because we cannot study this using an RCT you need to look at other data. We don't necessarily need RCT level data to help us answer this question. Currently, we don't know. But you should read the Giovanni Fava's papers on antidepressants and Rif El-Malakh, who coined the term "tardive dysphoria" to describe the depression that he hypothesizes results from chronic administration of antidepressants. It is certainly very plausible. Personally I think there are good psychological explanations of why people might become dependent on antidepressants and their use may undermine individual resources and create a narrative of helplessness where individuals come to see themselves as defective, their problems the result of aberrant neurochemistry, and come to feel powerless to change their life circumstances. A good psychiatrist will prescribe antidepressants communicating that the aim is to reduce the level of distress the patient is experience and give them the ability to make the changes the patient needs to. Unfortunately, we know this does not happen as often as it should and most antidepressants are not even prescribed by psychiatrists anyway but used to silence patients.
For me the most compelling data to start raising questions is we know that the incidence of depression is falling, but the prevalence has been increasing somewhat. This suggests that depression is becoming more chronic. Similarly, the incidence of antidepressant prescriptions hasn't increased as much as the prevalence, in fact incident prescriptions have been fairly stable the past 18 years or so. What we see is that people continue on them longer term. There is certainly a huge problem (particularly in primary care) where the long-term use of these drugs (along with others) is not carefully reviewed and prescriptions are unthinkingly refilled. Furthermore, we do not know enough about the appropriate way to withdraw these drugs in a way to minimize the chances of relapse of a withdrawal dysphoria syndrome.
Frankly, I think we need to always be open minded and reflective about the possibility of the harm we may be causing. Psychiatry has a terrible track record of denying the adverse effects of treatments: ECT and cognitive impairment, benzodiazepines and dependence, antidepressants and withdrawal syndrome/dependence, neuroleptics and tardive dyskinesia are among the effects that were initially underplayed or outright denied as ridiculous, and this has undermined the credibility of the field.
