Books: Evidence-biased Antidepressant Prescription: Overmedicalisation, Flawed Research, and Conflicts of Interest

Many thanks to BJGP Journal for publishing this review of Michael Hengartner's book ‘Evidence-biased Antidepressant Prescription: Overmedicalisation, Flawed Research, and Conflicts of Interest’ – the book which exposes clearly the extent of the biased evidence on which antidepressant prescribing, in clinical practice, is based.

Hengartner's work is being confirmed by others and in a wider context than just antidepressants. The BMJ article ‘The Illusion of Evidence-based medicine’ by Jureidini and McHenry,¹ based in Australia, raises similar issues, and another new book ‘Sickening’ by John Abrahmson (based in US) echoes the theme and is described in a detailed review for Undark² as being “written in tempered language backed up by hard data and historical examples to illustrate Big Pharma’s enrichment strategies.”

It seems clear that ‘evidence-based’ medicine is overlooking extremely important evidence – the evidence of harm (from prescribed medicine) being sustained by patients.³ This is especially true when doctors have, for decades now, been led to believe that very commonly prescribed antidepressants, are ‘safe and effective’ and ‘not addictive’.

These important new writings mirror what patients have been experiencing, clear patient evidence now published in the book 'Antidepressed' by Beverley Thomson.⁴ Thomson's book is reviewed for the journal 'Psychosis'⁵ by Stevie Lewis (author of the 2021 BJGP article ‘Four Research Papers I wish my doctor had read before prescribing Antidepressants’). Of course, the potential for antidepressants to cause first-episode psychosis has been known for decades, a study in 2001⁶ established that “Forty-three (8.1%) of 533 patients were found to have been admitted owing to antidepressant-associated mania or psychosis". This factor seems often to be overlooked and adverse drug reactions too often wrongly diagnosed 'worsening of illness' – resulting additional prescribing and further iatrogenic harm.

We really do need to ‘talk about antidepressants’ – and ‘Antidepressed’⁴ is written expressly to enable the most important of conversations – between patients and their prescribers – when decisions are being made about antidepressant prescribing and consumption, and indeed about the complications of ‘de-prescribing’ or ‘tapering’ off antidepressants.

References

1. Jureidini J, McHenry L B. The illusion of evidence based medicine. BMJ 2022; 376: 0702 doi:10.1136/bmj.o702
2. Farah, T. Online Book Review: A Doctor’s Impassioned Critique of Big Pharma. 2022 Undark. Book Review: A Doctor's Impassioned Critique of Big Pharma.
3. Brown M. Rapid Response to BMJ. ‘Judging the benefits and harms of medicines’ 2017 Evidence of harms of medicines being hidden in plain sight? BMJ. 
4. Thomson B. Antidepressed. 2022. Hatherleigh Press. ISBN 978-1-57826-923-5.
5. Lewis S.Antidepressed: a breakthrough examination of epidemic antidepressant harm and dependence. Psychosis 2022, DOI: 10.1080/17522439.2022.2056629.
6. Preda A, MacLean RW, Mazure CM, Bowers MB Jr. Antidepressant-associated mania and psychosis resulting in psychiatric admissions. J Clin Psychiatry 2001; 62(1):30-3. doi: 10.4088/jcp.v62n0107.