Antidepressants are all the rage but have a dark side

Chicago Tribune ^ | February 3, 2008 | Christopher Weber

[neverdem]

Despite recent bad publicity over withheld studies showing marginal results, the resume of America's arsenal of antidepressants is enviable: consort to celebrities, subject of best-selling books and tabloid headlines. They may be the most celebrated pills since Valium.

Prozac, Zoloft, Paxil, Celexa and Lexapro, among others, have become both household words and medicine-cabinet staples. Known collectively as selective serotonin reuptake inhibitors, or SSRIs, these antidepressants are prescribed for anxiety, social phobia, obsessive-compulsive disorder and numerous conditions besides depression.

SSRIs are now the most commonly prescribed of all medications in this country. The rate at which physicians prescribed SSRIs more than doubled between 1995 and 2004, according to the Centers for Disease Control and Prevention. SSRIs are considered the first line of defense in treating depression, an illness that afflicts more than 20 million Americans.

Given their wide circulation, SSRIs will have a profound impact on the nation's mental health in the decades to come. But whether their impact is for good or ill depends upon whom you ask.

Most antidepressants boost the amounts of messenger chemicals, or neurotransmitters, circulating in the brain. SSRIs were the first to target the key neurotransmitter serotonin, with highly touted...

--snip--

Just last month, a report in The New England Journal of Medicine showed that the makers of drugs such as Prozac and Paxil didn't publish results of trials indicating that their products performed just modestly better than placebos, which have no actual pharmaceutical value.

--snip--

Rosie Meysenburg of Dallas and Sara Bostock of California met at a public hearing on SSRIs sponsored by the Food and Drug Administration. Both had strong reservations about the safety of SSRIs. Together, they created a Web site, SSRIstories.com, which catalogs more than 2,000 news stories detailing violent acts -- murders, suicides, school shootings -- by individuals taking SSRIs...

[Quix]

Am retired from formal counseling but teaching part time . . .

Am torn about what summary to give my students.

Imho, there are significant hazards with the modern meds and more with the older ones. And if the modern meds are not greatly more useful than plecebo . . .

‘Taking each thought captive’ as Scripture exhorts seems like at least as viable a Cognative therapy option as the meds and I think the research is clear . . . just as effective in most cases . . . .

And, IIRC, going on and off the meds for some teens . . . can be quite hazardous.

So, what summary would you give to a class of intro-to-psych students re the modern anti-depressants?

[Marie2]

I never said they just need to “snap out of it.” Are you reading my posts? I am advocating years, if necessary, of hard work at developing coping skills, identifying weaknesses, strengthening weak areas, making necessary changes where necessary (like changing jobs if you were assaulted there, cutting off ties with brother if they molested you, etc.), nutritional therapy, positive activity, etc.

Why do you keep saying I am acting as though depression is no big deal? I am saying it IS a big deal, and needs a lot more work and attention, not a quick prescription. I am also saying that, in the end, if only a prescription will help, fine, but it should be the last resort, not the first.

[Marie2]

Your reply is condescending. You have not walked in my shoes. I am neither naive nor biologically ignorant. You and I may not share the same opinions, but that does not make me stupid.

[steve86]

I didn’t say stupid, but perhaps uneducated. What degree of training do you have in Neuropsychology?

[steve86]

How much do the doc’s get back when they prescribe these pills for life-whatever they are.Doctor’s get a kickback.Walk in the office,get a handful of pills.Later on take your life.Without meds some families see their loved ones as fine.What is the Doctor kickback in money.

I have a feeling that with the advent of generic Prozac (fluoxetine -- available for $4 copay at Walmart) that the kickback is rather small, not that it ever existed.

[steve86]

I would ask a patient considering SSRI therapy to consider OTC SAM-e. Acts on both Seratonin and Dopamine pathways and therapeutic efficacy is at least equivalent to the SSRIs. Side effects are low or nonexistent. Drawback is cost is quite a bit higher than the $4 Prozac copayment.

"Compared to placebo, treatment with SAMe was associated with an improvement of approximately 6 points in the score of the Hamilton Rating Scale for Depression measured at 3 weeks (95 percent CI [2.2, 9.0]). This degree of improvement is statistically as well as clinically significant and is equivalent to a partial response to treatment".

http://www.ahrq.gov/clinic/epcsums/samesum.htm

[neverdem]

Thanks for the info & link.

[ronnie raygun]

Yes, and we all know the dark side LIBERALISM

[StayoutdaBushesWay]

I take Prozac for heart palpitations. Every time I try to quit Prozac the palps come back. Although I’ve been told that the PVC’s are benign, I still would rather do without them, even if it means I stay on Prozac all my life.

[GSWarrior]

I can only speak of my own experiences. I have done each of the steps in your post. It was hard work. But it wasn’t enough. I am currently taking Zoloft. It is helping me feel like myself. If taking a prescription pill for the rest of my life keeps me from becoming depressed, I have no problem doing so.

[Just another Joe]

discipling themselves in appropriate ways;

I think you meant disciplining but the slip, if it was one, is appropriate also.

[SlapHappyPappy]

But for many people achieving those steps would be impossible without some sort of medication to take the edge off. It’s hard to address problems logically if the untreated depression is making logical though nearly impossible.

[toomanygrasshoppers]

Thank you for pointing out that depression is not about feeling sad or sorry for oneself. No one can truly understand the illness unless they have experienced it. I wish it had another label so that people would understand it better. Yes, sometimes events can trigger an “episode”, but usually you have already started slipping. If you don’t teach yourself to recognize the signs early then you can fall so deep into the “pit” that it is impossible to climb out until the episode passes. It’s easy to tell someone to “just get over it” or “think happy thoughts”. It’s a mental disorder that is unique to each sufferer. Some survive and some don’t.

[neverdem]

I under no circumstances have ever said that someone on SSRIs or any meds should stop taking them. I believe the man who shot up NIU should have stayed on his meds. I never said otherwise.

I also believe that, when his depressive symptoms first started being recognized,

Gun laws stronger, but not foolproof ("he had stopped taking prescription medicines for anxiety.") A poster on that thread said stated that a Chicago paper, I believe the Sun-Times, IIRC, said he was taking Prozac.

Making Sense of the Great Suicide Debate

This thread has 5 links from the professional literature and 2 links for the general public about the adverse effects of SSRIs. You can learn about the serotonin syndrome that can be caused by SSRIs and the SSRI discontinuation syndrome which may have occured at NIU. I'm a family practice doc who happens to have an interest in adverse drug reactions, privacy and the Second Amendment. I find the downplaying of the most serious reactions, killing and suicide, by the drug makers outrageous. According to a book reviewer, Dr. David Healy emphasized that, "depressives don't commit mayhem."

Antidepressants and Violence: Problems at the Interface of Medicine and Law

Healy is one of the co-authors.

[visualops]

spend a few years working with a severely depressed person, and there is no result, no result, no result, or they get worse, then sure, I’d say, try meds. Maybe they can have a halfway normal life.

So, the person suffering from a disorder, that could very well be chemical in nature, should spend "a few years" in some sorts of therapy before trying meds?? Does it occur to you that many need medication to get to the point where they can even think about accomplishing any changes in their life? That medication is necessary to even develop somewhat normal sleep habits, to hold even a part time job? I say again, your understanding of depression and depressive disorders is nil.

[Marie2]

“I didn’t say stupid, but perhaps uneducated. What degree of training do you have in Neuropsychology?”

I said in my first post I am not a doctor. What degree of training do you have in Neuropsychology?

[steve86]

I did the coursework for a doctorate: 4.0 GPA; did two year internship at Assistant Psychologist level, but couldn't come to an agreement with adviser on dissertation topic, so dropped out and changed fields.

Just as it makes sense to avoid fatty foods if one has a genetic predisposition to obesity, it makes sense to utilize some of the suggestions you gave in #15 in a relatively mild case of depression where situational factors and personality type are amenable to change. I myself know of a case where a rational/cognitive approach was quite successful.

The more severe cases of clinical depression, where hereditary factors are paramount and function is minimal will not respond to such an approach. They are no more able to change thinking style than a kindergartener is able to publish a dissertation. These patients are long-term unemployed, often sick with other chronic disorders, typically have no social network other than family, will agree to no significant physical activity and do not find any satisfaction in doing so, sometimes are catatonic, are suicidal to a greater or lessor degree all the time, and are in and out of therapy both outpatient and in. I'm sure you can readily agree that your suggestions are not realistic with respect to these patients and drug therapy is a given.

When I was in school MAO inhibitors and tricyclic antidepressants were the only choices. I was pleased to see SSRIs become available. IMO, it is easy to locate excessive hype both positive and negative concerning SSRIs. I really do see a lot of potential in SAM-e, as do many European practitioners, I guess, and it seems to me that if a supplement course could help a mild depressive case achieve your reorientation skills quicker it would be a good thing.

[steve86]

Jeez, when I was in a really bad depressive state, it threw me into such a state just trying to decide if I should do the laundry or vaccuum first.

Yours is a good description. I know someone who was trapped in such a severe case of indecision and compartmentalized thinking that she didn't vacuum for five years, because that would have meant they needed to move a box of photos which brought back bad memories.

[steve86]

Do the meds continue to work as well five or ten years down the road, or does their effectiveness wane after a while? If it does, what do you do then?

That can be a problem. In a severe case one can only hope for a new generation of pharmaceuticals, or perhaps an entirely new treatment modality.

[steve86]

Wikipedia about SAM-e. I hadn’t read before.

http://en.wikipedia.org/wiki/S-adenosyl_methionine

5-HTP (OTC) is worth investigating also.