Do Antidepressants and Other Psychiatric Drugs Kill a Half Million People a Year?

Executive Summary

  • Antidepressant use is very high
  • An anti-psychotic drug, Abilify, is the number one best-selling drug (by revenue) in the US
  • People who take psychiatric drugs have much higher death rates
  • Psychiatric drugs appear to be so ineffective that the higher death rates couldn’t possibly be justified

Antidepressant use is very high

Doctors hand out antidepressants and other psychiatric drugs like candy these days. Do antidepressants and other psychiatric drugs kill a half million people a year? Let’s look at the evidence.

Of Americans over the age of 12, 11% take antidepressants. Following graph is from the CDC, showing antidepressant use by age and sex. Women are much more likely, ~3 times so, to take them as men, in middle age, and ~2.5 times more overall. White people are 3 to 4 times more likely to take them than others. These data are nearly 10 years old, so it’s probably worse now.

Figure 1 is a bar chart showing the percentage of those aged 12 and over who take antidepressant medication by age group and sex.

Is it worse? Latest data indicates that ~23% of women in their 40s and 50s take antidepressants, the highest figure for any age group or sex. Given the higher rates of white people taking these drugs, the rate for middle-aged white women would be considerably higher.

These figures may or may not include the anti-psychotic drug Abilify, which is the top-selling drug in the U.S. They may include it in the data because it’s also marketed for major depression. Abilify costs $800 for a monthly supply of 30 tablets.

Are psychiatric drugs safe?

Peter C. Gøtzsche, a Danish professor of psychiatry, argues in an article in the BMJ that psychiatric drugs are both incredibly unsafe and incredibly ineffective.

Psychiatric drugs are responsible for the deaths of more than half a million people aged 65 and older each year in the Western world, as I show below. Their benefits would need to be colossal to justify this, but they are minimal.

He says that randomized trials are biased because they include patients already taking other drugs, and he estimates 15 times more suicides among people taking antidepressants than have been reported to the FDA.

A cohort study found 3.6% greater all-cause mortality in people taking antidepressants; the control group is the same people before they started taking them.

Gøtzsche used only people over 65 years old in his estimates, since falls are an important cause of death in people taking psychiatric drugs, and falls would presumably not kill many people in those under that age. Using Danish prescription data, and scaling up to the U.S. and the European Union, he estimates 539,000 annual deaths from these drugs.

As he says, the benefits are minimal.

Given their lack of benefit, I estimate we could stop almost all psychotropic drugs without causing harm—by dropping all antidepressants, ADHD drugs, and dementia drugs (as the small effects are probably the result of unblinding bias) and using only a fraction of the antipsychotics and benzodiazepines we currently use.

There’s a rebuttal to this (at the link), but given the bias toward prescribing these drugs, seemingly at the drop of a hat, this side of the story needs more airing.

Another article at the BMJ estimates the increased mortality from benzodiazepines, the class of tranquilizers that includes Valium and Lorezapam. (These are included in the previous estimates.)

For those taking more than 90 mg a day of benzodiazepines, death rates were nearly 7-fold higher than for those taking none. Death rates showed a dose-response effect too — the more they took, the higher the death rate.

Are antidepressants effective?

Given the high estimated death rate, antidepressants would have to be incredibly effective to justify their use. Dr. Gøtzsche believes they are not, and could and should be all but stopped. He advises using them acutely only, and tapering off as soon as possible.

I’m not qualified to argue against him, and my bias is to believe him. My own considerations tell me that one quarter of all middle-aged white women couldn’t possibly need an antidepressant, much less Abilify.

To me, it looks like a case of Big Pharma medicalizing a social problem for profit. For those interested in more on this, read the excellent Anatomy of an Epidemic.

 

 

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19 comments
Do Antidepressants and Other Psychiatric Drugs Kill a Half Million People a Year? says November 30, 2016

[…] Original Article: Do Antidepressants and Other Psychiatric Drugs Kill a Half Million People a Year? […]

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Daniel F. says November 30, 2016

“one quarter of all middle-aged white women couldn’t possibly need an antidepressant”

Around 20% of women over 40 are childless. Add in the additional women who instigate a divorce on the delusion that they will find a better man at that age, and you pretty much get there. Ending feminism, rather than prescribing anti-depressants, would go further towards solving the problem.

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    P. D. Mangan says November 30, 2016

    Can’t say I disagree.

    Reply
    Nick says December 1, 2016

    This reply has the potential for ugliness, which I want to avoid. But I would say that while I absolutely agree with the idea that these drugs are way over-used, I don’t agree with your points. First, the only women over 40 I know that are taking some sort of anti-depressants are mothers, not childless. Second, is that why people get divorced–because women want to find a better man than the one they have? Not in my experience. Anecdotal, sure, but there it is.

    I’m not sure what people mean by “feminism” any more, so don’t really know what to say to that.

    Also, these drugs appear to be affecting marine biology, according to discussions I’ve had with marine biologists. They’re getting urinated out and flushed into the oceans.

    Reply
      Nick says December 1, 2016

      Whoops…meant to reply to Daniel above, but I suspect that’s probably clear.

      Reply
      Ollie says December 1, 2016

      No offense, Nick, but for every anecdotal example of a clinically depressed mom, I’ve got at least 3 childless women on serious anti- depression meds to match it. Still, even that point is moot because feminism has been driving women of nearly every demographic to misery. Spend some time in the manosphere and read up. It’s time for you to take the red pill, my friend.

      Reply
        mark sanders says December 1, 2016

        Feminism is a threat to all the little men out there.

        Reply
        BeesMakeHoney says December 2, 2016

        Really? Feminism is why doctors over-prescribe antidepressants? That’s quite a leap in logic.

        Reply
    Ollie says December 1, 2016

    Couldn’t have said it better myself. There are a few studies out there showing that women are more miserable than they have ever been, and getting worse each year. #ThanksFeminism

    Reply
Sanity: A Change in Title and Direction | Sanity in The Diamond Age says November 30, 2016

[…] Probably 25% or more of white women in the US are taking “antidepressants” and we’re certain very few have ever been blown out the door of their vehicle by an IED. I think Progressivism, in a broad sense has contributed to this, but so has evolutionary psychology. “NRx” in an equally broad sense might be a partial cure, but it’s going to take more to deal with the meta-situation. That’s what I aim to do here. […]

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    P. D. Mangan says December 1, 2016

    Cancer cells don’t have as much metabolic flexibility as normal cells, so you can change the internal milieu rapidly and it will harm cancer but not normal cells. Much like going ketogenic. Anyway, that’s my take, I’m sure there’s more to it than that. http://www.nature.com/nrc/journal/v11/n2/full/nrc2981.html

    Reply
Rick Darby says December 1, 2016

As someone who has been dealing with my own depression for 30 years, I suppose I have some qualification for commenting on this.

My experience is that most (but not all) antidepressants offer temporary relief, but in my case, I develop a tolerance quickly and the improvement reaches an inadequate plateau where it stays. But I can honestly say that a combo of Venlafaxine (75 mg/day) and Mirtazapine (30 mg/day) has provided continuing benefit. I take 2 mg of Klonopin (a benzo) at night – not to reduce stress during the daytime – and I believe it helps me sleep.

I’m just one person, and maybe my experience means little against Dr. Gøtzsche’s study you cite. But a few things in the findings strike me as questionable.

He says that randomized trials are biased because they include patients already taking other drugs What kind of other drugs? Other antidepressants? If so, that isn’t an argument against antidepressants. [H]e estimates 15 times more suicides among people taking antidepressants than have been reported to the FDA. Fifteen times? I wonder how he came up with that figure – it sounds exaggerated to me. In any case, it would not be surprising if there are many more suicides among people who are depressed. That only suggests a correlation, not the meds as a cause.

A cohort study found 3.6% greater all-cause mortality in people taking antidepressants; the control group is the same people before they started taking them. So the group measured for mortality is older than the group measured earlier, maybe 3.6% older. If the subjects were all over 65, that could be a reasonable explanation of the greater mortality.

For those taking more than 90 mg a day of benzodiazepines, death rates were nearly 7-fold higher than for those taking none. Death rates showed a dose-response effect too — the more they took, the higher the death rate. Well, duh … more than 90 mg a day of benzos isn’t therapy, it’s drug abuse. It’s not good science to extrapolate from extreme cases to moderate usage.

To me, it looks like a case of Big Pharma medicalizing a social problem for profit. I agree that pharmaceutical companies encourage doctors (especially primary care doctors) to overprescribe and incorrectly prescribe many drugs, including antidepressants. Depression is a complex issue, and sometimes it includes unhealthy lifestyles, poor relationship-building skills, poverty, crippling diseases, etc. that are not likely to benefit much from drug therapy. But some people’s depression does involve messed-up biochemistry, for which antidepressants, while not a magic wand, offer some possibility of help.

Nevertheless, I applaud your continuing efforts to question conventional medical wisdom and offer alternatives.

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    P. D. Mangan says December 1, 2016

    Hi Rick – good to see you here. One reason I cite people like Dr. Gotzche is because if I said it myself, I’d get pilloried. I think his numbers at least hint that something’s wrong. Major depression is serious, maybe a good reason not to trivialize it by handing out SSRIs or benzos to anyone who feels the least bit blue.

    Reply
      Rick Darby says December 2, 2016

      Agreed. Doctors, especially primary care physicians, need to be better trained to distinguish between situational depression and biochemical depression. There is a huge difference between normal sadness at times such as loss of a loved one or problems associated with injury or aging. (Sometimes they coexist, when tough life conditions seem to trigger an underlying vulnerability to biological factors.) The questions around antidepressants are legion, but the best way of handling them is skill on the therapist’s part in choosing the best mode(s) of treatment for each individual — what works for one may be wrong for another.

      While it’s important to call out the dangers of misusing psychotropic meds, those who haven’t experienced depression shouldn’t be too quick to bash them all because of a political ideology against “Big Pharma.”

      Reply
    BeesMakeHoney says December 2, 2016

    Thank you this well thought out comment. I too fall into this camp. For me, life without not be worth living beyond age 65 without the low dose I rely on today. So I guess in one way I get to pick my poison.

    Reply
makaveli says December 5, 2016

I’ve read Peter Gøtzsche’s book deadly medicine and organized crime. He is the leader of the nordic Cochrane institute. what he says is legitimate.

I would like to say one thing though, not in praise of antipsychotics, but as a way of explaining where they should be used in my opinion. As a nurse student in a practice period in a psychiatric ward I can see why antipsychotics are prescribed. Some of these people are very very sick. I never imagined they existed. These people have no connections, family and friends close to non-existent. The psychotic schizophrenic people get a lot of antipsychotics in lack of better things to do. They are really sick. They hear voices. They see things. They are highly dangerous and violent unless they are drugged with benzodiazepines and antipsychotics. These drugs help these people not having constant anxiety and paranoia not becoming violent and not killing somebody. The voices and hallucinations are still there, definitely, but it’s slowing them down so much so they don’t act out and kill people.

So like Nasim Taleb points out in his book Anti-fragile, these drugs including antidepressants, should only be prescribed in severe cases. This is where they might have some effect. Or at least where you just try everything and then at some point something might help.

Over-prescription in the non-extreme groups is really a problem. But go to a psychiatric ward and you’ll see why these drugs are important in the severe cases. I’m sure a ketogenic diet and a hard workout regiment is just as effective if not more. But these people are so sick they think that the food is poisoned and that aliens are doing experiments on them. They are in a completely different reality and some of them have no idea that they are sick. No idea. Get them to realise they are sick and want to become not sick, and then you can talk about workout and ketogenic diet.

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    P. D. Mangan says December 5, 2016

    Thanks, makaveli, I wouldn’t disagree with anything you wrote. I’ve seen schizophrenics up close, and they are indeed sick. Some depressed people apparently also become so depressed they’re psychotic.

    Reply
Five Ways to Fight Depression - Rogue Health and Fitness says February 19, 2017

[…] Huge numbers of Americans take antidepressant meds, and they’re of dubious safety. Of people over the age of 12, 11% take antidepressants, and the rate is close to 1 in 4 middle-aged women. […]

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