Salmaso disagrees that antidepressants should be used as a last resort.

She says that reserving antidepressants only for extreme cases “doesn’t make sense” because depression can reduce “work productivity and has immense societal consequences.”

“The financial repercussions that can be attributed to depression in terms of the number of workdays missed, jobs lost, accidents caused, etc. are enormous,” she added.

However, studies examining the efficacy of antidepressants have not shown any meaningful effects, such as improvements in quality of life, and they make it more difficult for people to function.

In all countries where this relationship has been examined, the increased use of antidepressants has been accompanied by an increase in disability pensions for mental health reasons.

Salmaso argues that, “Depression significantly increases risk of cardiovascular disease, gastrointestinal disease, respiratory disease and Parkinson’s disease, to name a few. It also seems to worsen the outcomes for cancer.”

Antidepressants do not improve these conditions either. Overall, it is our view that Salmaso’s evidence and arguments are flawed and misguided.

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My co-author Peter C Gøtzsche is a Danish physician who writes extensively about psychiatry and has published several books. Gøtzsche’s upcoming book is titled, “Is psychiatry a crime against humanity?”

In the video, Gøtzsche comments on the prescription of psychiatric drugs to children in the film “Medicating Normal” http://medicatingnormal.com/