Are Antidepressants Necessary?

27Feb08

Chances are either you or someone you know has a prescription for an antidepressant. They have become conventional medicine’s default drug of choice: when in doubt, you’re probably depressed.

There are three different families of antidepressants, each with a different chemical mechanism. All of these drugs work with your neurotransmitters — the brain chemicals that regulate mood, sleep, and appetite, among other things. They also have very strong side effects. As a result, physicians have come to prescribe them with care just to people who really need them.

In the 1980’s a new family of antidepressants — SSRI’s, or selective serotonin reuptake inhibitors — was developed, and appeared to deliver results in regulating mood without the more serious side effects of its predecessors.

Due to the seemingly attractive risk/benefit ratio of SSRI’s, physicians expanded antidepressant use exponentially: in the 1990’s, spending on antidepressants grew by 600%! Today the various classes of antidepressants under such trade names as Prozac, Paxil, Zoloft, Celexa, Lexapro, Wellbutrin, Effexor, Cymbalta, and Sarafem are among the most widely prescribed drugs in the world. And while we know now that diminished serotonin reuptake does factor heavily into the mood regulation equation, SSRI’s and their pharmaceutical cousins are not the magic bullet pharmaceutical companies would have us believe.

The depressing truth about antidepressants

Can so many of us have the major form of depression that warrants such rampant drug use? I doubt it! This doesn’t mean that a lot of you don’t feel depressed or have symptoms that could be related to depression, but many such symptoms can be related to stress. This stress can be emotional and/or physical — that can be resolved without pharmaceutical drugs. This is especially true when it comes to subclinical forms of mood disorders such as SAD, PMS, or post partum depression.

Some studies have shown that antidepressants are no more effective in treating this kind of mild to moderate depression than a placebo. Furthermore, depending on how one defines depression, as many as one-third to a half of depressed patients do not show significant improvement with prescription medication, while as many as half of those who receive no such treatment improve anyway.

Numerous recent studies also tell us that regular exercise — 20–30 minutes, three to six times a week — can be a powerful antidote to mild or moderate depression. Even small amounts of exercise can make all the difference in the world (though we will generally benefit more from a higher amount). These studies show that sticking to a regular workout provides long-term mood stabilization, especially when combined with other antidepression measures, such as talk therapy.

In fact, antidepressants are contraindicated for short-term treatment of minor depression — something the drug companies don’t want publicized. Clinical practice guidelines indicate that SSRI’s need to be prescribed for at least six months for minimal treatment of major depression — longer than most episodes of minor depression last.

So with such doubt about their efficacy, why are so many doctors handing out prescriptions for an ever-growing list of symptoms including headaches, insomnia, PMS, menopausal symptoms and others that are not exclusively linked with severe depression?

Remember that these products are very powerful chemicals that alter your hormonal balance and perhaps permanently change your brain’s biochemistry. No one knows what the long-term effects of antidepressants are because most clinical trials to date study 3–5-year outcomes of a single drug at a time — never a combination.

There is evidence now that SSRI’s actually decrease levels of serotonin over time. Some kind of disruption of the neurotransmitter pathways occurs, because SSRI’s don’t create a new equilibrium: at some point in time the patient must be moved to a new drug to maintain the same effect.

The side effects of SSRI’s include weight gain or loss, intense restlessness, insomnia, fatigue, sexual dysfunction, panic attacks, and anxiety. And these are not rare side effects: for example, studies indicate that 18–50% of patients experience sexual dysfunction.

Other studies show an increased risk of bleeding disorders, such as GI bleeding, bruising and nosebleeds, with use of SSRI’s. Despite years of analysis, this link remains highly complex and not well understood. SSRI’s also carry strong potential for drug interactions.

A new view of ordinary depression

What makes this all so frustrating is that many forms of depression are natural, normal and temporary — rather like menopause. Indeed, the philosophically minded might simply attribute many of these feelings to the human condition. Likewise, they can be relieved through safe, gradual methods using your body’s natural mechanisms.

As with other symptoms of imbalance, depression is your body’s way of sending you a signal that something is awry. Antidepressants don’t address the underlying problem; they drown it out with a booming Don’t worry-be happy! But for how long and at what cost?

Think for a moment about how SSRI’s work. The idea is that you don’t have enough serotonin, so the drug conserves the limited amount in your body, blocking it from being changed into the next substance on its metabolic pathway. If you have major depression, you need to stay on your antidepressants. However, everyone who is on or thinking about taking an antidepressant should know what their choices are.

Depression includes a range of normal negative emotions. Clinical depression differs significantly from minor or situational depression or mood disorders, even though the symptoms can be the same. The differences is that in mild depression the symptoms ebb and flow and eventually lift, while in major depression they spiral down into a full-blown, entrenched mental health crisis.

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Tags: chronic pain, depression, fatgue, fibromylagia, headaches, indigestion, mood swings, post partum, symptoms