A Balanced Approach to Antidepressants

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Treatment for depression; sad girl
 

When we make decisions, we have to weigh the potential good of something against the potential bad.  The nature of this decision is nowhere more clear than in deciding whether or not to take a medication.

Antidepressants, particularly the selective serotonin reuptake inhibitors (SSRIs), have been hailed as a major scientific advance.  They seemed to be part of a trend where we are now able to treat mental conditions.  A man or woman who, in the past, would have been confined to sorrowful bed rest could be active and enjoy life again through the magic of a pill.

The advertisements for antidepressants play on this transformation to the maximum capacity allowed to them by law.  This builds hope and expectation.  And the effect of those medications can in fact be that dramatic.

Yet it is possible that people prescribed antidepressants aren’t fully informed to the potential benefits and risks.

Most troublingly, antidepressants have been linked to an increase in risk for suicidal ideation.  How significant that risk is remains to be fully determined, but it is not negligible, possibly as high as doubling it.  The State of New York won a major lawsuit against a pharmaceutical company for deliberately suppressing the risk of its antidepressant to cause suicidal thoughts in children.

For another, antidepressants in many studies don’t seem to work that much better than placebo.  To paraphrase a piece from the scientific journal Psychiatry, only half the studies into antidepressants show they work better than placebo, and the effect is modest at best.  About half the studies run into Valdoxan, a new antidepressant, showed no benefit over placebo.

Antidepressants also have serious and significant side effects.  They can cause sexual dysfunction, including the inability to orgasm.  They can cause weight gain in as much as 25% of those who use them for an extended time.  Additionally, they can cause physical dependence and serious withdrawal symptoms upon discontinuation.

Still, antidepressants can, for seriously depressed people,  be literally life saving.

And they can have impressive effects in terms of quality of life.  Some people who take antidepressants report being able to function for the first time as far as they can remember.  Instead of being overwhelmed by anxiety or a deep sense of sadness, they are able to live life normally.  For some people, antidepressants can make life livable and even enjoyable.

Because of how impressive antidepressants can be when they work, and the desire of clinicians to do the best for their patients, it is possible that their benefits have been overstated and their downsides understated.  Coming back to the initial point, I believe that patients need to be more informed when given the option to take an antidepressant.

Although I have not investigated the matter fully, the people I’ve spoken to who were prescribed antidepressants and were not told about the potential side effects felt betrayed when they experienced them.

There’s a reason that a very high percentage of people stop taking antidepressants shortly after starting.  Better information and disclosure of the benefits – and risks – would allow for a more informed decision.  It might also reduce the extremely high rate of discontinuation, where about half of users stop within several months of starting.

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Pharmaceutical analyst who loves blogging about health and medical issues. Has written more than 150 articles and a book on attention deficit disorder. Correctly predicted delayed approval of Bydureon, approval of Provenge by FDA, and the non-approval of Acthar on June 11.

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8 COMMENTS

  1. Good article; this is definitely a subject where all the facts can’t be covered by a single page, but absolutely one that requires honest discussion among the medical community, patients, and families. A google search using the phrase antidepressants placebo will give a wide variety of viewpoints on this specific subject. For the matter of side effects in this article, that’s an extremely wiggly can of worms. Some people won’t have any problem with them, while others will, and in between are people who can tolerate them. It doesn’t help that the clinical trial data has at time been altered by the pharmaceutical companies, as mentioned in the book Side Effects by investigative journalist Alison Bass.

  2. Thanks for the kind words, Andy. It is a horribly challenging issue and it sometimes feels like no matter what you say, people are going to be unhappy with you. It’s hard to do justice to the potential benefits of antidepressants while not losing site of what, in my opinion, are the potential downsides that are not always clearly explained.

    Investigative journalist Alison Bass does a great job; you can tell she worked at the Boston Globe, and the stuff of hers I read was informative and interesting.

  3. Antidepressants when given as a maintenance dose in usually normal people may make them feel and act like zombies. I know a teen-age girl who received prescription drugs for severe depression who became like an automaton during the course of her treatment. I wanted to advise her to take it easy on her drug regiment but I am not a doctor. When she moved to another state, she underwent physical therapy (Dallas Tx) for perceived (?) muscular and back pain. The approach was holistic and this was what I believed proved useful because her mom proudly told me she would prefer to be “drug” free. You are right that patients on antidepressant drugs should be informed of the side effects. It’s their body and mental health that is on the line here, anyway.

  4. I have taken antidepressants a few times and found them to be very beneficial. I wonder why after a few years I find myself in that same place of needing them again. This is my first time taking Wellbutrin and hope it works well for me. Yes, initially the side effects are hard to take, but the payoff was well worth working through the side effects.

  5. Jennifer Critchlow

    When I first took antidepressants at the age of 47 and they started working after 3 weeks I felt euphoric – not because they caused euphoria, but because for the first time in my life I felt “normal”, “OK” I thought, this is how normal people must feel. I took them for two years, as the psychiatrist diagnosed me with “disthymia” (long term depression?) and slowly stopped with his direction. The weaning side effects were almost unbearable, I was unable to function, couldn’t eat, sleep or drive. Then started a long slow decline into the most serious depression I have ever experience, when no rational thought stood in the way of my suicidal fantasies, and I realized this was not living, so I went to another psychiatrist, who again started me on the same antidepressant (Effexor) at a higher dose than originally, and after 5 weeks I finally found some peace again. I have since moved to Pristiq because of the side effects problems, but still suffer sleep disorder (can’t get to sleep, cant wake in the morning). I’m going to try Agomalatin next. I hope to hell it works as well as they say. I am one person who experienced dramatic improvements from antidepressants.

  6. I recently came across this article looking for research and info to back up my choice as of 3 years back to use anti-deppresants, so I could present it to my stepmother. In a conversation that we were having yesterday, she said that she didnt see the point in taking medicine in order to not face your problems and she thought that it was the wrong choice because getting off of them was so hard. Now, she was saying this to my cousin who recently tried to commit suicide and has been using drugs. So her being concerned with HIM not initially taking them, or finding other alternative since he has had a substance abuse problems is some what understandable. That however was not my issue as to why I have an issue with her and why I wanted to look up some facts. She asked my opinion on the matter and i told her that although I did recently get off of effexor (which was the most horrid experience ever) I had been on medications in the past that have actually helped and werent hard to come off of. I feel for the past 3 years of my life I have gotten myself pulled together from the mess that I once was, and the fact that she made a comment stating that she doesnt feel its a right or good choice, after she asked my opinion make me realize that one, she doesnt know me but also that she is soo misinformed. Anti deppresant do help. Some more than others, everyone is different. Researching and getting info is the best way for anyone to approach any kind of medicine that they are thinking about taking or are prescribed

  7. Zoloft better with ambien prior to sleep, i work irregular schedule,days,nights, fatigue worse with zoloft vs. prozac, thinking of quitting all but ambien..12 months into use, started prozac, now on zoloft.

  8. For me its bullshit to be honest!!! Might be helpful but it affects your brain permanently — im not speaking about antidepressants only but other pills of psyhicatric nature. I just remmeber having a good life before SUDDENLY being diagnosed with bipolar diosrder — i wanted to tell the shrink I was taking too much cocaine while away from “home” and this might be the cause but i failed. Anyway, i was hospitalized and remember for couple of weeks i couldnt hear or percept anything. I got eventually better and live the life again when suddenly my parents reported that i was in state of mania again —- which was completely ridiculous and was hospitalized again. Since than and that is 10 months now i walk and feel psyhologically and mentally dead!!! I lost my bussiness, apetite for life, and awerness that i have always had !! Now im taking SSSri antidepressants but SUCH a small dosage as i feel im completely brain washed after all and just here and about to start Wellbutrin and Valdoxan. I think this would be my last try really , Id rather be dead than living like this, I was perfectly well before all this pills being introduced to me , yes i had bad mood , bad periods but it was all transitory , yes i was drinking alcohol and excersised cocaine but I was working and functioning well without any interuptions!! Medicine can do wonders somethimes , but somethimes can worsen the things!! As far as im concerned I like a real life without medicine and in that real life to find the anti depressant solution. Now of course is hard as i feel after all pills and medical experiments over me completely brain washed , although have not a suicidal ideas as before after taking anti depressants , but FAR FAR from a real life happiness!!

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