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A Balanced Approach to Antidepressants

Admin — Thu, 29 Apr 2010 19:20:59 +0000

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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Paxil, Prozac, Zoloft Weight Gain

Admin — Fri, 19 Mar 2010 00:18:48 +0000

Are you taking or considering taking an SSRI antidepressant like Paxil, Prozac or Zoloft – and are you worried about the potential for weight gain?

The bad news is that you have reason to worry. The good news is that most of the weight gain takes place over time, and that it doesn’t necessarily happen that often.

Let’s go through the details.

And for some useful ideas on how to fight weight gain, see The Top 10 Ways to Lose Weight.

The SSRIs and Weight Gain

First, you should know that weight gain is a possible and common side effect from antidepressants. But how common is it?

An article on WebMD puts the incidence of weight gain on SSRI antidepressants in general as high as 25%. That means that one out of four people taking them will gain weight.

Yikes! Fortunately, the article also says that the weight gain may occur over use for more than 6 months.

That it takes some time for the weight to develop might explain why some studies have not shown it to be an issue. A study that runs for just a month might not catch any weight gain, especially since it takes a while to develop.

So you can gain weight from antidepressants. The confusing part? You can also lose weight from them. What’s it all mean?

It’s hard to say. Scientific research is very limited into the side effects of a medication. This makes it quite hard to figure out how common weight gain from SSRIs is and how much weight occurs in general.

On the one hand, you anecdotally hear about it all the time. On the other, it is very hard to find actual scientific analysis of the issue.

Zoloft weight gain

Plugging the search phrase “Zoloft weight gain” (or rather the technical phrase “sertraline weight gain”) into a medical research database shows only 42 results, and very few of those actually discuss the issue. This is despite millions of people taking that medication.

Prozac weight gain

Things look better for “Prozac weight gain” (166 results), but many of those results are dealing with a combination of Prozac and Zyprexa, not Prozac alone.

Paxil weight gain

Searching for “Paxil weight gain” finds only 71 results, and the vast majority of them have nothing to do with the subject directly.

Issues with the scientific research?

It is possible that the possibility of weight gain from antidepressants is overlooked due to how research is conducted.

We looked at a major analysis that was, on the surface, dedicated to finding the side effects from Zoloft. Yet we searched through it and could not find a single time the word “weight,” meaning it completely missed both the possibility of weight gain and weight loss.

If other research studies similarly ignore the possibility of weight gain or loss, it is likely that it will be overlooked.

Still, we found some hints of data that may clarify the issue.

Side effect database

We ran Zoloft, Paxil and Prozac through a medical database dedicated to reporting of side effects.

Zoloft: No numbers on weight gain, but weight loss is a reported side effect

Paxil: No numbers on weight gain, but up to 1% report weight loss

Prozac: No numbers on weight gain, but up to 3% report weight loss

It’s somewhat odd that there are numbers reported for weight loss from antidepressants while weight gain, which is likely much more common, has no numbers directly associated with it – that we could find.

Next, we looked at an analysis of 700 patient reports. The reports were generated on a site that allows patients to report side effects from medications. Of those 700 reports, 49 said that weight gain was a side effect. That’s about a 7% rate of weight gain.

One clinical study of several hundred people with major depression indicated that Paxil was associated with significant weight increase, Prozac with a modest, not-significant weight loss, and Zoloft with a minor and not significant weight gain.

Is Prozac or Zoloft more effective?

You may be confused because you don’t know what the differences between Prozac and Zoloft are. For a head to head comparison of them, see here.

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A Quick Guide to Depression Treatment

Admin — Mon, 21 Sep 2009 22:40:45 +0000

Depression.

Are you unhappy, worried about your life, and things don’t seem to matter?

It might be depression. And that should mean change of some sort. What that means can vary: it can mean eating healthier and exercising, to seeing a therapist and taking medication.

It’s important to realize what we know about depression – and what we don’t.

First, we aren’t sure what causes depression. While often depression can be linked to a significant event, it also often just happens, so to speak. It seems to make more sense for depression without a reason to require treatment.

And we don’t know how much of depression is normal. If someone just lost their parents, for instance, or was diagnosed with a fatal disease, it only makes sense for them to feel down – depressed. Making it more complicated, most depressive feelings pass with time.

The standard medical treatment for depression is, nowadays, medication. But there are reasons to hesitate before turning to medications, like how little we know about them. Also, they have only OK results – they work in about 60% of people who take them, as opposed to about 30% who respond to a placebo, or a sugar pill.

And that’s at best. Some studies have shown significantly lower success rates, and how well antidepressants work over the long run also seems to be lower.

Worse. Medications for depression often have serious side effects, including sexual dysfunction and can even cause suicidal thoughts. And they can be physically addictive.

On the other hand, antidepressants can help and are sometimes lifesaving. There is a reason that millions of people have taken them, and it’s not all due to adroit marketing by pharmaceutical companies. A good therapist can help you weight the pros and cons of medication and help find the right path.

Treatment – initial evaluation

If you’re concerned about possibly having depression, you should see both a regular doctor and a therapist for an evaluation. There are many physical causes of depression. Vitamin B12 deficiencies, for instance, as well as low levels of folic acid can cause depression. And physical conditions like hypothyroidism also can cause poor mood.

As such, the first step for treating depression should be a phyiscal work up to eliminate these and other conditions. Tests should be done for thyroid hormone levels and to ensure both proper levels of nutrients and proper digestive working.

Dietary modification and exercise are worth a try as an initial treatment for depression. Some doctors claim to see astonishing transformations from that alone, and several studies have shown that vigorous exercise works as well as medication for treating depression.

Seeing a therapist is a very good idea. Their expertise and ability to help you with your problems can be phenomenal just by itself. The fact is that therapy has been shown to be just as effective as medications for treating depression – with the only side effect being a smaller wallet.

Treatment – SSRIs

If you decide to go onto medication, a decision that shouldn’t be made lightly and should ideally come after trying the ideas above, most likely your doctor will recommend an SSRI.

The SSRIs are now the most commonly prescribed medication for depression. They are so called because they are Selective Serotonin Reuptake Inhibitors. What does that mean? Well, imagine two cells in your brain. There’s a gap in between the two, which is full of chemicals and substances, including serotonin. This stuff interacts with receptors on the cell, activating and creating all sorts of activity.

The SSRIs prevent cells from taking up serotonin, or removing it from the space in between the cells. That keeps serotonin around longer, which means it activates more of the receptors for it.

Why this does anything to improve mood we simply don’t know. Serotonin is a widely used neurotransmitter, and substances that effect it have unpredictable effects. Some pain killers effect it, as well as LSD, which causes hallucinations.

The SSRIs work in about 2/3 of patients who use them. In terms of side effects, they very commonly cause sexual dysfunction like inability to orgasm and some digestive issues. Shockingly, they have been linked to a significant increase in suicidal thinking, perhaps doubling the risk of it.

Treatment – Tricylics, MAO-inhibitors

These are older classes of medication but work on similar neurochemicals that the SSRIs do. The tricylclics might be slightly more effective than the SSRIs, but there are very good reason that both these medications are not used typically for initial treatment.

Tricylclics can be fatal in overdoses, and have other significant side effects. MAO inhibitors are also somewhat toxic and make the user extremely sensitive to certain foods, like cheese. If one of those foods are eaten, a life threatening increase in blood pressure can happen.

Treatment – if things don’t improve

If the ideas above don’t help with your depression, several things should be considered.

First, the depression may be caused by a related mood condition called Bipolar Disorder. Bipolar disorder often causes depression that does not respond to typical antidepressant treatment.

Second, switching medications is definitely worth considering. Several studies have shown that a significant percentage of people who don’t respond to initial treatment do to their second, or third medication. Importantly, there are medications that don’t work on serotonin that may work if an SSRI doesn’t.

In some cases, it might be worth considering adding a different class of medication. Antipsychotics have shown some but modest ability to help treat depression. Stimulants like Ritalin and Adderall might help increase energy and motivation.

In the worst case scenarios, physical interventions like electro-shock therapy might work. Electro-shock therapy is actually the most effective treatment for depression we have, but comes with serious side effects like memory loss.

Thoughts

Depression is a serious problem and medications can help. That said, there are limitations to both our understanding of the condition and the pills to treat it. If you’re feeling depressed, you might want to consider if it makes sense. As direct/rude as it may sound, if your life is crappy, why would you expect to feel otherwise?

The best treatment would seem to be seeing a therapist who very well understands the relevant issues. They can guide medication decisions as well as help you with the problems in your life that may be causing the depression.

Remember:

Never lose hope. Never give up. There is a combination of dietary change, exercise, therapy and medication that will change things for the better. Sometimes clouds cover the sun, but that doesn’t it isn’t there – or that it won’t shine again, soon.

If you are feeling actively suicidal, please consider getting immediate help.

You might like:

10 Ways to Treat Persistant Depression

Agomelatine: A New Treatment for Depression

Thanks for reading!

Zoloft vs Prozac: Side Effects, Benefits

Admin — Wed, 16 Sep 2009 16:42:26 +0000

Zoloft vs Prozac

Everyone’s heard of these two drugs. They’re that popular. But what are they? How do they compare? And in the analysis of Zoloft vs Prozac, which comes on top?

Zoloft might have a slight advantage over Prozac. Yet they both can have serious side effects, and don’t always work.

For a discussion about the pros and cons of antidepressants, you may be interested in reading a balanced approach to antidepressants.

Let’s start at the beginning.

Zoloft

Zoloft was discovered during the 70s/80s by accident. A team at Pfizer was researching compounds for a condition not related to depression. One of those, what would later become Zoloft, had impressive selective serotonin reuptake inhibitor (SSRI) effects. Against the wishes of higher management, the team pushed for the development of the medication.

Initial approval of Zoloft almost didn’t happen. The FDA was concerned about the poor efficacy of the medication, and by the improper design of the studies. Zoloft didn’t seem to work well, and the studies that showed that were not examples of good science. Yet they gave it the green light.

Within 15 years, it would become the most popular antidepressant, with 29 million prescriptions in 2007.

Prozac

Prozac was one of the first SSRI medications altogether. It was discovered slightly before Zoloft.

It’s entry to the market changed how depression is treated. The earlier medications, the MAO inhibitors and Tricyclics, had very significant and serious side effects. It seemed at first that Prozac was much safer. And it worked about as well.

In 2007, 22 million prescriptions were filled for fluoxetine, the generic form of Prozac.

Comparison of Prozac vs Zoloft

Both work in about the same time span, of 4-6 weeks. Both should be taken once daily, and the difference in doses aren’t important. Both have some benefit in 50-70% of those who take them.

Crucially, they are both SSRIs, and they both work by almost the same mechanism. This means that they aren’t really that different (and this is also true for many other antidepressants like Paxil).

Some analysis of many, many patients showed slight superiority in Zoloft’s efficacy for treating depression. One paper put it the difference between the two that Prozac is certainly not better than and probably not worse than Zoloft.

The main difference between the two may be in side effects. One study analyzing Zoloft vs Prozac found that Prozac had slightly less “retardation,” or feeling of being slowed down. The same study, however, showed that Prozac might have more anxiety and irritability.

On the other hand, diarrhea is more associated with Zoloft than Prozac.

They both have similar rates of sexual dysfunction, and similar rates of physical addiction. And they both tend to cause significant weight gain.

Remember

Antidepressants are very hit and miss. They often don’t work, and it’s possible that a lot of their effect is from placebo. They are powerful medications and have been shown to double the risk of suicidal thinking in some analysis. Because they have significant side effects, a high percentage of people taking them stop shortly after starting.

That said, they can also be life-changing. For some people, they can make normal living possible. As always, the key is to balance the potential benefits against the potential harms of a treatment.

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