A new study conducted by Jeffrey Vittengl at Truman University has found that taking antidepressant medications resulted in more severe depression symptoms after nine years.

The study, published in Psychotherapy and Psychosomatics, examined outcomes over a nine-year period and included initial depression severity as well as other factors. Vittengl divided treatment into categories and compared them to those who received no treatment:

inadequate treatment without medication (fewer than eight sessions of therapy)

inadequate treatment including medication (fewer than four appointments with prescriber)

adequate treatment without medication (at least eight sessions of therapy)

adequate treatment with medication (at least four appointments with prescriber)

Of participants with depression, 38.1% received no treatment, 25.2% received inadequate treatment with medication, while 13.5% received adequate treatment with medication. 19.2% received inadequate treatment without medication, and only 4.1% received adequate treatment without medication.

The results were startling. Even after controlling for depression severity, participants who took medication had significantly more severe symptoms at the nine-year follow-up than participants who did not. In fact, even people who received no treatment at all did better than those who received medication. “Adequacy” of treatment did not appear to make much of a difference.

These results add to a body of research that indicates that antidepressants worsen long-term outcomes. In an article published in 1994, the psychiatrist Giovanni Fava wrote that “Psychotropic drugs actually worsen, at least in some cases, the progression of the illness which they are supposed to treat.” In a 2003 article, he wrote: “A statistical trend suggested that the longer the drug treatment, the higher the likelihood of relapse.”

Previous research has also found that antidepressants are no more effective than placebo for mild-to-moderate depression, and other studies have questioned whether such medications are effective even for severe depression. Concerns have also been raised about the health risks of taking antidepressants—such as a recent study which found that taking antidepressants increases one’s risk of death by 33% (see MIA report).

In fact, studies have demonstrated that as many as 85% of people recover spontaneously from depression. In a recent example, researchers found that only 35% of people who experienced depression had a second episode within 15 years. That means that 65% of people who have a bout of depression are likely never to experience it again.

Critics of previous findings have argued that it is not fair to compare those receiving antidepressants with those who do not. They argue that initial depression severity confounds the results—those with more severe symptoms may be more likely to be treated with antidepressants. Thus, according to some researchers, even if antidepressants worked as well as psychotherapy or receiving no treatment, those treated with antidepressants would still show worse outcomes—because they had more severe symptoms in the first place.

That is why, in the current study, Vittengl included initial and follow-up depression severity in his analysis, as well as other variables that might provide alternate explanations for the results. This provides a direct counterargument to those who argue that initial severity confounds the results.

To this end, he used data from the Midlife Development in the United States Survey, which tracked depression severity as well as types of treatment utilized over the course of nine years. The data were collected in three waves (1995-1996, 2004-2006, and 2013-2014), and 3,294 participants remained in the study by the third wave.

The survey collected data on depression, generalized anxiety disorder, panic disorder, as well as other medical conditions, family history of mental health conditions, and childhood trauma. Additional data included personality factors, social support, daily functioning, and alcohol use. Because all of this information was included in the survey, Vittengl was able to add it in his analysis.

He found that although these factors impacted depressive symptoms, they did so equally between the groups. That is, initial depression severity does predict lack of improvement—but it does so whether the person is taking medication or not. Therefore, it does not explain how outcomes could be worse with medication.

Perhaps the most notable limitation of Vittengl’s study is his distinction between “adequate” or “inadequate” treatment based solely on the number of sessions (because that was tracked in the survey). This may not be the best indicator of whether participants were receiving sufficient care. However, this does not impact his general findings comparing treatment with medication to treatment without medication and to the group that received no treatment.

Although Vittengl writes that antidepressants may have an immediate, short-term benefit, he argues that long-term use appears to be detrimental. His results suggest that in general, people actually fare better over the long-term if they seek no treatment at all than if they take antidepressant medications. Psychotherapy, on the other hand, appeared to have no detrimental effects. However, even doing nothing was more successful at reducing symptoms after nine years than medication use.

****

Vittengl, J. R. (2017). Poorer long-term outcomes among persons with major depressive disorder treated with medication. Psychotherapy and Psychosomatics, 86, 302-304. doi: 10.1159/000479162 (Link)