A wave of international research is prompting a global rethinking of how antidepressants are prescribed, especially in the United States where these drugs are widely used to treat depression, anxiety, and sleep problems. New findings challenge long-held beliefs about how these medications work, their long-term benefits, and their risks. The implications extend beyond the U.S., influencing mental health practices in Thailand as local care evolves.
In recent years, antidepressants moved from tightly controlled clinical tools to commonly endorsed remedies. Guidelines in some parts of the United States often recommend antidepressants as a first-line treatment for mild to moderate depression, a stance that contrasts with guidance from global health authorities and Thai care providers who emphasize caution for milder cases. The Covid-19 era saw a surge in prescriptions, underscoring a strong reliance on these medications within American health systems.
Key research has begun to question several pillars of the American approach. A pivotal 2022 review by a team of psychiatrists, including Joanna Moncrieff, argued against the classic “chemical imbalance” theory of depression and noted that scientists do not fully understand how antidepressants affect the brain. The authors stress the importance of patient education and informed decision-making in treatment choices.
The STAR*D trial, a major government-backed study that helped shape prescriptions in the U.S., has faced renewed scrutiny. A 2023 reanalysis found remission rates lower than initially claimed, with only a minority of participants maintaining wellness over time. Critics also point to data concerns within the study, prompting calls from some experts to reexamine or retract the findings.
Foundational placebo research led by Harvard researchers suggests that when all data—published and unpublished—are considered, antidepressants may not offer a clear advantage over placebos. This highlights the powerful role of the placebo response in perceived benefits and raises questions about the true effectiveness of these drugs for many patients.
If antidepressants are not substantially more effective than placebos for many individuals, attention turns to potential harms. Common side effects include sexual dysfunction, emotional blunting, and weight gain. More recently, studies have linked long-term antidepressant use with increased risk of adverse outcomes in some groups, leading to growing emphasis on careful consideration of duration and tapering. Safe discontinuation often requires gradual withdrawal under professional guidance, with processes that can take months or years.
A new perspective, the “drug-centered model,” suggests antidepressants are mind-altering substances with broad, unpredictable effects. This view contrasts with the idea of a targeted cure and highlights potential long-term risks and the possibility of dependence or neurobiological changes.
Thailand’s own care landscape is evolving. While Thai guidelines typically advocate a balanced approach—combining psychotherapy with medication for more severe cases—urban areas have seen rising antidepressant prescribing alongside increasing public discussion of mental health. Public figures and influencers in Thailand have begun speaking openly about their experiences, reflecting a broader shift toward normalization but also underscoring the need for careful, evidence-based care.
Thai policy leaders emphasize that medication should not be the sole focus for depression treatment. The Royal College of Psychiatrists of Thailand and the Mental Health Department at the Ministry of Public Health encourage strengthening family support, expanding community-based care, and improving access to counseling. With rising advertising and consumer demand, keeping a cautious, informed approach becomes crucial.
Culturally, Thailand’s holistic traditions—emphasizing family support, mindfulness, and social connectedness—remain valuable components of mental health care. These practices align with growing evidence for non-pharmacological approaches to mild and moderate depression, and they should be integrated alongside medical treatments in a culturally appropriate way.
Looking ahead, the global research community is calling for greater transparency about long-term effects and more balanced treatment guidelines. If evidence continues to question routine prescription for mild cases, Thailand’s policymakers and clinicians may need to revise guidelines and expand access to non-drug therapies, including counseling and culturally resonant wellness programs.
For Thai readers, the takeaway is clear: if you or a loved one is considering antidepressants, seek a detailed understanding of long-term benefits and risks, and explore non-drug options that fit your needs. Build coping skills rooted in mindfulness, social support, and family involvement, and insist on receiving up-to-date, balanced information from healthcare professionals. Mental well-being is shaped by medicines, but also by our communities and culture.
In-text attributions reflect research and guidance from leading international and Thai institutions, presented in a way that preserves narrative flow and avoids external links.