Antidepressants

-Forensic psychiatrist Andrew Shepherd reviews a recent study on withdrawal effects from coming off antidepressant drugs.

The BMJ article on The Marketing of Serotonin has stirred some interest. There are some  highly technical comments on the BMJ site but of course the key point behind the piece is the rather obvious fact that twenty-five years ago many people were saying it was all a myth. The extraordinary Michael Leunig nailed it twenty years ago in the sketch above. (Leunig is wonderful across the board and razor sharp on medicine and mental health).

-The Council for Evidence-based Psychiatry reports that antidepressant use in the UK has increased 7.5% since 2013, and over 500% since 1992.

A recent article on the website i09 titled, ‘The Most popular Antidepressants are Based on an Outdated Theory” has again raised the issue of Chemical Imbalances.  It is interesting that the author of the  i09 piece cites Dr. Peter Kramer and states, “Some psychiatrists vehemently disagree with the way journalists and other psychiatrists have pushed back against the chemical imbalance theory….” In both cases he cited what he considered the best evidence in support of the theory, but he did not discuss the research in any depth. Back in 2008, we took an in-depth look at the evidence that Dr. Kramer used to support the chemical imbalance theory. When one takes a closer look at that research we do not think it supports the theory. For this reason, we are reposting our 2008 essay about this.

The serotonin reuptake inhibiting (SSRI) group of drugs came on stream in the late 1980s, nearly two decades after first being mooted. The delay centred on finding an indication. They did not have hoped-for lucrative antihypertensive or antiobesity profiles. Even though a 1960s idea that serotonin concentrations might be lowered in depression had been rejected, drug companies marketed SSRIs for depression even though they were weaker than older tricyclic antidepressants. They sold the idea that depression was the deeper illness behind the superficial manifestations of anxiety. The approach was an astonishing success, central to which was the notion that SSRIs restored serotonin levels to normal, a notion that later transmuted into the idea that they remedied a chemical imbalance.

Zoloft caused up to six-fold increases in build-up of atherosclerosis plaque in the coronary arteries of monkeys.

A JAMA Psychiatry study found links between PTSD, type 2 diabetes, and antidepressants.

The impact of long-term SSRIs on memory-related nerve cell receptors does have functional consequences. Research shows that SSRIs impair the acquisition of fear memories. (Perhaps a positive outcome.) But unlearning fear memories involves new learning as well, and according to a study by LeDoux and colleagues, long-term exposure to SSRIs makes it harder to unlearn fear memories.

-A selection of recent commentaries from around the web about the Germanwings plane crash...

The first of more than 1,000 lawsuits about Zoloft and birth defects has gotten underway.

A retrospective study in the Journal of Clinical Psychiatry examined cases of people who suffered sexual dysfunction that endured even after stopping taking SSRI antidepressants.

I thought I would make a small contribution to the discussion about how coverage of the recent airline tragedy focuses so much on the supposed ‘mental illness’ of the pilot and not so much on the possible role of antidepressants. Of course we will never know the answer to these questions but it is important, I think, to combat the simplistic nonsense wheeled out after most such tragedies, the nonsense that says the person had an illness that made them do awful things. So, just to confirm what many recipients of antidepressants, clinicians and researchers have been saying for a long time, here are some findings from our recent New Zealand survey of over 1,800 people taking anti-depressants, which we think is the largest survey to date.

-Peter Hitchens argues that the public discussion about the Germanwings crash has to start distinguishing between whether depressed people should be flying and whether people taking antidepressants should be.

With the current focus on the possible contribution of psychoactive drugs to the crash of GermanWings flight A320 on Tuesday, March 24, it is useful to identify potential links between the effect of the antidepressants and the events.  In all 47 cases listed on SSRIstories, the pilots were taking antidepressant medications, mostly SSRIs, often in combination with other medications and sometimes with alcohol.

The crash last week of the Germanwings plane has shocked many. In view of the apparent mental health record of the co-pilot Andreas Lubitz, questions have been asked about the screening policies of airlines. The focus has generally been on the conditions pilots may have or the arguments they might be having with partners or other situational factors that might make them unstable. Even when the issue of the medication a pilot may be taking is raised, it is in the context of policies that permit pilots to continue on drugs like antidepressants to ensure any underlying conditions are effectively treated. But fewer treatments in medicine are effective in this sense than people might think and even when effective they come with effects that need to be balanced against the likely effects of the underlying condition.

The German pilot who apparently deliberately crashed a passenger plane reportedly had antidepressant drugs in his home, use of which is restricted or disallowed by many aviation regulators.

The majority of people taking antidepressant medications have never had major depressive disorder, and 38% have never met criteria for having any mental disorder.

A literature review found that the extensive off-label use of antipsychotic medications in nursing homes is causing many adverse effects and providing limited benefits.

Pneumonia cases in the elderly are strongly associated with use of anticholinergic medications, including benzodiazepines and tricyclic antidepressants.

In 2010, Acta Psychiatrica Scandinavica published a study by Göran Isacsson et al.  The paper was titled Antidepressant medication prevents suicide in depression. It's a complicated article, with some tenuous logic, but, in any event, it's all moot, because the article was retracted by the authors and by Acta Psychiatrica Scandinavica about sixteen months after publication.  The retraction had been requested by the authors because of "… unintentional errors in the analysis of the data …"

Common scientific beliefs about serotonin levels in depression and how antidepressants act on the brain appear to be completely backwards.

In the first systematic review of withdrawal problems that patients experience when trying to get off SSRI antidepressant medications, researchers found that withdrawing from SSRIs was comparable to trying to quit addictive benzodiazepines.

-Pharmaceutical drug policy researcher Alan Cassels discusses the role of name changes and marketing in depression treatment.

When I was researching Anatomy of an Epidemic and sought to track the number of people receiving a disability payment between 1987 and 2007 due to “mental illness,” I was frustrated by the lack of diagnostic clarity in the data. The Social Security Administration would list, in its annual reports on the Supplemental Security Income and Social Security Disability Insurance (SSDI) programs, the number of people receiving payment for “mental disorders,” which in turn was broken down into just two subcategories: “retardation,” and “other mental disorders.” Unfortunately, the “other mental disorders,” which was the category for those with psychiatric disorders, was not broken down into its diagnostic parts.

Greater cumulative doses of drugs that are anticholinergic or block the neurotransmitter acetylcholine are associated with significant increases in dementia and Alzheimer's.