Antidepressants: Criticism of Prescribing Practices Is Growing

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Written By Kampretz Bianca

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Monika Spahn was in her early 20s when she was diagnosed with depression. That was about 30 years ago. She still has life ahead of her at that time. A life that she sees destroyed today, at 51 years old.

Spahn receives a disability pension. She couldn’t leave the house for many years. She was unable to start a family. She is largely responsible for an antidepressant. She was once given a prescription, with the advice that there was no other way to treat her depression other than taking medication “for the rest of her life.”

Stopping can become a problem

The 51-year-old is suffering from it today. She says that despite medication, her depression never completely went away. She went through twelve “withdrawals,” which is what she calls her attempts to stop taking her medication. Each time they were accompanied by enormous physical symptoms and led her to take the medication again. She is not alone in this situation. Experts confirm this. It has long been known that stopping appropriate medication can become a problem.

However, more and more antidepressants are being taken. The number of daily doses of antidepressants prescribed has increased significantly in recent decades. Although there were around 1.3 million daily doses prescribed for all legal health insurance companies in 2012, ten years later there were around 1.8 million, according to the “Scientific Institute of AOK” (WIdO).

Are more diseases being detected?

Is this because more and more diseases are being recognized and people are therefore receiving better help? Psychology professor Reinhard Maß contradicts this thesis in an interview with BR. Psychiatry expert Professor Tom Bschor, who co-wrote the “National Care Guidelines for Unipolar Depression” for the Drug Commission, also assumes that the number of patients has not increased significantly. According to experts’ opinions, more people are taking antidepressants, but there are more people suffering from depression.

It can also be observed that the number of prescriptions for antidepressants has increased – all over the world – especially because, contrary to what the name suggests, these medications are not only used against depression, but also for anxiety or compulsions. According to the OECD, these prescriptions have almost doubled worldwide since 2000. Germany is still below the OECD average, but the number is increasing here too.

Specialized clinic takes a different approach

Maß takes a different approach at Oberbergklinik Marienheide in Bergisches Land. As a psychology professor on the management team of a psychiatric ward, he is an exception, as is his therapeutic concept. He treats people suffering from severe depression completely without medication – and has been doing so for years.

He recommends that anyone who comes to his ward with antidepressants stops taking them. Maß refers to the “best experiences” with him. He says psychotherapy treatment without antidepressants is actually more successful, according to the data.

Critical: Therapy aims for short-term success

Professor Ulrich Voderholzer, medical director of the Upper Bavarian Schön Klinik Roseneck, makes a similar statement. As a specialist in psychiatry and psychotherapy, he is not an absolute opponent of medication, but he is quite critical of psychotropic drugs – especially in the treatment of children and adolescents. He estimates that 40 percent of children and young people with anxiety, depression or eating disorders come to his clinic with medications — many of them with medications not approved for their age.

Psychopharmacotherapy often focuses on short-term success, says the professor. According to their experiences and studies, psychotherapy is much more sustainable in the long term than simply taking medication because it triggers real behavioral changes.

People who underwent psychotherapy would be better off in the long term than those who were treated with antidepressants alone. Because: If someone underwent psychopharmacotherapy and then stops taking the medication, they never learned to overcome difficulties, says Voderholzer. Especially because stopping it can be very difficult, as Monika Spahn experienced.

The list of side effects is long

According to the “National Care Guideline,” the list of withdrawal problems, as well as the list of side effects, is long. Depending on the active ingredient, this ranges from dry mouth, sleep problems and sexual dysfunction to an increased risk of suicide.

Psychiatrists like Jann Schlimme, who supports people in discontinuing medication in his Berlin practice, therefore call for more information, sensitivity and support when prescribing antidepressants.

Stopping is “generally forgotten”

But this apparently does not always happen, as can be seen in the “National Care Guidelines”. Patients often continue to take their medication – simply because no one is checking its effectiveness, the document says. According to the guidelines, continuing therapy despite non-response is not ethically justifiable.

However, the prescriptions continue, especially because the prescription has become easier, as criticized by psychology professor Maß. According to him, weaning “is generally forgotten”.

Patient follows his own path

And that’s exactly the problem with patients like Monika Spahn. She is now following her own path. The 51-year-old is now convinced that psychotherapy and relaxation methods have put her in a good enough position to survive without medication. For over a year she has been reducing the dosage in very small steps and filing the pills with a nail file.

However, not everyone who suffers from depression and has been taking medication for years is able to follow this path. Experts such as Professor Bschor self-critically state that they are now much more cautious in prescribing medications and explaining problems with discontinuation. And patient organizations also advise stopping the medication in much slower and smaller steps than general practitioners and psychiatrists typically recommend.

Psychotropic drugs: controversial pharmacological effects

💬 BR24 users discussed the effects of psychotropic drugs in the comments. The team of “Your Argument” added:

It is now common sense in science that such medications cause side effects and sometimes serious complications when they are stopped. This is also addressed in the National Care Guideline (NVL) Unipolar Depression. The controversial pharmacological effects of these medications are also a problem. Because much of the effectiveness of antidepressants, as can also be read in the NVL meta-analysis cited in 2022, is due to the placebo effect. There is no doubt that these medications help some people. The guideline, however, mentions a rather small difference in efficacy compared to placebo. 💬

You can find out more about this topic today (June 5) at 12:17 pm on the BR24 Funkstreifzug radio program. Radio patrol is also available as weekly podcast. You can find it, for example, in the ARD audio library.

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