Things Your Doctor Should Tell You About Antidepressants

Paul Andrews

September 12, 2012

By Paul W. Andrews, Lyndsey Gott & J. Anderson Thomson, Jr.

Antidepressant medication is the most commonly prescribed treatment for people with depression. They are also commonly prescribed for other conditions, including bipolar depression, post-traumatic stress disorder, obsessive-compulsive disorder, chronic pain syndromes, substance abuse and anxiety and eating disorders. According to a 2011 report released by the US Centers for Disease Control and Prevention, about one out of every ten people (11%) over the age of 12 in the US is on antidepressant medications. Between 2005 and 2008, antidepressants were the third most common type of prescription drug taken by people of all ages, and they were the most frequently used medication by people between the ages of 18 and 44. In other words, millions of people are prescribed antidepressants and are affected by them each year.

The conventional wisdom is that antidepressant medications are effective and safe. However, the scientific literature shows that the conventional wisdom is flawed. While all prescription medications have side effects, antidepressant medications appear to do more harm than good as treatments for depression. We reviewed this evidence in a recent article published in the journal Frontiers in Psychology (freely available here).

The widespread use of antidepressants is a serious public health problem, and it raises a number of ethical and legal issues for prescribers (physicians, nurse practitioners). Here, we summarize some of the most important points that prescribers should ethically tell their patients before they prescribe antidepressant medications. We also discuss the ways that prescribers could be held legally liable for prescribing antidepressants. Finally, we implore practitioners to update the informed consent procedure for antidepressant medication to reflect current research and exercise greater caution in the prescription of antidepressants.

1. How antidepressant medication works

Most antidepressants are designed to alter mechanisms regulating serotonin, an evolutionarily ancient biochemical found throughout the brain and the rest of the body. In the brain, serotonin acts as a neurotransmitter—a chemical that controls the firing of neurons (brain cells that regulate how we think, feel, and behave). However, serotonin evolved to regulate many other important processes, including neuronal growth and death, digestion, muscle movement, development, blood clotting, and reproductive function.

Antidepressants are most commonly taken orally in pill form. After they enter the bloodstream, they travel throughout the body. Most antidepressants, such as the selective serotonin reuptake inhibitors (SSRIs), are intended to bind to a molecule in the brain called the serotonin transporter that regulates levels of serotonin. When they bind to the transporter, they prevent neurons from reabsorbing serotonin, which causes a buildup of serotonin outside of neurons. In other words, antidepressants alter the balance of serotonin in the brain, increasing the concentration outside of neurons. With long-term antidepressant use, the brain pushes back against these drugs and eventually restores the balance of serotonin outside of the neuron with a number of compensatory changes.

It is important to realize that the serotonin transporter is not only found in the brain—it is also found at all the major sites in the body where serotonin is produced and transported, including the gut and blood cells called platelets. Since antidepressants travel throughout the body and bind to the serotonin transporter wherever it is found, they can interfere with the important, diverse processes regulated by serotonin throughout the body. While physicians and their patients are typically only interested in the effects of antidepressants on mood, the harmful effects on other processes in the body (digestion, sexual function, abnormal bleeding, etc.) are perfectly expectable when you consider how these drugs work.

2. Antidepressants are only moderately effective during treatment and relapse is common

Since the brain pushes back against the effects of antidepressants, the ability of these drugs to reduce depressive symptoms is limited (see our article for a review). While there is some debate over precisely how much antidepressants reduce depressive symptoms in the first six to eight weeks of treatment, the consistent finding is that the effect is quite modest.

Many people who have suffered from depression report a substantial symptom-reducing benefit while taking antidepressants. The problem is that symptoms are also substantially reduced when people are given a placebo—a sugar pill that lacks the chemical properties of antidepressant medications. In fact, most of the improvement that takes place during antidepressant treatment (approximately 80%) also takes place with a placebo. Of course, antidepressants are slightly more effective than placebo in reducing symptoms, but this difference is relatively small, which is what we mean when we say that antidepressants have a “modest” ability to reduce depressive symptoms. The pushback of the brain increases over months of antidepressant treatment, and depressive symptoms commonly return (frequently resulting in full blown relapse). Often this compels practitioners to increase the dose or switch the patient to a more powerful drug. Prescribers fail to appreciate that the return of symptoms often occurs because the brain is pushing back against the effect of antidepressants.

3. The risk of relapse is increased after antidepressant medication has been discontinued

Another effect of the brain pushing back against antidepressants is that the pushback can cause a relapse when you stop taking the drug. This pushback effect is analogous to the action of a spring. Imagine a spring with one end attached to a wall. An antidepressant suppresses the symptoms of depression in a way that is similar to compressing the spring with your hand. When you stop taking the drug (like taking your hand off the spring from its compressed position), there is a surge in the symptoms of depression (like the overshoot of the spring before it returns to its resting position). The three month risk of relapse for people who took a placebo is about 21%. But the three month risk of relapse after you stop taking an SSRI is 43%—twice the risk. For stronger antidepressants, the three month risk is even higher.

4. Antidepressants have been found to cause neuronal damage and death in rodents, and they can cause involuntary, repetitive movements in humans

Antidepressants can kill neurons (see our article for a review). Many medical practitioners will be surprised by this fact because it is widely believed in the medical community that antidepressants promote the growth of new neurons. However, this belief is based on flawed evidence—a point that we address in detail in our article. One way antidepressants could kill neurons is by causing structural damage of the sort often found in Parkinson’s disease. This neurological damage might explain why some people taking antidepressant medication can develop Parkinsonian symptoms and tardive dyskinesia, which is characterized by involuntary and repetitive body movements. Many prescribers mistakenly think these syndromes only occur in patients taking antipsychotic medications.

5. Antidepressants may increase the risks of breast cancer, but may protect against brain cancers

Recent research indicates that antidepressants may increase the risk of cancer outside of the brain, such as breast cancer. However, the neuron-killing properties of antidepressants may make them potentially useful as treatments for brain cancers, and current research is testing this possibility.

6. Antidepressants may cause cognitive decline

Since neurons are required for proper brain functioning, the neuron-killing effects of antidepressants can be expected to have negative effects on cognition. In rodents, experiments have found that prolonged antidepressant use impairs the ability to learn a variety of tasks. Similar problems may exist in humans. Numerous studies have found that antidepressants impair driving performance, and they may increase the risk of car accidents. Recent research on older women also indicates that prolonged antidepressant use is associated with a 70% increase in the risk of mild cognitive impairment and an increase in the risk of probable dementia.

7. Antidepressants are associated with impaired gastrointestinal functioning

The action of antidepressants results in elevated levels of serotonin in the intestinal lining, which is associated with irritable bowel syndrome. Indeed, antidepressants have been found to cause the same symptoms as irritable bowel syndrome—pain, diarrhea, constipation, indigestion, bloating and headache. In a recent study, 14-23% of people taking antidepressants suffered these side effects.

8. Antidepressants cause sexual dysfunction and have adverse effects on sperm quality

Depression commonly causes problems in sexual functioning. However, many antidepressants make the problem worse, impairing sexual desire, arousal, and orgasm. The most widely studied and commonly prescribed antidepressants—Celexa, Effexor, Paxil, Prozac, and Zoloft—have been found to increase the risk of sexual dysfunction by six times or more. Evidence from case studies suggests that antidepressants may also interfere with attachment and romantic love. Some antidepressants have been found to negatively impact sperm structure, volume, and mobility.

9. Antidepressant use is associated with developmental problems

Antidepressant medication is frequently prescribed to pregnant and lactating mothers. Since SSRIs can pass through the placental barrier and maternal milk, they can affect fetal and neonatal development. Generally, if SSRIs are taken during pregnancy, there is an increased risk of preterm delivery and low birth weight. Exposure during the first trimester can increase the risk of congenital defects and developing an autism spectrum disorder, such as Asperger’s Syndrome. Third trimester SSRI exposure is associated with an increased risk of persistent pulmonary hypertension in the newborn (10% mortality rate) and medication withdrawal symptoms such as crying, irritability, and convulsions. Prenatal exposure to SSRIs is also associated with an increased risk of respiratory distress, which is the leading cause of death of premature infants.

10. Antidepressant use is associated with an increased risk of abnormal bleeding and stroke

Serotonin is crucial to platelet function and promotes blood clotting, which is important when one has a bleeding injury. Patients taking SSRIs and other antidepressants are more likely to have abnormal bleeding problems (for a review see our article). They are more likely to have a hemorrhagic stroke (caused by a ruptured blood vessel in the brain) and be hospitalized for an upper gastrointestinal bleed. The bleeding risks are likely to increase when SSRIs are taken with other medications that reduce clotting, such as aspirin, ibuprofen, or Coumadin

11. Antidepressants are associated with an increased risk of death in older people

Depression itself is associated with an increased risk of death in older people—primarily due to cardiovascular problems. However, antidepressants make the problem worse. Five recent studies have shown that antidepressant use is associated with an increased risk of death in older people (50 years and older), over and above the risk associated with depression. Four of the studies were published in reputable medical journals—The British Journal of Psychiatry, Archives of Internal Medicine, Plos One, and the British Medical Journal—by different research groups. The fifth study was presented this year at the American Thoracic Society conference in San Francisco.

In these studies, the estimated risk of death was substantial. For instance, in the Women’s Health Initiative study, antidepressant drugs were estimated to cause about five deaths out of a 1000 people over a year’s time. This is the same study that previously identified the dangers of hormonal replacement therapy for postmenopausal women. In the study published in the British Medical Journal, antidepressants were estimated to cause 10 to 44 deaths out of a 1000 people over a year, depending on the type of antidepressant. In comparison, the painkiller Vioxx was taken off the market in the face of evidence that it caused 7 cardiac events out of 1000 people over a year. Since cardiac events are not necessarily fatal, the number of deaths estimated to be caused by antidepressants is arguably of much greater concern.

An important caveat is that these studies were not placebo-controlled experiments in which depressed participants were randomly assigned to placebo or antidepressant treatment. For this reason, one potential problem is that perhaps the people who were taking antidepressants were more likely to die because they had more severe depression. However, the paper published in the British Medical Journal was able to rule out that possibility because they controlled for the pre-medication level of depressive symptoms. In other words, even among people who had similar levels of depression without medication, the subsequent use of antidepressant medications was associated with a higher risk of death.

These studies were limited to older men and women. But many people start taking antidepressants in adolescence or young adulthood. Moreover, since the risk of a relapse is often increased when one attempts to go off an antidepressant (see point 3 above), people may remain on medication for years or decades. Unfortunately, we have no idea how the cumulative impact of taking antidepressants for such a long time affects the expected lifespan. In principle, long-term antidepressant use could shave off years of life.

It is commonly argued that antidepressants are needed to prevent depressed patients from committing suicide. Yet there is a well-known controversy over whether antidepressants promote suicidal behavior. Consequently, it is not possible to reach any firm conclusions about how antidepressants affect the risk of suicidal behavior. However, most deaths attributed to antidepressants are not suicides. In other words, antidepressants appear to increase the risk of death regardless of their effects on suicidal behavior. We suggest that antidepressants increase the risk of death by degrading the overall functioning of the body. This is suggested by the fact that antidepressants have adverse effects on every major process in the body regulated by serotonin.

12. Antidepressants have many negative effects on older people

Most of the research on the adverse health effects of antidepressants has been conducted on older patients. Consequently, our conclusions are strongest for this age group. In addition to cognitive decline, stroke and death, antidepressant use in older people is associated with an increased risk of falling and bone fracture. Older people taking SSRIs are also at an increased risk of developing hyponatremia (low sodium in the blood plasma). This condition is characterized by nausea, headache, lethargy, muscle cramps and disorientation. In severe cases, hyponatremia can cause seizures, coma, respiratory arrest and death.

The fact that most research has been conducted on older people does not mean that antidepressants do not have harmful effects on the young. As previously discussed, antidepressants can have harmful effects on development. Moreover, many people start taking these drugs when they are young and remain on them for years or decades. In principle, the negative effects of these drugs could be substantial over such long periods of time.

Altogether, the evidence leads us to conclude that antidepressants generally do more harm than good as treatments for depression. On the benefit side, the drugs have a limited ability to reduce symptoms. On the cost side, there is a significant and unappreciated list of negative health effects because these drugs affect all the processes regulated by serotonin throughout the body. While the negative effects are unintended by the physician and the patient, they are perfectly expectable once you understand how these drugs work. Taken together, the evidence suggests that these drugs degrade the overall functioning of the body. It is difficult to argue that a drug that increases the risk of death is generally helping people.

There may be conditions other than depression where antidepressants are generally beneficial (e.g., as treatments for brain tumors and facilitating recovery after a stroke), but further research in these areas is needed (see our article).

Ethical and Legal Issues

Physicians and other medical practitioners have an ethical obligation to avoid causing greater harm to their patients. The Latin phrase primum non nocere (“first, do no harm”) that all medical students are taught means that it may be better to do nothing than to risk causing a greater harm to a patient. Although all prescription medications have adverse side effects that can cause harm, practitioners have an ethical obligation to not prescribe medications that do more harm than good. The evidence we have reviewed suggests practitioners should exercise much greater caution in the prescription of antidepressants and to reconsider their use as a first line of treatment for depression. Additionally, we suggest that physicians and other medical practitioners should consider their potential legal liability.

Legal liability for prescribing antidepressants

Medical practitioners can be sued for prescribing antidepressant medications if doing so violates their state’s standard of care laws. In most states, the standard of care is what a “reasonably prudent” practitioner in the same or similar field would do. The standard of practice is not defined by what the majority of physicians do because it is possible for an entire field to be negligent. Since studies on the health risks associated with antidepressant use (e.g., stroke, death) have been published in well-respected medical journals, medical practitioners could possibly be vulnerable to malpractice lawsuits. For instance, it seems likely that a reasonably prudent physician should be aware of the medical literature and avoid prescribing medications that could increase the risk of stroke and death.

Prescribers can also be held liable for not discussing information about medical risks so that patients can give informed consent for medical treatments and procedures. Prescribers have a duty to discuss the benefits and risks of any recommended treatment. Consequently, medical practitioners should discuss with their patients that antidepressant medication is only modestly more effective than placebo and could increase the risk of neurological damage, attentional impairments, gastrointestinal problems, sexual difficulties, abnormal bleeding, cognitive impairment, dementia, stroke, death, and the risk of relapse after discontinuation.

Antidepressants must cause harm to create liability

A medical malpractice lawsuit can only succeed if the antidepressant caused harm to the patient. It is important to realize that the antidepressant does not need to be the only cause of the harm—it only needs to contribute to or exacerbate the harm.

As we have argued, antidepressants play a causal role in many adverse health outcomes because they disrupt serotonin, which regulates so many important processes throughout the body. This may make it particularly difficult for a medical practitioner to defend against a medical malpractice suit from a patient who experiences any of a number of adverse health effects while taking an antidepressant. For instance, if a patient has a stroke while taking an antidepressant, the evidence that antidepressants increase the risk of stroke suggests that the antidepressant may have contributed to the patient’s stroke, even if it was not the only cause.

Conclusion

The evidence now indicates that antidepressants are less effective and more toxic than commonly believed. From ethical, health, and legal perspectives, it seems prudent for individual practitioners and professional medical organizations to revise informed consent guidelines and reconsider the status of antidepressants in standards of care for many diagnoses and as the front line treatment for depression. With older people, for instance, the current data suggest informed consent must include a discussion of the increased risk of hemorrhagic stroke and even early death.

We suspect that if prescribers realized they were placing themselves at legal risk for failing to discuss the adverse health effects of antidepressants with their patients, not only would they be more likely to discuss such information, they would be less likely to recommend these drugs in the first place.

 

Paul W. Andrews is an assistant professor in the Department of Psychology, Neuroscience & Behaviour at McMaster University in Canada. He has a PhD in Biology from the University of New Mexico and a law degree from the University of Illinois at Urbana-Champaign. His work on the evolution of depression with J. Anderson Thomson, Jr. has been featured in the New York Times Sunday Magazine and Scientific American Mind.

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Lyndsey Gott is an undergraduate student in the Honours Psychology, Neuroscience & Behaviour program at McMaster University.

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J. Anderson Thomson, Jr. is associate faculty at the Institute of Law, Psychiatry & Public Policy at the University of Virginia. He is also a staff psychiatrist at the University of Virginia Student Health Services. He received his MD from the University of Virginia in 1974 and has been a full-time practicing outpatient psychiatrist for over 35 years.

Paul Andrews

Paul W. Andrews is an assistant professor in the Department of Psychology, Neuroscience & Behaviour at McMaster University in Canada. His work on the evolution of depression with J. Anderson Thomson, Jr. has been featured in the New York Times Sunday Magazine and Scientific American Mind.


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33 thoughts on “Things Your Doctor Should Tell You About Antidepressants

  1. Yes, this is a very helpful article. As an attorney myself, I especially was interested in the discussion of potential legal liability for the people who negligently prescribe these toxic drugs. I’m not aware of any cases yet involving SSRI’s, though I know there have been a number of such cases involving antipsychotics.

    Unfortunately, any doctor being sued for this stuff really experiences no consequences, because his or her insurance company provides a legal defense and pays any judgment.

    Yet the fact is that if a doctor’s negligent prescription leads to someone’s death, they have committed a crime. This would be called involuntary manslaughter here in California. Other states may call it by such names as criminally negligent homicide. The idea is that you don’t have to have intended to kill someone to be criminally responsible for their death. But you have a legal duty of care to act in such a way that you don’t endanger their lives.

    People DO get prosecuted for involuntary manslaughter when they drive drunk or recklessly, and as a result someone dies, even if they didn’t intend for that to happen. That is, they get prosecuted as long as they aren’t wealthy.

    And that’s why these doctors never are prosecuted for killing people. But we should be demanding that this happens.

  2. until it becomes a liability they are not going to quit forcing the toxic drugs on people. If some of them would actually be prosecuted and end up in prison I think that most of them would get th eidea and quit dispensing them. Nothing is going to change until some of them have to pay the ultimate price and lose their freedom.

  3. I still say a lot of that so-called “relapse” after discontinuation of antidepressants is misdiagnosed withdrawal syndrome.

    Those studies finding “relapse” after quitting contained no protocols to distinguish withdrawal symptoms. The statistics on relapse are, therefore, questionable.

    The good news is that “relapse” after discontinuation may not be all that frequent. The bad news is that withdrawal syndrome is more common, severe, and long-lasting than just about anyone wants to admit.

  4. Thanks to those of you who provided comments, and thanks as well to whoever posted a link on Facebook. For many readers of MIA, I’m sure this piece is like ‘preaching to the choir’. I originally wrote this piece for the Huffington Post, who invited me to write something about antidepressants after my colleagues and I had published an article on this in the open-access, on-line journal Frontiers in Psychology:

    http://www.frontiersin.org/Evolutionary_Psychology/10.3389/fpsyg.2012.00117/full

    However, on the eve of publication, the Huffington Post changed their mind and decided not to post it–ostensibly because it was too long. I later had some communication with a senior editor at the Huffington Post, who assured me that the piece would be published regardless of how long it was. That was the last communication I had from the Huffington Post. They never published the piece, and they never answered my subsequent email queries about it.

    This was irritating because they had invited me to write the piece, and the only time we heard something about a word limit was on the eve of publication when they declined to post it. Moreover, my collaborators Lyndsey Gott and Andy Thomson worked very hard to help me put together what I think is an excellent, well documented piece for them. (We also got a very helpful assist from Andy’s wife, Christine, who is a medical malpractice attorney. She helped me ensure the accuracy of the legal aspects of the piece.)

    Anyway, I’m very glad Bob Whitaker was interested in the piece and gave it a home. If you think it is a good overview of the effects of antidepressants, please pass it around. That’s why we wrote it.

    Incidentally, one of the most powerful reasons to believe that antidepressants do more harm than good is the evidence (reviewed above) that antidepressant use is associated with an increased risk of death. One can quibble that our list of benefits and harms is incomplete, but mortality data naturally synthesize all the costs and benefits, even those that have not yet been identified. It is difficult to argue that a drug is really helping people when it increases their risk of death. And all five of the studies that we are aware of show an increased risk of death in older people with depression who take antidepressants. That’s a pretty consistent and troubling pattern.

    Cheers,
    Paul

    • I looked up your article
      at Frontiers in Psychology:

      http://www.frontiersin.org/Evolutionary_Psychology/10.3389/fpsyg.2012.00117/full
      and it’s not there. It says “Article Not Found.” I tried googling with your name and the above URL DOES come up but when I click on it, again I get “Article not Found.”

      This is a very good article–above–but there are important omissions.The most important omission is the tendency of SSRIs to cause manic states. This is a major theme in Bob Whitaker’s last book. THis is significant because about 20%
      of youth put on SSRIs will become manic. Then they will be diagnosed as bipolar with no awareness or willingness of the psychiatrist to acknowledge that the problem is caused by SSRIs. So now you have millions of person labeled bipolars. That is a gateway to hell–a lifetime on cocktails of psychiatric drugs and the assurance by the shrinks that the patient has an illness for which there is no cure.

      If you read the work of Ann Blake Tracy (Prozac:Placebo or Pandora),Peter Breggin (he has several on this topic but Medication Madness is very powerful) or David Healy (Let them Eat Prozac) you’ll find SSRIs are even greater risks than you state. Quite a few people become violently deranged on this class of drug. People with no history of violent behavior commit bizarre kinds of homicide: They will murder their spouse or children or parents.They will shoot innocent persons with whom they have no history of rancorous relationships. These are puzzling and inexplicable crimes because they appear to lack sufficient motive.Nor are they committed by violent or anti-social individuals. THOSE kind of crimes are unfortunately common enough and do not require SSRIs to trigger them. The jealous boyfriend whose woman is cheating on him, the serial killer etc. THe SSRI crimes effect a Jekyl and Hyde personality transformation. If you read about a mother who kills her own children or an adult male who shoots his wife and elderly parents the odds are above 95% they are taking an SSRI or have just stopped taking one. Dr Tracy (whose FB page I recommend) says that over 99% of the school shooters were on SSRIs.In the above book by Breggin
      he describes many persons whom he saved from life without parole prison sentences by testifying as an expert witness. David Healy compiled a long list of crimes of this nature–and posted it online.(You’ll have to search–try his website.) Although this is not common it has resulted in many tragedies and thousands of death. Also a significant percentage of people with no history of suicidal behavior engage in suicidal acts, or suicide. The drug companies went to considerable lengths to conceal this but as you know after resisting for years eventually the FDA placed a black box warning for suicide on SSRIs–although unreasonably only for youth under 24.
      Thanks,
      Seth Farber, Ph.D.
      http://www.amazon.com/Spiritual-Gift-Madness-Psychiatry-Movement/dp/159477448X/ref=sr_1_1?s=books&ie=UTF8&qid=1379577504&sr=1-1&keywords=farber+gift

  5. Blood Sugar Levels Linked to Brain Loss
    http://www.medpagetoday.com/Neurology/GeneralNeurology/34588

    Higher blood glucose levels were associated with brain atrophy among healthy individuals in their early 60s, even when levels remained within the official normal range, an Australian study demonstrated….

    Study: Higher normal fasting plasma glucose is associated with hippocampal atrophy: The PATH Study
    http://www.neurology.org/content/79/10/1019.abstract

  6. Far too many times people are going through divorce, loss of a loved one, birth, career change, move, and just flat out life, and the emotions that go along with them and they are said to have a mental illness because of it. It is far too easy for someone to walk into a doctor’s office and after literally just minutes, be told they are depressed, bipolar, etc. and be prescribed drugs that can do so much more harm than good. I have looked at a few questionnaires that are given to those who see a doctor for sadness or anxiety and they are quite basic and without much more in depth probing, are not very good at determining if they are really experiencing something more than “life”. Some of the questions include do you have difficulty falling asleep at night, are you in a relationship, and are you irritable?

    Now yes, some people truly do have mental disorders and these drugs do help them, but, when these drugs have not been around long enough to gauge their long term effects, and we have people experiencing horrible side effects and even committing murder or suicide while on them, I do not think they should be handed out like it’s no big deal.

    Anti-depressants are so commonly prescribed that they are actually the most prescribed medication for people up to the age of 59. I think that statistic speaks volumes and we should be looking at treating the underlying problem that most of these individuals face, whatever that may be, instead of giving them a pill and letting them believe they will be instantly cured.

    According to an article from April 2012, a study actually suggested that anti-depressants do more harm than good. Previous patient studies were examined by Paul Andrews, an evolutionary biologist, and determined that the benefits the anti-depressants are capable of delivering, compare very poorly to their risks. Andrews said it perfectly, “you’ve got a minimal benefit, a laundry list of negative effects – some small, some rare and some not so rare. The issue is: does the list of negative effects outweigh the minimal benefit?” To me, the answer is without a doubt, no.

    While doing research for this paper I have read absolute horror stories from people who were given these medications and claim they are now a completely different person. There are numerous websites dedicated to life after prescription anti-depressants. That topic alone would cause me to raise an eyebrow and wonder what in the world these drugs are capable of doing if there are support forums and information pertaining to life after.

    One of the most interesting things I came across was the information in regards to adverse reactions to these medications. Some people may have reactions to these drugs after only one dose that can take up to 24-36 months to recover from. That is mind blowing. However, something even scarier is the fact that some people experience what is called Protracted Withdrawal Syndrome or SSRI Discontinuation Syndrome. Some people who have taken these drugs and either abruptly stop taking them or even slowly wean off of them may send their body into a state of chaos. It can impact both physical and psychological well being and the person may experience anxiety, depression, obsessive thoughts, insomnia, pains, cognitive problems, etc. and in some cases, this lasts forever. Having your mind permanently altered and/or damaged, would be enough to make anyone feel that they are “going crazy” when in fact, these drugs that were given to them to help them, is the true culprit. I can only imagine how horrific it must be for someone who is suffering from this.

    There are several things that can be done to help those dealing with everyday stressors as well as those suffering from legitimate mental health issues. The list includes taking a fish oil supplement due to the fact that essential fatty acids help with brain health and mood regulation, exercising regularly because it is a natural stimulant of many of the hormones which can impact a person’s moods, and avoiding sugar completely. Start a journal, spend time alone to take care of yourself but also make sure you are surrounding yourself with friends and family who will lift you up, and of course, seek professional help from a counselor if there is something you just really cannot seem to work through on your own.

    In conclusion, as I previously stated, anti-depressants can be beneficial for certain people in specific situations. However, for most people, by taking the steps previously mentioned, it can truly make a world of difference and completely eliminate the need for these “magic pills.”

    • thank you for writing this, i never quite knew what to call it or how to explain to others, i am one of those people, by body has never recovered or shifted from the withdrawal symptoms i went through, the beginning stages were pure hell and went for months and months, & now its just a constant were my body has adapted to living with the stresses of them.

      its been 13 years of hell so far and i have spent hundreds & thousands of dollars over the years seeing everyone and trying everything to shift what happened and nothing works, my body switched to chaos mode and it wont switch back

      most doctors arent interested in hearing my story they think its my anxiety disorder which simply changed over time into something more severe,

      i have no quality of life and im in pain & suffering everyday, i wont bother to list all the neuro, and physical symptoms, its been so many years im over thinking of them..

      im on a disability pension & i guess i will be living with my parents for the rest of my life..simply because a pension isnt enough to survive on

      i would love to go to court and sue them…. not to get back at them but because i will never be financially independent and it makes me very angry, and i also have lost 13 years of what should have been the best years of my years
      i am now 35 years old. so much has been taken away from me

      the practicing psychiatrist gave me Moclobemide (Aurorix) in 1997 and said you may experience “nausea” and that was it, kicked me out & told me to continue getting the drug through my GP

      Is not an SSRI but its a mighty mighty powerful drug & should be banned

      Interetingly i had a Brain Spect and was told i have the brain of someone with ADHD, i was never like this before the drug, i am now also dyslexic, and thats just 2 of the 100 different other symptoms etc etc that come about after using that destructive drug

      “““““““““““““““““““““““““`
      One of the most interesting things I came across was the information in regards to adverse reactions to these medications. Some people may have reactions to these drugs after only one dose that can take up to 24-36 months to recover from. That is mind blowing. However, something even scarier is the fact that some people experience what is called Protracted Withdrawal Syndrome or SSRI Discontinuation Syndrome. Some people who have taken these drugs and either abruptly stop taking them or even slowly wean off of them may send their body into a state of chaos. It can impact both physical and psychological well being and the person may experience anxiety, depression, obsessive thoughts, insomnia, pains, cognitive problems, etc. and in some cases, this lasts forever. Having your mind permanently altered and/or damaged, would be enough to make anyone feel that they are “going crazy” when in fact, these drugs that were given to them to help them, is the true culprit. I can only imagine how horrific it must be for someone who is suffering from thi

      • You know there are people who have gotten off these drugs
        after 12-15 years. At least two of them post here.Laura Delano and Monica (www.Beyondmeds.com). You coyuld ask them for advice. Most people who have been on the drugs 15 years find it harder to get oiff. Their body as habituated to them despite the drawbacks. But according to you, you’re in hell anyway. You write, “I have no quality of life and im in pain & suffering everyday, i wont bother to list all the neuro, and physical symptoms…” You might as well try. It took Monica (whose nom de plume was Gianna Kali) 5 yrs to get off the drugs. At the end she experienced great fatigue- I don’t know how she feels now, about 2 yrs later.
        Good luck.
        Seth Farber, Ph.
        http://www.sethHfarber.com

        • i stopped this drug 13 years ago, its the state the withdrawal left me in. the damage this drug did to my brain cannot be erased,

          i was replying to the comment

          “One of the most interesting things I came across was the information in regards to adverse reactions to these medications. Some people may have reactions to these drugs after only one dose that can take up to 24-36 months to recover from. That is mind blowing. However, something even scarier is the fact that some people experience what is called Protracted Withdrawal Syndrome or SSRI Discontinuation Syndrome. Some people who have taken these drugs and either abruptly stop taking them or even slowly wean off of them may send their body into a state of chaos. It can impact both physical and psychological well being and the person may experience anxiety, depression, obsessive thoughts, insomnia, pains, cognitive problems, etc. and in some cases, this lasts forever. Having your mind permanently altered and/or damaged, would be enough to make anyone feel that they are “going crazy” when in fact, these drugs that were given to them to help them, is the true culprit. I can only imagine how horrific it must be for someone who is suffering from this “

      • “most doctors arent interested in hearing my story they think its my anxiety disorder which simply changed over time into something more severe,

        i have no quality of life and im in pain & suffering everyday”

        They never listen (or maybe they don’t understand). One must set aside what they think they know, in order to hear. We hear with our hearts, anyway. So if they literally do not care, they will never hear. They have to care. Whether or not they can even hear what I just said is their own little test.

        I won’t go to another “doctor” on this planet without a medical malpractice attorney. My reason? Many, but primarily – TO PROTECT ME.

        • i like this idea, something i wish i thought of well, earlier,” a medical malpractice attorney”

          i was too young to know anything about any of this, i was just doing what i was told by authority, ie parents, doctors

  7. Thankyou for the article. It is the first editorial I have found that makes a direct link between taking anti depressants and IBS. I stumbled upon the possibility that they were linked when I was sourcing threads from users about the withdrawal process of Efexor and realised that most of the symptoms being recounted were more severe versions of the symptoms that I have had off and on for a decade and a half and had associated with IBS. Interesting, No? I’ll have to check with family members, but I’m 90% sure that I commenced taking Efexor prior to the manifestation of the (allegedly) IBS symptoms. For a while there,, they were so severe that I really strugged to function properly. The only treatment to give me any real relief was Chinese acupuncture utilizing a mild electrical current. That period of several months was the worst of it and since then I have intermittently experienced mild bouts lasting generally no longer than 24 hours (as opposed to a week) and usually coinciding with the advent f my menstrual cycle – another interesting thing to note since, in your article, you also mention that serotonin is also involved in the regulation of the reproductive system.

    Circles within circles!

    Re. your article, I can understand and appreciate the validity of your conclusions with regard to the prescribing of anti depressants in situations where the depression is NOT SEVERE AND LONGSTANDING or where other options such as CBT, diet, exercise, lifestyle analysis etc have not been explored. HOWEVER, I also deem your conclusions to be extremely concerning in that they appear to be on the path of demonizing anti depressants wholesale rather than the obscene over-prescribing of them willy billy as a quick fix ‘happy pill’, rather than as a last resort.

    As someone either born with clinical depression (runs rampant in the family genes) or a vulnerability to it which was quickly triggered by an abusive parent (unsurprisingly the one with depression) who endured crippling anxiety and associated miserable depressive episodes for over 30 years before trying ADs, I can truly say that I tried everything else first. 17 years ago mental health had not yet become a fashionable oxymoron, and taking drugs was serious business.

    I still vividly remember the first time I woke up, stretched, smiled (the sun was streaming through my window) and very HAPPY just for being there. An unforgettable experience for someone who had until then had felt like every day was a battle just to exist and maintain a facade of normalcy, all the while waiting for the axe to fall and to be ‘found out’ for the abysmal example of humanity I really was. Nice, huh? It was like being in a constant state of Fight/Flight syndrome. Awful, exhausting and relentless.

    Anyway, life didn’t magically become a fairy tale but the drugs did give me a space to breathe, to be calm, to understand what was happening and to stop blaming myself.

    Essentially, ANTI DEPRESSANTS GAVE ME BACK MY LIFE.

    Now, I know they don’t work for everyone. For some people it takes many tries and different combinations of drugs and therapy etc. The fact that every sufferer is SO individual and each regime needs to be finely-tuned to each individual for maximum efficacy, makes anti depressants an easy target when they are mis-prescribed or not properly monitored by members of the medical profession. I was lucky because the first drug prescribed for me worked and, in tandem with my doctor (who was refreshingly honest about the fact that, REALLY, they didn’t know exactly why these drugs worked), got to a dosage which seemed optimum and away I strode into my future.

    It really is tediously, boringly predictable that anti depressants were going to go from being Humanity’s Saviour to the latest excuse for lazy doctors and their lazy patients to blame anyone but themselves for the fact that ADs are causing problems for those that never should have been taking them in the first place.

    A little aside after that rant. I have the greatest respect for most medical practitioners and, indeed, sympathize with the increasing pressure they are under to ‘production line’ patients and from patients to provide a ‘quick fix’ but these drugs are too strong to hand out like candy.

    It’s time for everyone to take some responsibility. We all know, after all, that anything worth having has to be worked hard for. What kind of world are we living in that our mental health is given such short shrift in the value stakes?

    Yes, for Goodness Sake let’s be more circumspect about WHEN we use these drugs but don’t make the mistake of making desperate people too afraid to take them when they may be the only thing that could alleviate their suffering.

    I’m not a ‘party of one’ either. There are many, many stories out there about people who have reclaimed their lives with the help of ADs, and no doubt many millions more who are out there quietly and calmly living meaningful lives who do not feel the need to advertise. And Yes, I know there are plenty of horror stories out there too. Often these individuals are the victims of ignorance, negligence or irresponsibility. Also, we all know that more than anyone, whingers like a forum. When I read comments such as “the dr gave me this drug and it’s made me feel all speedy and nauseous” I have to roll my eyes. Firstly, didn’t you read up about this “hardcore” drug first Doofus? And secondly, I still remember a time when feeling “speedy and nauseous” instead of anxious and depressed, would have been BLISS.

    Wow. Dem dere’s a lotta words. Thankyou and Goodnight.

    Kathryn :-)

  8. What then is the recommendation for me? Having been left on these drugs since 1986 on the advice of a doc who felt they would prevent another episode of major depression. Do I try to stop them?

  9. Thank you! I have been shocked since finding out how dangerous these drugs are. My time on them was disastrous, and I was on them for a pain condition. I have since read a little here and there, but I’ve noticed (mainly in online comments on other sites) that people have an almost violent reaction to criticism of these drugs. The same goes for most areas of mental health, at least what I can gauge from other articles online. I was harmed by these drugs, which also made me horribly depressed, and I don’t suffer from depression normally. I can’t imagine what they’re doing to people who have a similar reaction to them but suffer from depression. If I hadn’t known I wasn’t at all myself on these meds, I might have thought I was on the best treatment for a mental disorder and it just wasn’t working. As it was, I liked the brief respite from the pain syndrome (which has pretty much run its course), but I prefer my unaltered and happy brain, especially as the effects on pain didn’t last beyond the 1 year mark and the side effects were frankly a bit devastating.

    Thank you, thank you, thank you.

  10. Paul Andrews this seems an incredibly negatively biased article. Write the percentages of people who suffer as is written from negative effects of these meds. Minimal. This article does not give the full picture. The people who agree with this article should do more research before they add their “me toos”. Add CBT or the derivative ACT to the med being used and probability of prolonged wellness and cessation of antidepressant use is excellent. The positive effects of antidepressants far outweighs the negatives. You went for effect not accuracy or helpfulness. Disappointing.

    • Mikeke, The people on this site–authors and respondents–cited books and articles and their own experience.You cite not a single article, nor your own experience.
      The article by Andrews is very good but as I noted it leaves out some of the most alarming effects. For example as Whitaker pointed out in his last book SSRIs cause manic states in many people and thus explain the rise in “bipolar” among teenagers.
      Although SSRIs appears to be very minimally more effective than placebos, that edge would likely disappear if they were ever tested against an active placebo, since we know active placebos are more effective than sugar pills. In other words the therapeutic effects of SSRIs is probably entirely a placebo effect. You don’t even take the placebo effect into account.
      You write, “The people who agree with this article should do more research before they add their “me toos”.” How disingenuous can you get. You present no evidence you’ve done a scintilla of the research (reading) of the authors or respondents.
      The one alleged finding you mention–although you give no reference–could easily be attributed to the placebo effect. AT any rate there is most probably no drug effect–all of the efficacy is due to the placebo effect of these highly advertized and popularly praised drugs. See Dr Irving Kirsch’s writings on this.Orthe book Mad Science by Stuart Kirk, David Cohen et al
      So upon what is YOUR authority based?
      Perhaps you’re a psychiatrist who prescribes these drugs.
      Seth Farber, Ph.D.
      http://www.sethHfarber.com
      http://www.sethHfarber.com

  11. In her late sixties now, my mother’s mental decline has been rapid and she suffers seizures and seems to have dementia. She has been on antidepressant medication for thirty years and in the past ten has changed from a caring, intelligent, proactive woman to one who sleeps all day and has little interest in anything. It is truly frightening how GPs dish out these drugs like lollies for any life stress – used as a panacea for those who have genuine reasons for being sad – partner break up, stress – real actual reasons to be unhappy. Lazy and dangerous doctoring. What’s going to happen epigenetically ? The ramifications are astounding. In my own middle class wealthy neighbourhood, the GPs seem to be more interested in sport and recreation…perhaps their minds are not really on their jobs ! Do they research these drugs or just prescribe and hurry on to the next patient ? They should be accountable as I am in my cafe. I’m amazed they are still prescribed so prolifically and readily. Thank you for the article and interesting website.

  12. I stumbled upon this article from a Google search on antidepressant over-use. I’ve been on Zoloft for 2 years now after talking to a nurse practitioner about menopausal symptoms, attempting to give up cigarettes and excessive sleeping. I want to wean myself away from this drug, but get an attitude from reluctance from the doctor and NP.It did help quickly, initially, but I feel it has possibly “opened up” an issue with impulse control, most obviously with unnecessary spending at a store or eating certain sweets I enjoy. It’s as though I haven’t the will to stop or curb these urges….and that is NOT like me. I have always been a bit indulgent, but only moderately…in a way of occasionally “enjoying life.” These over-indulgences of late, however, are destructive.
    I definitely will be having this conversation with my new Dr in an upcoming visit and plan to share this article with him. He’s a pretty smart guy and is a teaching Dr, who I think would welcome any input I have and be willing to address my concerns based on the latest information available.
    I am curious to know if any others have experienced similar impulse control behaviors while taking an antidepressant like Zoloft.

    • Hi MommaBear,

      Yes, people definitely do experience impulse control problems on (so-called) antidepressants. I had been taking Paxil and other SSRIs for 13 years. During that time, I developed problems with alcohol, binge eating, impulse buying, and all kinds of other compulsive behaviors. I had never before had any problems like these, and the urges to do such things have all vanished since I stopped taking Paxil.

      It is also extremely common to be faced with resistance on the part of prescribers when one expresses the desire to stop taking these kinds of drugs, regardless of the reasons that one began taking them in the first place and regardless of the problems the drugs may be causing.

      In addition, you should be aware that many doctors don’t seem to understand that some people experience serious withdrawal effects when coming off SSRIs. For me, it was an ordeal, but I came off much too quickly and I was completely unprepared. If I could do it over again, I would first check out resources like this
      http://www.freedom-center.org/freedom-center-icarus-project-publish-coming-psychiatric-drugs-guide
      and this
      http://survivingantidepressants.org/.

      You wrote that Zoloft may have “opened up” a problem with impulse control. I think you are probably correct, only I would use the word “caused”. Good luck.

  13. Is there a safe plan for withdrawing from SSRI’s? I am interested in getting off them after 10 years of use.

    • hi gerrilegstrom…

      I will give you a couple of links so that you can educate yourself on safer withdrawal methods.

      First: Harm Reduction Guide to Coming Off Psychiatric Drugs http://www.theicarusproject.net/HarmReductionGuideComingOffPsychDrugs

      you can download the manual there for free.

      Also Beyond Meds page with information on withdrawal in general: Psychiatric drug withdrawal and protracted withdrawal syndrome round-up http://beyondmeds.com/2012/12/04/psychiatric-drug-withdrawal/

      and lastly an online support group with very good advice and support:

      Surviving Antidepressants http://survivingantidepressants.org/

      those are all good places to get information about withdrawing as well as about how to find a doctor you can work with even if you have to help educate them while you learn together about withdrawal.

    • Hi gerrilegstrom,

      Whatever you do, don’t stop abruptly. I did and am living in hell. I took Cymbalta for ten years and stopped about ten days ago. (I normally do not suffer from impulse control, but reached a breaking point.)

      In the past ten days, I’ve suffered from hypnogogic hallucinations (without sleep paralysis), chronic vertigo, nightmares, insomnia, daily headaches, “brain zaps,” nausea, abdominal cramps, diarrhea, tremor, numbness, “pins and needles,” muscle pain and weakness, anxiety, crying bouts, increased depression, and more.

      It should be noted that Eli Lilly, the manufacturer of Cymbalta, has no protocol for discontinuing Cymbalta. I have been taking 60mg per day. The lowest dose is 30mg, and they’re capsules. The half-life is 10-12 hours. I believe higher math is required to formulate a plan, as I don’t recommend opening the capsules.

  14. I’m sure I read this excellent, informative article before, Paul, but I’m coming back to it because of a dialogue I’m having with my PCP about psych meds in general and antidepressants in particular. I doubt whether anyone will read this, given how long ago the article was written, but I’m hoping so because I’d like to get some feedback on a question. In response to an article i attached to an email to my family doctor, indicating that the “low serotonin hypothesis” of depression has long been debunked, his defense of antidepressants included the following:

    ” I believe the chemical imbalance hypothesis is difficult to disprove until we have a thorough understanding of neurotransmitter metabolism at the level of the CNS. A blood serum level of serotonin or norepinephrine does not have to correlate with a neurosynapse serotonin or NE level. For example, most of our potassium is in the cells, not in the blood.”

    I’ve tried some internet searches to address this question of blood serum levels of serotonin or norepinephrine versus neurosynapse levels and haven’t come up with anything definite yet. I would really appreciate any light anyone has to shed on this issue.

  15. Hi, Russerford. Your doctor is quite correct that serotonin levels likely vary across the blood-brain barrier and thus merely measuring blood levels is of limited use. However, I’d like to point out that in science theory is derived from strengthening and confirmation of a hypothesis. In other words, the onus is on psychiatry to PROVE the serotonin theory of depression, not on skeptics to DISPROVE it.

    • Thanks, Francesca! Yes, I thought it was a bit strange that he seemed to be implying that since “the chemical imbalance hypothesis is difficult to disprove” that it follows that we can assume it’s true until disproven! In my response to his response, i included the following:

      “I hear your point about the difficulty disproving the chemical balance hypothesis; however, I’m concerned that the false story keeps going forward full steam (despite evidence to the contrary) that depression and other mental health difficulties are KNOWN to be caused by chemical imbalances in the brain, which can be corrected by specific medications. And then it seems to me that the potential benefits of these supposed “brain chemistry correcting” drugs tend to be greatly inflated and the risks minimized–which is contrary to the principal of ‘informed consent’”.

  16. I had been on antidepressants since about 1995, various meds, various dosages until I thought that death would be better than this. Against my physician’s advice, I did a slow wean of meds over six months, still checking in monthly with my physician. (He had suggested a week’s wean if I thought I had to go off them.) May 2013 was my last medication. By the end of June 2013, everything in my mind fell apart. I can only describe it as the medications being a door holding back all the horrible thoughts and memories of my life, and when the memories or horror would seep in around the cracks of the door, they would add more medication. But without any medication, the door burst and I had a flood of memories and emotions that were unstoppable and not manageable. Many, many days I had to lock myself into my room to keep myself safe along with my family as I remembered things from as early as two and three years old; things I wore, events that had happened (not pleasant memories, I might add). I thought this was a new kind of hell I was going through and all through August I stayed in my room. By September, my thoughts were beginning to “calm” down and by the end of October, I found out that I was still alive. By the end of 2013, I discovered I was a human being worthy of living. It is now September, 2014, and the last 9 to 11 months have been the best months of my entire life (excepting a seven-year-period late 80′s early 90′s). I MUST tell you that my faith in God got me through those times of horror. But let me tell you this was an eye opening event because now it is clear to me why all these people who go off their medication do horrendous things to others. They are literally out of their mind. (You hear of shootings etc., and then way too often “he/she was off her meds.”)
    (Also by the way, I never felt like I was going to hurt someone else, but definitely would have hurt myself. Still with children in the house, I was a little disheveled to look at, and could not really take care of myself very well physically. I could not tolerate anything of the real life, thus I hid in my room.)

    Being on medication was NEVER as good as I am doing now; and while I cannot tell anyone to go off theirs, I know for myself I will never go back on it. I am a writer, and thus have documented most of this experience. My only regret in all of this is that I was not someone’s “study” to show the effects of antidepressant medication and the horrors of being on it and coming off of it. I can only give credit to God above, that I am even alive today. On medications, I did not want to live. Going off medications, I thought I was going to die. But NOW, I am living a healthier life than I ever have in my whole 55 years of living. (Lost weight, eat healthier, exercise, etc.)

    When my friend’s husband died unexpectedly at 50 years old, she became quite depressed. I advised her to NEVER begin antidepressants. Depression is horrible, I’ve documented what depression is like in my own writings, but depression on antidepressant medication is hell.

    Disclaimer: I am not now, nor can I ever be responsible for someone reading my words and discontinuing their medication. I cannot be responsible for someone not seeking a professional opinion regarding antidepressants or their depression. These words were intended only for the sharing of my experience and never meant to be counsel for someone else. Thank you.

    • Thank you for sharing your story. I am so glad you are now free. I’ve been through this as well and my experience was very similar.

      But let me tell you this was an eye opening event because now it is clear to me why all these people who go off their medication do horrendous things to others. They are literally out of their mind. (You hear of shootings etc., and then way too often “he/she was off her meds.”)

      Exactly. It’s not because they needed to be on the drugs because of some faery tale chemical imbalance; it’s because the withdrawal effects can be devastating. And meanwhile, you have people who call themselves doctors denying the severity of withdrawal symptoms and using the violence to promote the very same drugs that likely caused the violence in the first place! It’s disgusting.

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