Talk:Antidepressant

Edits regarding references to the Management of depression article
Hi I made another edit to that sentence in the lede. Please let me know what you think.

I'm curious about why you removed the link from the "see also" section to the Management of depression article. I think that the link is good to include there. ↠Pine  (✉)  01:40, 24 April 2020 (UTC)
 * Hey User:Pine hope all is well. Since we link to management of depression in the lead IMO we do not need to put that in the see also section aswell. Doc James  (talk · contribs · email) 01:47, 24 April 2020 (UTC)
 * Hi I think that the link is good to include there for the benefit of readers who go take time to read the entire article and may want to read related pages after they get to the bottom of the article. Also, I use the "see also" section  to find related articles in a way that is similar to how I use categories, and from my admittedly non-expert perspective the article Management of depression is closely related to the topic of antidepressants, so I think that including the link in the "see also" section is preferable.  ↠Pine   (✉)  01:57, 24 April 2020 (UTC)
 * Yah. We have WP:See also "As a general rule, the "See also" section should not repeat links that appear in the article's body". I am easy either way if you want to return it. Doc James  (talk · contribs · email) 02:56, 24 April 2020 (UTC)

Complete inefficacy
According to a rich line of research by Kirsch, Burns and others, there are systematic biases in most research about antidepressants. Keeping in mind that all current research finds tiny effects barely above statistical significance, and definitely below clinical significance, that means that probably all so-called antidepressants are just placebos with underestimated adverse effects.

I tried to add a small paragraph with sources about that in articles on common SSRIs and SNRIs but it keeps getting deleted with little or no explanation. Can I add it here or will someone get offended (or maybe hurt in his/her economic interests)? AndreaGMonaco (talk) 17:03, 8 March 2021 (UTC).


 * It would definitely deserve at least a subsection's worth of mention. Calling them just placebos isn't correct though, Kirsch noted that they do have a true effect in severely depressed patients, if I recall correctly. Regardless, try to avoid sourcing his studies directly, because Wikipedia prefers secondary sources. Using primary sources allows for some very easy cherry-picking of studies, plus it doesn't establish notability well enough. So yeah, go ahead and find a reliable secondary medical source or two and add it.--Megaman en m (talk) 20:22, 8 March 2021 (UTC)


 * But "Should antidepressants be used for major depressive disorder?" by Jakobsen, Gluud and Kirsch (https://ebm.bmj.com/content/25/4/130) is a meta-analysys, that is a secondary source, and other sources I used are secondary too. In the Conclusions of that study they say that "The benefits of antidepressants seem to be minimal and possibly without any importance to the average patient with major depressive disorder. Antidepressants should not be used for adults with major depressive disorder before valid evidence has shown that the potential beneficial effects outweigh the harmful effects." Also, there is no mention of different results for severe depression: they write that "Despite biases inflating beneficial effects of review results, they still show only negligible differences between antidepressants and placebo on depressive symptoms, and the ‘true’ effect of antidepressants might not even be statistically significant." AndreaGMonaco (talk) 14:21, 13 March 2021 (UTC)
 * The Jakobsen, Gluud and Kirsch article also states: "Several reviews have assessed the effects of antidepressants compared with placebo for depression.30 All these previous reviews show that antidepressants have statistically significant effects on depressive symptoms." That is certainly not "complete inefficacy" of antidepressants. Andrea seems to be cherry-picking the quotations confirming his POV. Remember, Neutral point of view requires that your writing "must be written from a neutral point of view (NPOV), which means representing fairly, proportionately, and, as far as possible, without editorial bias" the views of the sources.The Sceptical Chymist (talk) 15:32, 13 March 2021 (UTC)
 * That quote appears in the middle of the article and is immediately and thoroughly challenged. The Findings section instead summarises that: "Several reviews have assessed the effects of antidepressants compared with placebo for depression. Generally, all the previous reviews show that antidepressants seem to have statistically significant effects on depressive symptoms, but the size of the effect has questionable importance to most patients. Antidepressants seem to have minimal beneficial effects on depressive symptoms and increase the risk of both serious and non-serious adverse events.". Also remember that statistical significance has arguably no meaning; a stronger proof of clinical significance is required in clinical settings AndreaGMonaco (talk) 14:39, 16 March 2021 (UTC).


 * Exactly, we need to present both to sum up the Kirsch article fairly. Also, I suggest not putting your suggested revision into a separate chapter Research or subchapter Lack of Efficacy but as a new paragraph to the chapter depression. Also I have no problems with you adding the first paragraph starting Research by Irving Kirsch, and ending with journal=Psychotherapy and Psychosomatics, 68}}. The criticisms, I think, are summed up fairly. You can go ahead and add it, if there are no other objections. It is the second paragraph (the summation of 2019 review) that I have problems with (as I wrote above), and non-encyclopedic language like "so-called antidepressants". The Sceptical Chymist (talk) 16:24, 16 March 2021 (UTC)


 * To make it clear, adding the following two paragraphs by AndreaGMonaco to the article is being discussed The Sceptical Chymist (talk) 02:39, 17 March 2021 (UTC)

Research by Irving Kirsch, David D. Burns and many others contends that most studies on so-called antidepressant medication are confounded by several biases: for example the lack of an active placebo, which means that many people in the placebo arm of a double-blind study may figure out that they are not getting any true treatment, thus destroying double-blindness; a short follow up after termination of treatment; studies being paid for by the industry; selective publication of results.

Most studies on antidepressant medication find small positive effects, barely above statistical significance and clearly below clinical significance. Taking into account all of the aforementioned biases, which all play in favor of the drugs, this line of research contends that all currently existing so-called antidepressants have no beneficial effect and have worse adverse effects than is currently thought. In the conclusions of a 2019 meta-review by Jakobsen, Gluud and Kirsch: "The benefits of antidepressants seem to be minimal and possibly without any importance to the average patient with major depressive disorder. Antidepressants should not be used for adults with major depressive disorder before valid evidence has shown that the potential beneficial effects outweigh the harmful effects."
 * This point of view is represented in the article at this point by a single sentence at the end of Depression subchapter: "Some reviews of antidepressants in adults with depression find benefits[19][13] while others do not.[14]" This certainly can be expanded. It would be nice, though, if you can support your expansion by direct quotations from Kirsch et al writings (here at the Talk). Please avoid going beyond what Kirsch says in his articles: it is "original research", a mortal sin on Wikipedia - No original research. The Sceptical Chymist (talk) 23:32, 8 March 2021 (UTC)

Flaws in Antidepressant Research
It has by now been well-documented that there are a number of unacceptable and significant flaws in the antidepressant research literature, particularly in the early trials conducted in the 90s/00s. In some cases this has led to significant public scandals, as in Study 329 or in Lilly's practice of misclassifying suicides. The flaws in the original trials mean that in many cases the prominent meta-analyses (such as Cipriani's) have had to use low-quality or uncertain evidence. Considering the magnitude of the problem, it is not well-represented in the article, given only a few sentences under MDD and a well-sourced but incomplete treatment in pharmacology. Some issues, such as widespread misreporting and ghostwriting, are mentioned only in passing or not at all. The problems with the literature should be substantially explicated somewhere in the article, possibly even with its own section or at least subsection. When I have the time I will try to do so. Feline negativity (talk) 08:04, 16 January 2023 (UTC)


 * @Medgirl131 Your contribution is excellent but I wonder whether some of it would be better-suited to a "Controversy" section. I'm currently drafting one and a lot of the points you've added also belong there. There should certainly be something about the active placebo theory under pharmacology, but I think some of it should be moved up to this new section. If you have any thoughts they'd be very welcome. Feline negativity (talk) 09:39, 22 January 2023 (UTC)
 * Have now added a "Controversy" section. It needs a bit of work, including a more detailed presentation on the case for why the efficacy of antidepressants is underestimated, but I think it's a fair summary. In the past it seems there was more information on the controversy, it's unclear why there no longer is given that the debate remains alive and well. Feline negativity (talk) 15:45, 23 January 2023 (UTC)

Akathisia
There appears to have been a bit of edit-warring about akathisia as a common side effect. Akathisia doesn't seem to be mentioned elsewhere in the article. It is well-known that akathisia can be a side effect of antidepressants, there are countless case reports and I believe the package inserts also mention it. The trouble is that as far as I can tell there are no reliable estimates of how common akithisia actually is. I'll keep looking but if someone does have a source on how often it occurs it would be very helpful. Feline negativity (talk) 14:12, 24 February 2023 (UTC)


 * There is a real paucity of research on this. Again it's well-known they can cause akathisia, but very hard to estimate how often. A 2016 BMJ systematic review found doubled odds of akathisia, but the results were not statistically significant, authors also say likely underestimated due to misreporting. A 2009 review in BJPsych found the incidence of what they termed "jitteriness/anxiety syndrome" to be between 4 to 65 percent, which really underscores the difficulty of knowing how common it is. Loonen and Stahl cite Lipinski et al.'s paper (on fluoxetine) to put the incidence between 9.8 and 25 percent. Given that it's a known side effect it should appear somewhere in the article, but since the incidence estimates are unreliable I don't know that it should be in the list of common side effects right at the start. Worth noting perhaps that agitation (of which akathisia is an extreme manifestation) does appear as a "common side effect." Feline negativity (talk) 12:41, 17 March 2023 (UTC)

pharmacology section
The pharmacology section seems to mainly be about addressing the criticisms of the monoamine hypothesis and antidepressants in general. It is relevant to reference these, but I think it would be fair to mention other documented indirect effects of (certain) antidepressants such as increased BDNF expression and down-regulation of certain serotonin receptors as well. I am not a medical professional so maybe someone who knows about neuropsychopharmacology could provide some information/sources. 83.233.200.105 (talk) 18:25, 12 March 2023 (UTC)


 * @83.233.200.105 Agreed, section definitely in need of work/updating. BDNF very popular now, this review could be a good source: https://doi.org/10.1016/j.biopsych.2021.05.008 Feline negativity (talk) 11:56, 17 March 2023 (UTC)