Anti-depressants: The trials last 8 weeks; People take them for 8+ years

Troubles with the evidence base

In a new paper led by Will Ward, my team takes a look at anti-depressants, including SSRIs like Prozac

Here are some of our key findings

First, people take these pills for years and even decades.

In fact according to NHANES the percent of people using these products for more than a decade has grown.

Second, these drugs were only studied in randomized trials typically lasting a median of 8 weeks

Where does that leave us? Do we know that taking the drug 10 years later is better than never having started at all? We do not. That is concerning.

Some critics say: but we have discontinuation studies. In other words, we know that if you take people on these medications and randomize them to stop or not, the group that stops or switches to placebo does worse.

Unfortunately, this confuses withdrawal effects from continued benefit. If I take people who drink 40 drinks a day and randomize them to stop, the group that continues drinking might even do better, but that doesn’t mean it is is a good idea to drink 40 drinks a day— and remember I am, if anything, the pro alcohol person!

Many rightly criticize these trials because they do not wean people off gradually minimizing withdrawal effects. In fact, we can randomize users who take SSRIS to continue their drug, except each pill says 1mg less every 3 days vs. actually take a placebo-SSRI combo pill and each pill says 1mg less every 3 days till eventually nothing. Follow both groups for another 2 years. This will separate the drug’s benefit (placebo taper group) from actual taper.

What we need are randomized trials of starting SSRI vs passive placebo vs active placebo (a pill with a little dry mouth) that run for years upon initiation of therapy. Critics say these trials are unethical. That is wrong. These trials should target not those with profound depression but those with mild to moderate depression— who typically get these pills in clinic. We have little credible evidence that someone is better off a year after starting these drugs than not. Moreover, these trials should ask and report sexual dysfunction a common and devastating side effect.

This is what we write in our paper

If you believe in what I am doing, subscribe

Remember anti-depressants are big business

Also visit www.vkprasadlab.com