Michael Pascal Hengartner

Verified

Michael verified their affiliation via an institutional email.

Learn more

Verified

Michael verified their affiliation via an institutional email.

Learn more

• Professor of Clinical Psychology
• Professor (Full) at Kalaidos University of Applied Sciences

Background There is ongoing controversy whether antidepressant use alters suicide risk in adults with depression and other treatment indications. Methods Systematic review of observational studies, searching MEDLINE, PsycINFO, Web of Science, PsycARTICLES and SCOPUS for case–control and cohort studies. We included studies on depression and various...

Background Relapse prevention trials build the scientific foundation for recommendation of antidepressant continuation and maintenance therapy. However, the validity of the evidence is disputed and may be biased due to withdrawal confounding. Methods We analysed survival curves from all antidepressant relapse prevention trials submitted to the Uni...

The serotonin hypothesis of depression is still influential. We aimed to synthesise and evaluate evidence on whether depression is associated with lowered serotonin concentration or activity in a systematic umbrella review of the principal relevant areas of research. PubMed, EMBASE and PsycINFO were searched using terms appropriate to each area of...

Available evidence suggests that there is no effect of moon phases on suicidal behavior. However, a Finnish study recently reported elevated suicide rates during full-moon, but only among premenopausal women and only in winter. This could not be replicated in an Austrian study and stirred a discussion about whether the Finnish finding was false-pos...

Objectives: To investigate if observational studies showing favorable results for antidepressants on suicidal behavior (reduced risk) are preferably and more easily published in psychiatric journals and cited more often, compared to studies with unfavorable results (increased risk). Study design and setting: Prespecified secondary analysis inclu...

There is a lack of a synthesis of longitudinal studies that clarify the relationship between gaming disorder (GD) symptoms and mental health issues, psychological distress, and well-being. To address this gap, we undertook a systematic review with meta-analysis of longitudinal studies. The study protocol was preregistered online on PROSPERO (CRD420...

Background Mirtazapine is used to treat depression worldwide, and the effects of mirtazapine on depression rating scales are well-known. Our primary objective was to assess the risks of adverse events with mirtazapine for major depressive disorder. Methods We searched relevant sources from inception to 7 March 2024 for randomised clinical trials c...

Objective: The study's principal aim was to explore the usefulness of the Harmful Dysfunction Analysis (HDA) in identifying individuals with pathological social media use (PSMU) and potentially other behavioral addictions as an alternative to using DSM-5-TR-based diagnostic criteria for substance use disorders (SUD) or research criteria for interne...

### details about the review process at https://rr.peercommunityin.org/articles/rec?id=664 ### Objective: The present study is an attempt to advance the debate on the validity of the diagnosis of gaming disorder and other specified disorders due to addictive behaviours by improving the differentiation between excessive/high involvement versus path...

Aims Venlafaxine is used to treat depression worldwide. Previous reviews have demonstrated that venlafaxine lowers scores on depression rating scales, producing statistically significant results but the relevance to patients remains uncertain. Knowledge of the incidence of the adverse effects associated with venlafaxine has previously been based on...

This manuscript has been accepted for publication in the Asian Journal of Psychiatry on May 17, 2024 (https://doi.org/10.1016/j.ajp.2024.104084). This preprint corresponds to the accepted manuscript because no change was required during the review process except for a few changes to the supplementary material.© 2024. This manuscript version is made...

### Personalized Share Link: https://authors.elsevier.com/a/1jAOy6gcL7Fnxh ### This manuscript was accepted for publication in the Asian Journal of Psychiatry on May 17, 2024 (https://doi.org/10.1016/j.ajp.2024.104084). Its preprint was published on the Open Science Framework on May 21, 2024 (https://doi.org/10.31219/osf.io/gxv74). The preprint co...

Background: Previous ecological studies reported that increasing antidepressant prescriptions were associated with decreasing suicide rates. Aim: To determine whether antidepressant prescription prevalence is negatively associated with suicide rates (i.e., as antidepressant prescribing increases, suicide rates decrease) between 1999 and 2020. Metho...

Question Tricyclic antidepressants are used to treat depression worldwide, but the adverse effects have not been systematically assessed. Our objective was to assess the beneficial and harmful effects of all tricyclic antidepressants for adults with major depressive disorder. Study selection and analysis We conducted a systematic review with meta-...

The present study aimed to (1) provide an update on trends in AD consumption both at the national and regional unit of analysis for the period 2000–2020 in Italy and (2) analyze sociodemographic and healthcare system-related factors associated with AD prescribing at the regional-population level between 2000 and 2019. Data were extracted from repor...

The factor structure of Personality Disorder (PD) criteria has long been debated, but due to previous heterogenous findings, a common structure to represent covariation among DSM-IV/DSM-5 Section II PD criteria remains an open question. This study integrated a total of N = 30,545 PD assessments from 25 samples to conduct an individual participant m...

Purpose Antidepressant use has increased in many European countries, mostly driven by longer treatment duration. The aim of this study was to provide prevalence rates of long-term users of antidepressants for the Swiss population over the last decade and to investigate associated factors for longer use. Methods We examined the prevalence rates of...

We believe that the NHS has a clinical and moral obligation to help those who have been harmed by taking their medication as prescribed. Panorama has revealed the scale of the problem and the horrendous impact it has had on so many people’s lives. To help mitigate these impacts, we therefore urgently call upon the UK government to fund and implemen...

Purpose: Antidepressant use has increased in many European countries, mostly driven by longer treatment duration. The aim of this study was to provide prevalence rates of long-term users of antidepressants for the Swiss population over the last decade and to investigate associated factors for longer use. Methods: We examined the prevalence rates of...

Background: Major depressive disorder causes a great burden on patients and societies. Venlafaxine and mirtazapine are commonly prescribed as second-line treatment for patients with major depressive disorder worldwide. Previous systematic reviews have concluded that venlafaxine and mirtazapine reduce depressive symptoms, but the effects seem small...

Purpose: Antidepressant use has increased in many European countries, mostly driven by longer treatment duration. The aim of this study was to provide prevalence rates of long-term users of antidepressants for the Swiss population over the last decade and to investigate associated factors for longer use. Methods: We examined the prevalence rates of...

Background: Steroid hormones (i.e., estradiol, progesterone, and testosterone) are considered to play a crucial role in the regulation of women’s sexual desire and sexual attraction to sexual stimuli throughout the menstrual cycle. However, the literature is inconsistent, and methodologically sound studies on the relationship between steroid hormon...

Adaptation of the brain to the presence of a drug predicts withdrawal on cessation. The outcome of adaptation is often referred to as ‘physical dependence’ in pharmacology, as distinct from addiction, although these terms have unfortunately become conflated in some diagnostic guides. Physical dependence to antidepressants may occur in some patients...

Despite findings from previous studies, there is still little consistent knowledge regarding the co-occurrence patterns of somatic, depressive and anxiety symptoms in childhood and adolescence. Moreover, functional disability due to somatic symptoms at different concomitant levels of depression and anxiety is understudied. The present study examine...

Background : As eating behavior changes in relation to the menstrual cycle and weight changes with menopausal transition, ovarian hormones appear to be involved in regulating eating behavior. However, observations are contradictory and are difficult to compare, due to methodological problems related to nutritional epidemiology. To better understand...

Background Non-pharmaceutical interventions (NPI) play an important role in national efforts to control and contain the spread of SARS-CoV-2, but some people do not comply with these public health measures. The aim of this study was thus to describe this group of noncompliant people. Methods A random sample of 1,157 people was drawn from the adult...

ZUSAMMENFASSUNG Ketamin und Esketamin werden als rasch und stark wirksame Mittel zur Reduktion von Depressivität und Suizidalität beschrieben. Dieser Beitrag gibt einen Überblick zur Wirksamkeit von Ketamin und Esketamin zur Reduktion von suizidalen Gedanken und Handlungen, basierend auf randomisierten kontrollierten Studien, die bis Dezember 2021...

An amendment to this paper has been published and can be accessed via the original article.

Background and objective. Studies exploring longitudinal reciprocal associations between depressive, anxiety, and substance use disorders (DD, AD and SUD, respectively) over long periods of time are mainly lacking. Therefore, the aim of the present study is to test longitudinal associations (i.e. temporal dynamics) between DD, AD and SUD from young...

This chapter deals with the manifold competing financial and professional interests that contemporary medicine is subjected to. It focuses on the dismissal of harms resulting from medical interventions and the censoring and discrediting of experts questioning the benefit–harm ratio of established healthcare practices. A special emphasis is put on t...

This chapter summarises the various classes of antidepressant drugs prescribed for depression and provides a brief account of the history of antidepressant use. Then it details the efficacy and safety of antidepressants and concludes with a comprehensive assessment of the benefit–harm ratio of these drugs in various forms of depression.

This chapter provides a summary of the topics discussed in this book and offers solutions on how to curb the overdiagnosis of depression and the over-prescribing of antidepressants in self-limiting, non-severe depression. It also makes suggestion as to how medical research, education, and practice can be freed from corporate bias, thus putting publ...

This chapter provides a short introduction into the themes of this book and the author’s career in psychiatric research. It details how and why the author started to study the efficacy and safety of antidepressants and the corruption of evidence-based medicine.

This book addresses the over-prescribing of antidepressants in people with mostly mild and subthreshold depression. It outlines the steep increase in antidepressant prescription and critically examines the current scientific evidence on the efficacy and safety of antidepressants in depression. The book is not only concerned with the conflicting vie...

Background GPs frequently prescribe antidepressants in mild depression. The aim of this study was to examine, how often Swiss GPs recommend antidepressants in various clinical presentations of mild depression and which factors contribute to antidepressant treatment recommendations. Methods We conducted an online survey among Swiss GPs with within-...

Background: Some authors claimed that the US Food and Drug Administration (FDA) black box warning on treatment-emergent suicidality with antidepressants in adolescents (issued 2004) and young adults (issued 2006) led to an increase of suicides, based on the analyses of ecological data with debatable assumptions about putative changes in suicide rat...

This chapter is focused on the concept of depression, and how this mental disorder was transformed from a rare but severe condition into a highly prevalent and heterogeneous catch-all diagnosis, often including mild and transient episodes of normal sadness and unhappiness. It further details how academic psychiatry, with strong support from the pha...

This chapter starts with a short description of the principles of evidence-based medicine and how this contemporary approach to healthcare was corrupted by the pharmaceutical industry to serve its commercial interests. The main objective is to outline the conduct and dissemination of antidepressant trials. The author details the multiple methodolog...

Previous studies have shown that specific personality dimensions, -e.g., the Big Five-, consistently intercorrelate, such that they form a general factor of personality (GFP). It has been hypothesized that the GFP reflects social effectiveness. Similarly, in the clinical domain, overlap between various psychopathological symptoms has also been repo...

Background Major depressive disorder is a common psychiatric disorder causing great burden on patients and societies. Tricyclic antidepressants are frequently used worldwide to treat patients with major depressive disorder. It has repeatedly been shown that tricyclic antidepressants reduce depressive symptoms with a statistically significant effect...

Background Major depressive disorder is one of the most common, burdensome, and costly psychiatric disorders worldwide. Antidepressants are frequently used to treat major depressive disorder. It has been shown repeatedly that antidepressants seem to reduce depressive symptoms with a statistically significant effect, but the clinical importance of t...

The efficacy of antidepressants in the acute treatment of moderate-to-severe depression remains a controversial issue. The minimal important difference (MID) is relevant to judge the clinical significance of treatment effects. In this analysis paper, we discuss estimates of the MID for common depression outcome measures. For the Hamilton Depression...

The putative association between hormones and cognitive performance is controversial. While there is evidence that estradiol plays a neuroprotective role, hormone treatment has not been shown to improve cognitive performance. Current research is flawed by the evaluation of combined hormonal effects throughout the menstrual cycle or in the menopausa...

Objectives. On 31 January 2020, a new type of coronavirus was first confirmed in Italy and spread rapidly across the country leading to a national lockdown. The aim of this pilot study was to explore the impact of the public health emergency due to COVID-19 on individual’s mental health among 299 Italian adults after a month of home isolation due to...

Background Protracted withdrawal syndrome (PWS) after stopping antidepressants (frequently also referred to as post-acute withdrawal syndrome or PAWS) has been described in a few case reports. However, a detailed quantitative analysis of specific symptom manifestations in antidepressant PWS is still lacking. Methods We extracted patient narratives...

Background: Protracted withdrawal syndrome (PWS) after stopping antidepressants (frequently also referred to as post-acute withdrawal syndrome or PAWS) has been described in a few case reports. However, a detailed quantitative analysis of specific symptom manifestations in antidepressant PWS is still lacking. Methods: We extracted patient narrativ...

Background: Ecological studies have explored associations between suicide rates and antidepressant prescriptions in the population, but most of them are limited as they analyzed short-term correlations that may be spurious. The aim of this long-term study was to examine whether trends in suicide rates changed in three European countries when the fi...

This paper is a response to the study of Meyer-Rochow et al. (2020), who found a statistically significant increase of suicides during full moon among women in the region of Oulu, Finland. We argue that this may be a false-positive finding because of subgroups not specified a-priori and the many negative previous findings. Furthermore, we could not...

Background: In antidepressant trials for pediatric patients with depression or anxiety disorders, the risk of suicidal events and other severe psychiatric adverse events such as aggression and agitation is increased with antidepressants relative to placebo. Objective: To examine whether largely mentally healthy adolescents treated for a non-psyc...

Background: The issue of unblinded outcome-assessors and patients has repeatedly been stressed as a flaw in allegedly double-blind antidepressant trials. Unblinding bias can for example result from a drug's marked side effects. If such unblinding bias is present for a given drug, then it might be expected that the placebos of that drug are rated s...

Antidepressiva-Verschreibungen haben seit den 1990er-Jahren weltweit stark zugenommen. Nutzen und Risiken von Antidepressiva werden aber weiterhin kontrovers diskutiert. In diesem Artikel wird die aktuelle Evidenz zur Wirksamkeit von Antidepressiva in der Behandlung von Depressionen kurz zusammengefasst. Es werden auch unerwünschte Wirkungen und mö...

Background: There is ongoing controversy whether antidepressant use alters the suicide risk in adult routine-care patients with depression and other treatment indications. The aim of this study was thus to examine the suicide risk with antidepressants in observational studies, considering financial conflicts of interest (fCOI) and publication bias....

The aim of this article is to discuss the validity of relapse prevention trials and the issue of withdrawal confounding in these trials. Recommendations for long-term antidepressant treatment are based almost exclusively on discontinuation trials. In these relapse prevention trials, participants with remitted depression are randomised either to hav...

Objective To examine the association between cannabis use in adolescence and the occurrence of depression, suicidality and anxiety disorders during adulthood. Methods A stratified population-based cohort of young adults (n=591) from Zurich, Switzerland, was retrospectively assessed at age 19/20 for cannabis use in adolescence. The occurrence of de...

Background It has been claimed that efficacy estimates based on the Hamilton Depression Rating-Scale (HDRS) underestimate antidepressants true treatment effects due to the instrument’s poor psychometric properties. The aim of this study is to compare efficacy estimates based on the HDRS with the gold standard procedure, the Montgomery-Asberg Depres...

There is a lack of prospective studies that test pre-specified hypotheses on the role of personality traits in outpatient psychotherapy. A total of 47 patients with a broad range of psychopathological syndromes were enrolled in a prospective 6-month observational study conducted in Zurich, Switzerland. We found evidence for remarkably high differen...

Objectives To investigate if the treatment effect of antidepressants in patients with depression substantially varies in each patient (patient-by-treatment interaction or treatment heterogeneity), a necessary but largely unexplored prerequisite of personalised antidepressant treatment. Design Meta-analytic variance comparison of treatment outcome...

Background: It has been claimed that efficacy estimates based in the Hamilton Depression Rating-Scale (HDRS) underestimate antidepressants true treatment effects due to the instrument’s poor psychometric properties. The aim of this study is to compare efficacy estimates based on the HDRS with the gold standard procedure, the Montgomery-Asberg Depre...

Osler and colleagues published a cohort study investigating antidepressant medication and suicidal behaviour and violent crime in patients and conscripts (1). They report an increased incidence rate for both events before and after treatment initiation when compared to the follow‐up period. They conclude that there is likely no causal effect of ant...

Several international guidelines for the acute treatment of moderate to severe unipolar depression recommend a first-line treatment with antidepressants (AD). This is based on the assumption that AD obviously outperform placebo, at least in the case of severe depression. The efficacy of AD for severe depression can only be definitely clarified with...

The forthcoming National Institute for Health and Care Excellence depression guideline reviews short-term outcomes for long-term depression. We present effect sizes for long-term outcomes in trials that report these data. Psychological therapies become more effective, whereas antidepressants become less effective over the long term. We review other...

Withdrawal reactions when coming off antidepressants have long been neglected or minimised. It took almost two decades after the selective serotonin reuptake inhibitors (SSRIs) entered the market for the first systematic review to be published. More reviews have followed, demonstrating that the dominant and long-held view that withdrawal is mostly...

Background: Individual placement and support (IPS) has proven to be effective for vocational outcomes in people with mental illness. The original concept of IPS requires temporally unlimited provision of support. Using limited placement budgets and investigating factors that predict their effectiveness may inform decisions about resource allocation...

Background The most effective rehabilitation model for job (re-)entry of people with mental illness is supported employment. A barrier to introducing supported employment into standard care is its temporally unlimited provision, which conflicts with health and social legislation in many European countries. Aims To test the impact of different ‘pla...

In a recent commentary with the polemic title 'Antidepressants; what's the beef?', Goodwin and Nutt argued that the benefit-risk ratio of antidepressants had been questioned inappropriately (Goodwin & Nutt, 2019). Personally I think it is a great achievement that our medical system can offer pharmacological treatments to people who suffer from seri...

It is worrying that antidepressants are causing withdrawal effects that can be long lasting and severe and that this is not being sufficiently recognised by current clinical guidelines—and, by extension, many prescribers. NICE is now in the process of updating its depression guidelines, and we call on it and the royal colleges to revise their pract...

Background: Involuntary admission (IA) for psychiatric treatment has a history of controversial discussions. We aimed to describe characteristics of a cohort of involuntarily compared to voluntarily admitted patients regarding clinical and socio-demographic characteristics before and after implementation of the new legislation. Methods: In this...

Regression to the mean and spontaneous improvements are rarely considered in interpretations of treatment trials for acute major depression. Here I suggest that regression to the mean and spontaneous remission may account for most improvements seen in placebo groups and also for a large proportion of variance in the acute treatment outcome of both...

Background: Some evidence suggests that antidepressants may relate to poor outcomes in depression. The aim of this study was, therefore, to examine, whether antidepressant use may worsen the long-term outcome in real-world psychiatric patients with both primarily affective and non-affective mental disorders. Methods: Based on a total of n = 151 inp...

Objectives Endometriosis is a gynaecological disease most commonly causing severe and chronic pelvic pain as well as an impaired quality of life. The aim of this study was to investigate if and how endometriosis affects choices regarding professional life as well as the quality of daily working life. Design, setting and participants In the context...

It was recently found that differences between monozygotic twins in the general factor of personality were positively correlated with differences in adulthood recollections of maternal and paternal affection. The current study used data from the Swedish Adoption/Twin Study on Aging to possibly replicate and extend these findings. The results were c...

Life history (LH) theory provides an evolutionary account of individual differences in various traits, including wellbeing. The theory distinguishes between a fast LH strategy, indicated by a short-term perspective (e.g., impulsivity), versus a slow LH strategy, indicated by a long-term perspective (e.g., more constraint behavior). Previous studies...

Following the publication of a recent meta-analysis by Cipriani et al. (1), various opinion leaders and news reports claimed that the effectiveness of antidepressants has been definitely proven (2). E.g., Dr. Pariante, spokesperson for the Royal College of Psychiatrists, stated that this study “finally puts to bed the controversy on antidepressants...

Background: Employment is an important aspect of psychiatric rehabilitation. The objective of this analysis was to explore how quality of life (QoL) may affect the outcome of supported employment and vice versa. Methods: A total of 116 participants with severe mental disorders were randomly assigned to either 25, 40, or 55 h placement budgets, whic...

Antidepressant drugs are the mainstay of depression treatment in both primary and specialized mental health care. However, academic psychiatry holds false beliefs about antidepressants and we expose two of them in this essay. First, recent attitude surveys conducted among psychiatrists and general practitioners have revealed that physicians attribu...