New one on me, comments anyone?
Can Long-term Treatment With Antidepressant Drugs Worsen The Course Of
Depression? For further information, please contact:
Giovanni Andrea Fava
Editor Psychotherapy and Psychosomatics
fava at psibo.unibo.it
17 March 2003
Medical, Health, Psychology
The Journal of Clinical Psychiatry releases a review by Giovanni A. Fava
(University of Bologna) which is likely to stir a lot controversy and be
disliked by the Big Pharma.
The possibility that antidepressant drugs, while effectively treating
depression, may worsen its course has received inadequate attention.
A review of the literature, suggesting potential depressogenic effects of
long-term treatment with antidepressant drugs was performed. A Medline
search was conducted using the key-words tolerance, sensitization,
antidepressive agents, and switching. This was supplemented by a manual
search of Index Medicus under the heading "antidepressant agents" and a
manual search of the literature for articles pointing to paradoxical effects
A number of reported clinical findings point to the following possibilities:
very unfavorable long-term outcome of major depression treated by
pharmacological means; paradoxical (depression-inducing) effects of
antidepressant drugs in some patients with mood and anxiety disturbances;
antidepressant-induced switching and cycle acceleration in bipolar disorder;
occurrence of tolerance to the effects of antidepressants during long-term
treatment; onset of resistance upon re-challenge with the same
antidepressant drug in a few patients; and withdrawal syndromes following
discontinuation of mood-elevating drugs. These phenomena in susceptible
individuals may be explained on the basis of the oppositional model of
tolerance. Continued drug treatment may recruit processes that oppose the
initial acute effects of a drug and may result in loss of clinical effect.
When drug treatment ends, these processes may operate unopposed, at least
for some time, and increase vulnerability to relapse. This hypothesis needs
to be tested, even though its scientific exploration is likely to encounter
considerable methodological and ideological difficulties. The clinical
implications of this hypothesis in depression are considerable.
Antidepressant drugs are crucial in the treatment of major depressive
episodes. However, appraisal of paradoxical effects that may occur in
susceptible patients during long-term treatment may lead to a more effective
use of the drugs.