This book addresses the over-prescribing of antidepressants in people with mostly mild and subthreshold depression. It outlines the steep increase in antidepressant prescription and critically examines the current scientific evidence on the efficacy and safety of antidepressants in depression. The book is not only concerned with the conflicting views as to whether antidepressants are useful or ineffective in various forms of depression, but also aims at detailing how flaws in the conduct and reporting of antidepressant trials have led to an overestimation of benefits and underestimation of harms.
The transformation of the diagnostic concept of depression from a rare but serious disorder to an over-inclusive, highly prevalent but predominantly mild and self-limiting disorder is central to the books argument. It maintains that biological reductionism in psychiatry and pharmaceutical marketing reframed depression as a brain disorder, corroborating the overemphasis on drug treatment in both research and practice.
Finally, the author goes on to explore how pharmaceutical companies have distorted the scientific literature on the efficacy and safety of antidepressants and how patient advocacy groups, leading academics, and medical organisations with pervasive financial ties to the industry helped to promote systematically biased benefit-harm evaluations, affecting public attitudes towards antidepressants as well as medical education, training, and practice.
Author(s): Michael P. Hengartner
Publisher: Palgrave Macmillan
Year: 2021
Language: English
Pages: 361
City: Cham
Contents
List of Tables
1: Introduction: How Did I Get Here?
The Inconvenient Truth about Scientific Research
The Issue with Antidepressant Research
2: Antidepressants in Clinical Practice
Antidepressant Prescribing
Effectiveness of Antidepressants in Depression
Drug Regulatory Assessments
Evaluation of Average Treatment Effects
Long-term Outcomes
Addressing Counterarguments
Efficacy in Minors, Old Adults, and Bipolar Depression
Adverse Effects and Benefit-harm Ratio of Antidepressants
Benefit–harm Balance
3: The Transformation of Depression
Medicalisation and Pharmaceuticalisation
Overdefinition of Depression
Overdetection of Depression
Digression: The Medicalisation of Shyness and Anxiousness
Is Depression a Public Health Crisis?
Biological Reductionism
The Biological Revolution in Psychiatry
The NIMH Mission
Putting the “Mental Disorders are Brain Disorders” Notion to the Test
The Failure of the Biological Revolution
Marketing and Promotion of Antidepressants
The Chemical Imbalance Theory of Depression
Bottom Line: A Public Health Analysis
4: Flaws in Antidepressant Research
The Corruption of Evidence-Based Medicine
Methodological Biases
Methodological Biases Distorting Efficacy Estimates
Methodological Biases Distorting Safety/Tolerability Estimates
Discontinuation Trials, Placebo Response, and Other Issues
Selective Reporting and Spin
Selective Reporting in Antidepressant Trials
Creating the Right Marketing Message for Antidepressants
Paroxetine Study 329
5: Conflicts of Interest in Medicine
Denial and Minimisation of Harm
Psychiatry Comes to the Defense of Antidepressants
My Personal Experience
Physical Dependence and Withdrawal Reactions from Antidepressants
Treatment-Emergent Suicidality With Antidepressants
Corporate Bias
Drug Regulators
Academic Medical Departments, Researchers, and Medical Journals
Medical Organisations, Medical Education, and Clinical Practice
6: Solutions for Reform
Restoring Confidence in the Depression Domain
References
Index
