Antidepressants provide little good, says Danish expert

Antidepressants and other psychiatric drugs provide so little benefit that doctors could stop writing 98 per cent of all prescriptions without causing harm, a Danish expert argues this week in a leading medical journal piece that has renewed the debate around fast-growing prescriptions of mood-altering drugs.

Dr. Peter Gotzsche argues in the British Medical Journal that flawed and biased industry-funded drug trials have overplayed the benefits and understated the deaths from antidepressants, tranquillizers and antipsychotics.

Canadian leaders in psychiatry call the claims misleading, misguided and dangerous.

But Gotzsche calculates that psychiatric drugs contribute to the deaths “of more than half a million people” aged 65 and older in the Western world alone, including deaths due to suicide.

“Their benefits would need to be colossal to justify this,” he writes in the BMJ, “but they are minimal.”

New guidelines are needed to reflect that psychiatric drugs — including ADHD drugs — should “almost exclusively be used” in acute situations in the short-term, “and always with a firm plan for tapering off,” writes Gotzsche.

In Canada, 47.1 million prescriptions for antidepressants alone were filled by retail drugstores in 2014, representing sales totalling $1.91 billion, according to prescription drug-tracking firm IMS Brogan.

Montreal psychiatry professor Dr. Joel Paris says 11 per cent of the population is on antidepressants, but ‘‘the prevalence of severe mood disorders is nowhere near that high.…”

But Paris says Gotzsche is dangerously exaggerating the problem, especially around suicide and mortality.

And antidepressants and other psychiatric drugs, when used properly, are an “essential part of psychiatric practice,” said Paris, past chair of psychiatry at McGill University.

The problem, he says, isn’t that the drugs are not effective for very sick people — “they clearly are” — but rather that they are overprescribed for people whose problems “are closer to normal.”

Newer antidepressants known as SSRIs, or selective serotonin reuptake inhibitors, a class that includes Prozac, Paxil and their generic cousins, ranked 8th, and “other antidepressants” ranked 10th out of the top 10 drug classes by total public drug program spending in Canada in 2012, according to the Canadian Institute for Health Information.

Drug companies were ordered a decade ago to add a warning of increased risk of suicidal thinking to SSRIs.

However, Paris said that, in the case of severe depression, people “absolutely need these medications.”