Anti-depressants: panacea or problem?

Depression has become very big. A recent (2004) publication of the World Health Report, produced by the World Health Organisation showed that “ mental and behavioural disorders are common, affecting more than 25% of all people at some time in their lives”. Strong epidemiological data also show a 10% increase in rates of depression in the US population every decade for the last 100 years.

Feelings of helplessness, loss of hope, sadness, crying, sleep or appetite disturbances or difficulty in concentrating for at least two weeks, are sufficient for the very common diagnosis of clinical depression.

But, if you are in the antidepressant drug business, depression is anything you want it to be. The blues, feeling down, out of sorts, bothered, inconvenienced – no level of depression is so trivial that the average Joe couldn’t use a sampler pack of Prozac or Zoloft to get started.

Selective Serotonin Reuptake Inhibitors
The National Institute for Health and Clinical studies recently recommended that antidepressants, specifically SSRIs, should be the first line treatment for moderate to severe depression.
The brain uses chemical messengers (neurotransmitters) to enable nerve cells to talk to each other. For about 30 years depression has been linked to low levels of serotonin, a brain chemical that regulates mood. The drugs called selective serotonin reuptake inhibitors, such as Prozac, are said to ease depression by keeping serorotonin active within the synapses between nerve cells, enhancing the chemical’s positive effect.

Serotonin is, however, a multifunctional messenger, present also in the gut, where it regulates the secretion of digestive juices and helps control the passage of food.

Contemporary neuroscience has failed to provide direct proof of seroronin deficiency in any mental disorder, and has in fact provided significant counterevidence to the explanation of a simple neurotransmitter deficiency. (Castren E 2005. Nat. Rev. Neuroscience 6:241) The brain is vastly complex, and poorly understood.

“The public is being misinformed about the precision of these SSRIs when the medical profession oversimplifies their action in the brain, and ignores the body as if it exists merely to carry the head around. In short these molecules of emotion regulate every aspect of our physiology” – Professor Candace Pert, neuroscientist.

Recent studies (2002) even call into question the very efficacy of these SSRIs. Professor Irving Kirsch and colleagues gained access to all clinical trials of antidepressants submitted to the Food and Drug Administration – the drug watchdog in America – by the pharmaceutical companies for medication approval. When the published and unpublished trials were pooled, the placebo (dummy pill ) duplicated about 80% of the antidepressant responses, and 57% of these pharmaceutical company funded trials failed to show a statistically significant difference between antidepressants and inert placebo.
The small difference between the drug response and the placebo response has been a dirty little secret, known for years to researchers who conduct clinical trials. (Kirsch, Moore, et al 2002. Prevention and Treatment 2002. Vol 5: article 33)

Treatment of depression is based on a flawed paradigm of “abnormal behaviour” being caused by chemical imbalance in the brain to be “corrected” by tweaking little understood biological pathways.

Side Effcts
Although all the long-term side-effects of these central nervous system drugs are still not known, antidepressants carry some potentially serious side-effects. Long-term use of antidepressants is controversial and withdrawal from them can be as difficult as the disorder itself.

Akathisia is a medication-induced disorder consisting of extreme restlessness, irritability and agitation. It is often associated with the withdrawal symptoms of insomnia, headaches, nervousness, anxiety, loss of appetite, tremors and nausea. It can be coupled with suicidal ideation, homicidal thoughts and acts. It may create an inability to control impulses. A study on Prozac, reported in the Journal of Clinical Psychiatry, estimated that the number of Prozac users who experience akathisia is between 10-25%.

The inescapable truth is that the perpetrators of many of the most horrendous murder rampages in the US, in recent years, were taking or coming off prescribed psychiatric drugs.

There is evidence linking SSRIs to increased birth defects, and additional evidence of SSRI toxicity in the developing brain. According to a recent study out of Columbia University, antidepressants may change “crucial phases of brain development that might, paradoxically, predispose children to depression and anxiety disorders later in life.” One of the researchers warned that the widespread use of SSRIs is a “ large scale experiment with our nation’s youth – we don’t know what the long-term effects are.” Newborns, exposed to SSRIs, can also experience serious withdrawal symptoms.

SSRI- -discontinuing syndrome includes symptoms like anxiety, crying spells, mood lability, tremors and vomiting Up to 25% of patients stopping these drugs, can experience withdrawal symptoms. ( Ditto K E ;J. of Postgraduate Medicine 2003. 114)

Childhood depression
The editorial in the Lancet (April 2004) pointed out “the story of research into SSRIs use in childhood depression is one of confusion, manipulation and institutional failure”. The underlying study that sparked the strongly worded editorial – also published in Lancet April 2004 – found that after a systematic review of published versus unpublished antidepressant clinical trial data, involving children and adolescents, the published data alone showed a favourable profile, while hidden, unpublished data show the risk/benefit profile as unfavourable.

Another article published in the BMJ (April 2004), similarly concluded “ Investigators’ conclusions on the efficacy of newer antidepressants in childhood have exaggerated their benefits – adverse reactions have been downplayed. Antidepressant drugs cannot confidently be recommended as a treatment option for childhood depression”.

The Food and Drug Administration (US) issued a warning in 2004, that children and young adults who use SSRIs , may have an increased risk of suicide. After reanalysing the results of hundreds of SSRIs studies, the FDA issued a second warning in August 2005, cautioning doctors and SSRI users to watch closely for signs of suicidal behaviour. Studies found that taking antidepressants caused an additional 14 out of every 1000 patients under age 18 to have suicidal thoughts or behaviour.

The use of antidepressants, excluding Prozac, for patients under 18 has been banned in Britain since 2003.

In 2005, the scientific panel of the European Medicines Agency – Europe’s drug watchdog – banned the use of Prozac, and other modern antidepressants, for use in under 18s, because of the increase of suicidal thoughts and suicide attempts among children and adolescents on these drugs.

More people suffer from depression today than ever before. Despite the wide array of antidepressant medications on the market, conventional psychiatric medication is clearly failing to successfully manage the mood disorders that plague millions of adults, teenagers and children. Since the most expensive clinical study ever, sponsored by the US government, showed that popular antidepressant medications, such as Prozac, Zoloft and Paxil, benefited only 50% of the depressed patients who used them, many scientists and medical practitioners believe that it is time to re-evaluate the standard approach to mental health treatment. (Rubinow D R 2006 NEJM: March; 23)

Without discounting the very serious cases of depression that may best be treated pharmaceutically, there are more effective solutions to help restore emotional balance to life than relying on medication, Our emotional and spiritual needs can not be met by popping a pill – relief is not just a swallow away.