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.