Austin Perlmutter

Long-term use of SSRIs and SNRIs for depression is only slightly better in terms of outcomes compared to placebo.

"long-term use of these medications is only slightly better in terms of the outcomes than placebo when— HOST: In the context of depression. GUEST1: In the context of depression." (said at 0:37:16)

The claim that long-term use of SSRIs and SNRIs for depression is only slightly better than placebo is contradicted by extensive meta-analytic evidence from randomized controlled maintenance and discontinuation trials. Systematic reviews demonstrate that long-term maintenance therapy with second-generation antidepressants provides a substantial reduction in depression relapse compared to placebo, roughly halving the risk (relapse rates of approximately 20% on medication versus 40% on placebo over long-term follow-up) with a number needed to treat (NNT) of 5.

• contradicts: Meta-analysis of major depressive disorder relapse and recurrence with second-generation a… (Psychiatric services (Washington, D.C.) 2008) · cited 115x in the literature

  "Pooled data for the class of second-generation antidepressants compared with placebo suggested a relatively large effect size that persists over time. For preventing both relapse and recurrence, the number of patients needed to treat is five (95% confidence interval of 4 to 6)." (abstract, results, passage verified)

  pubmedfull study (doi)
• contradicts: Discontinuation of antidepressants after remission with antidepressant medication in major… (Molecular psychiatry 2021) · cited 151x in the literature

  "Across 40 studies (n = 8890), the relapse rate was significantly lower in the antidepressant group than the placebo group by about 20% (OR = 0.38, CI: 0.33-0.43, p < 0.00001; 20.9% vs 39.7%)." (abstract, results, passage verified)

  pubmedfull study (doi)