This week, Mad in America examines recent antidepressant research questioning withdrawal severity, a study of unsupported biological beliefs about mental “illness,” and research linking sleep apnea to poor mental health.
Incidence and Nature of Antidepressant Discontinuation Symptoms
A new study published in JAMA Psychiatry reports that most people withdrawing from antidepressants do not experience clinically significant withdrawal symptoms. This study, led by Michail Kalfas of King’s College London, asserts that “Mood worsening was not associated with discontinuation; therefore, later presentation of depression after discontinuation is indicative of depression relapse.”
This claim, that withdrawal symptoms associated with psychiatric drugs are actually a relapse, has consistently been psychiatry’s reasoning when confronted with the reality of withdrawal. It is worth noting that the majority of the authors of this research reported receiving payments from the pharmaceutical industry, and that a correction had to be published with the article indicating that one of the authors “inadvertently omitted” ties to 20 pharmaceutical companies.
This study has come under criticism for its questionable methods in assessing withdrawal symptoms in people coming off of antidepressants. While past research has found that using antidepressants for longer durations (especially two years or longer) is linked to more severe withdrawal symptoms, the authors based their findings mainly on 11 randomized control trials of shorter term antidepressant use. Ten of these exclusively examined service users that had been taking antidepressants for 12 weeks or less. One trial looked at service users that had been taking agomelatine, an antidepressant known not to cause withdrawal, for 26 weeks.
In a letter to the editor’s of BMJ critical of the this study, Mark Horowitz observes:
“Studying what happens to people after just eight to 12 weeks on antidepressants is like testing car safety by crashing a vehicle into a wall at 5km/h – ignoring the fact that real drivers are out on the roads doing 60km/h.”
In another letter critical of this research, authors Michael Hengartner, Martin Plöderl, and John Read note that this research excluded trials that showed worse withdrawal effects after longer durations taking antidepressants. For example, a commonly cited study led by J. F. Rosenbaum finding that withdrawal effects for sertraline and paroxetine were significantly worse after 4 or more months of treatment compared to fluoxetine was not included in the main analysis.
This research is likely an example of what might be described as industry propaganda being published by researchers with industry ties. Critics note that if these kinds of studies are taken seriously, “millions of patients at high risk or currently suffering withdrawal will be mis-diagnosed by clinicians leading to mis-management and unnecessary harm.”
Beliefs About the Biological Nature of Mental Disorders and How They Affect Antidepressant Use and Withdrawal
A new study published in the Journal of Affective Disorders finds that people with biological beliefs about the causes of depression and anxiety took antidepressants for longer periods of time, were less likely to attempt to stop taking these drugs, and were more likely to believe both that they had benefited from antidepressants and that they could not cope without them. This research, led by Mollie Griffin Williams from University College London, also finds that biological beliefs about depression were not associated with the severity of depression or anxiety symptoms.
The authors sent online surveys to people enrolled in the free UK based “Talking Therapies” service for depression and anxiety disorders. This self-report survey asked participants about their experiences with antidepressants, antidepressant withdrawal, and beliefs about the causes of depression and anxiety. Participants were free to endorse multiple beliefs about causes of their condition, meaning some participants expressed belief that both biological and other causes contributed to their diagnoses. All participants were over the age of 18 and were using, or had used, antidepressants. In total, the authors analyzed data from 497 participants.
The most commonly endorsed belief regarding the causes of anxiety and depression was as “a response to issues in my life” (65.6% of participants). Despite the debunking of the chemical imbalance hypothesis of mental “illness,” 36% of participants believed their condition was caused by a chemical imbalance and 15.1% believed it was a “brain illness.” When accounting for participants that endorsed both beliefs, a total of 203 (40.8%) of participants believed their condition had biological origins.
Thirty-four percent of participants believed antidepressants corrected a chemical imbalance in their brain, 27% believed that antidepressants treated a serotonin abnormality, and 16.9% thought antidepressant corrected a brain abnormality. A total of 284 participants (57.1%) endorsed at least one biological belief about their condition, antidepressants, or both.
The authors write:
“Informing people that depression has not been demonstrated to be caused by specific biological mechanisms may reduce the perceived need for medication and help people who no longer need it to come off it successfully.”
The study’s design means the data can only show associations between biological beliefs and behaviors around antidepressant use. This study cannot definitively say that these beliefs cause these behaviors. The sample investigated in the study were participating in psychotherapy, meaning they were more likely than the general population to endorse psychosocial causes of their conditions, and less likely to endorse biological ones. The self-report nature of the survey could also bias the data through misremembering or misreporting.
Obstructive Sleep Apnea Risk and Mental Health Conditions Among Older Canadian Adults in the Canadian Longitudinal Study on Aging
A study recently published in JAMA Network Open finds that high risk of obstructive sleep apnea (OSA) is linked to worse mental health outcomes. This research, led by Tetyana Kendzerska of the Ottawa Hospital Research Institute, additionally identified several other factors associated with worsening mental health outcomes among those at high risk for OSA, including female sex, a household income under $50,000 per year, and polypharmacy. The authors write:
“The associations between OSA risk and mental health were moderate in strength but consistent across outcomes and analytic approaches. Although significant associations were observed for general psychological distress (K10) and anxiety disorder, the strongest associations appear to be with self-reported mood disorders and clinical depression.”
The authors used data from the Canadian Longitudinal Study on Aging. This study collected information from 30,097 participants for a baseline analysis in 2011, and 27,765 participants for a follow-up analysis between 2015 and 2018. All participants were between 45 to 85 years of age. High risk of OSA was determined using the STOP questionnaire, a self report survey that assesses snoring, daytime sleepiness, witnessed apnea during sleep, and high blood pressure, with scores of 2 or higher indicating high risk. Poor mental health was defined as the presence of at least one of the following:
Overall, participants at high risk of OSA were 40% more likely to have poor mental health compared to those not at high risk. This was true both at the baseline and follow-up analyses. Participants at high risk for OSA that did not qualify as having poor mental health at the baseline analysis were 20% more likely to have poor mental health at follow-up compared to those not at high risk.
The design of this study means the data can only speak to links between high risk of OSA and poor mental health, not causality. In other words, the authors cannot conclusively say that high risk of OSA causes poor mental health. The self-report nature of the surveys used in the study could have potentially biased the data due to misremembering and participants answering based on what was most socially desirable rather than what was true.
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Hengartner, M. P., Plöderl, M., & Read, J. (2025). Short-term trials underestimate antidepressant withdrawal. JAMA Psychiatry, 82(12), 1255. (Link)
Horowitz, M. (2025). Review underestimates antidepressant withdrawal effects [Rapid response to “Most people have no severe withdrawal from antidepressants, large review finds”]. The BMJ. (Link)
Kalfas, M., Tsapekos, D., Butler, M., Et al. (2025). Incidence and nature of antidepressant discontinuation symptoms. JAMA Psychiatry, 82(9), 896. (Link)
Kendzerska, T., Mallick, R., Li, W., Et al. (2025). Obstructive sleep apnea risk and mental health conditions among older Canadian adults in the Canadian Longitudinal Study on Aging. JAMA Network Open, 8(12). (Link)
Williams, M. G., Horowitz, M., Davies, J., & Moncrieff, J. (2026). Beliefs about the biological nature of mental disorders and how they affect antidepressant use and withdrawal. Journal of Affective Disorders, 400, 121069. (Link)
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