The latest in-depth investigations by international psychiatrists and psychologists are prompting a global rethink over the widespread use and perceived efficacy of antidepressants, especially in the United States, where such medications have become almost ubiquitous for treating depression, anxiety, and insomnia. New findings sharply question the central assumptions about how these drugs work, their long-term benefits, and the risks they carry—a discussion that resonates far beyond America’s borders, including in Thailand, as local mental health practices continue to evolve.
In recent years, antidepressants have moved from being tightly controlled clinical tools to publicly endorsed remedies, sometimes even glamorized on social media. American healthcare guidelines often recommend antidepressants as the first line of treatment for mild to moderate depression, a stance at odds with advisories from the World Health Organization and the UK’s National Institute for Health and Care Excellence (NICE), which expressly advise against their use for less severe cases. During the Covid-19 pandemic, prescriptions soared, highlighting Americans’ deep reliance on these medications (Source: Mad in America, April 2025: https://www.madinamerica.com/2025/04/americas-unhealthy-relationship-with-antidepressants/).
Recent research dismantles several pillars of the American approach to antidepressant use. A pivotal review by psychiatrist Joanna Moncrieff and colleagues in 2022 thoroughly debunked the popular “chemical imbalance” theory, which suggests depression is simply a deficit of brain chemicals such as serotonin. Moncrieff’s work underscores that scientists do not clearly know how antidepressants impact the brain and stresses that patients must be allowed to make more informed choices (Source: BMJ, 2022 - https://www.bmj.com/content/378/bmj.o1743).
One of the foundational studies justifying antidepressant prescription in the US—the massive government-funded STARD trial—has also come under intense scrutiny. While original claims from STARD boasted remission rates of 67% for those treated with antidepressants, a 2023 reanalysis led by psychologist H. Edmund Pigott and team found true remission rates closer to just 35%, with only 3% of participants remaining well after 12 months. Furthermore, critics have detailed extensive research misconduct in the STARD dataset, resulting in calls from leading psychiatrists for the study’s retraction (Review: “The STARD Trial: It Is Time to Reexamine the Clinical Beliefs That…” - https://pmc.ncbi.nlm.nih.gov/articles/PMC4314062/).
Landmark placebo studies led by Harvard researcher Irving Kirsch have found that, when both published and unpublished data are included, antidepressants typically offer no real clinical advantage over inactive sugar pills—raising concerns about a vast “placebo response” (Kirsch I, “Antidepressants and the Placebo Effect,” Zeitschrift für Psychologie, 2014: https://pubmed.ncbi.nlm.nih.gov/26171126/). This means improvements observed in some studies may be driven by participants’ expectations rather than the drug itself. “Most, if not all, of the benefits of antidepressants in the treatment of depression and anxiety are due to the placebo response,” Kirsch’s reviewers conclude.
If antidepressants are no more effective than placebos for most people, what harm could come from taking them long term? The risks, evidence suggests, are far from trivial. Not only are sexual dysfunction, emotional blunting, and weight gain common side effects, but a growing number of studies link antidepressants to increased rates of suicidal behaviors in young people—a concern serious enough that the US Food and Drug Administration (FDA) mandates “black box” warnings for patients up to 25 years old (Source: Wikipedia summary and FDA communications - https://en.wikipedia.org/wiki/Antidepressant).
Long-term outcomes look even grimmer. The overwhelming majority of trials submitted to US regulators last only 12 weeks, leaving massive blind spots about what happens when people stay on these drugs for years—the reality for millions of people. Longer follow-up studies, such as a 2018 Swiss study tracking 591 adults for three decades, found that antidepressant use predicted worse depression symptoms over time. Similar results appeared in a nine-year US cohort study, where those on antidepressants reported greater long-term depression than those who sought counseling or no treatment at all (Source: PMC, 2016 - https://pmc.ncbi.nlm.nih.gov/articles/PMC4970636/; Bristol University, 2022 - https://www.bristol.ac.uk/primaryhealthcare/news/2022/adverse-health-outcomes-associated-with-long-term-antidepressant-use.html).
Researchers are now examining the phenomenon of “tardive dysphoria”—a theory that long-term antidepressant exposure actually induces persistent depressive states, akin to the known neurological harms that antipsychotic medications can cause. The mechanism, called “oppositional tolerance,” suggests the brain may adapt to these drugs in harmful ways, potentially driving the very chemical imbalances the drugs are meant to correct.
Complicating matters further, patients trying to discontinue antidepressants often face severe withdrawal symptoms, including “brain zaps” and intense agitation—a far cry from the widely held myth that stopping is a simple process. The Maudsley Deprescribing Guidelines, the gold standard from the UK, call for months or sometimes years of cautious tapering off, especially for those on antidepressants long-term.
Despite pharmaceutical companies’ persistent promotion of these drugs as safe and effective, new research suggests the need for an entirely different perspective—the “drug-centered model,” as advanced by Moncrieff. Rather than seeing antidepressants as laser-focused cures akin to insulin for diabetes, this model frames them as mind-altering chemicals with broad and unpredictable impacts, similar to the effect of alcohol on the brain. While these psychoactive effects can sometimes numb short-term distress, their long-term impacts raise disturbing parallels with dependency and neurotoxicity.
For Thailand, these findings should be studied closely. Although the country’s official depression treatment guidelines generally emphasize a combination of talk therapy and psychiatric medication for moderate to severe cases, social change, increased Western influence, and rising rates of diagnosed psychiatric disorders have spurred a steady uptick in antidepressant prescriptions, particularly in urban areas. Recent years have seen Thai public figures and influencers openly discuss their use of antidepressants on social media, normalizing their use much as in the United States.
Crucially, Thailand’s mental health policy is positioned to learn from these international missteps. The Royal College of Psychiatrists of Thailand and the Mental Health Department at the Ministry of Public Health generally discourage over-reliance on medication alone, especially for mild depression. Instead, they recommend strengthening family support, community-based care, and access to professional counseling. Yet, as commercial pharmaceutical advertising increases and patients seek quick fixes, pressures may mount to loosen these restraints—making it all the more important to confront emerging international evidence head-on.
In Thai cultural terms, there is also a risk that adopting American psychiatric models wholesale could clash with longstanding local approaches. Traditional Thai beliefs around emotional well-being emphasize holistic practices, family bonds, and the merits of mindfulness meditation—a tradition increasingly supported by research as a viable treatment for mild and moderate depression. Thai society’s strong emphasis on social and spiritual support should not be brushed aside in favor of imported clinical paradigms that may not serve the population’s best interests.
Looking forward, the global research community is pushing psychiatry to embrace greater transparency and humility. Future studies will need to explore not just the short-term management of symptoms but also the true long-term consequences of chronic antidepressant use. Should the weight of evidence continue to accumulate against the routine prescription of these drugs for mild and moderate depression, Thailand’s mental health policymakers and clinicians must remain open to revising guidelines and investing in non-pharmacological therapies—including public education, expanded access to counseling, and culturally relevant wellness programs.
For Thai readers, the key takeaway is clear: If you or a loved one are considering or currently taking antidepressants, ask detailed questions about what evidence exists for long-term benefit, what risks may arise, and which non-drug therapies could better suit your needs. Educate yourself on coping skills—draw from Thailand’s rich tradition of mindfulness and social support—and insist that healthcare professionals provide up-to-date, balanced information. Ultimately, mental well-being is shaped not just by tablets, but by family, community, and culture.
Sources:
- Mad in America, 2025, “America’s Unhealthy Relationship with Antidepressants”: https://www.madinamerica.com/2025/04/americas-unhealthy-relationship-with-antidepressants/
- BMJ, 2022, “The serotonin theory of depression: a systematic umbrella review of the evidence”: https://www.bmj.com/content/378/bmj.o1743
- “The STAR*D Trial: It Is Time to Reexamine the Clinical Beliefs That …”: https://pmc.ncbi.nlm.nih.gov/articles/PMC4314062/
- PMC, 2016, “Long-term antidepressant use: patient perspectives of benefits and adverse effects”: https://pmc.ncbi.nlm.nih.gov/articles/PMC4970636/
- University of Bristol, 2022, “Adverse health outcomes associated with long-term antidepressant use”: https://www.bristol.ac.uk/primaryhealthcare/news/2022/adverse-health-outcomes-associated-with-long-term-antidepressant-use.html
- Wikipedia, “Antidepressants”: https://en.wikipedia.org/wiki/Antidepressant