When Antidepressants Don't Work
There's no doubt that since the introduction of SSRI antidepressants in the 1980s suicide rates have dropped significantly.
However, three studies have shown that these types of antidepressants work only in the severest
forms of depression - and then only some of the time. Even more shocking - for mild, moderate, and even severe depression, they work no better than
sugar pills (Fournier et al., 2010).
According to the latest study, published January 6, 2010 in the Journal of the American Medical Association, "True drug effects...
were nonexistent to negligible among depressed patients with mild, moderate, and even severe baseline symptoms..." The researchers,
from the University of Pennsylvania, Vanderbilt University, the University of Colorado at Boulder, and the University of New Mexico School of Medicine,
examined six studies randomly selected from the FDA's database.
A 2008 review of previous research uncovered via the Freedom of Information Act determined that four of the most commonly prescribed
antidepressants, fluoxetine (Prozac), venlafaxine (Effexor), nefazodone (Serzone), and paroxetine (Seroxat/Paxil), worked no better than
sugar pills for mild to moderate depression (Kirsch, 2008). For the study, researchers analyzed 47 clinical studies conducted by
pharmaceutical companies that were never released. It included studies submitted to the FDA during the drug approval process, but not
published in medical journals. The review found that the drugs were only effective for the most severely depressed patients. In people
with lower levels of depression, the results of the antidepressants were quite modest or disappeared entirely. Other studies have had
similar findings. In a 2002 Washington State study, investigators looked at 52 studies of antidepressants in the FDA’s database and
determined that in 48% of the studies the results were no better than placebo (Khan, Leventhal, Khan, & Brown, 2002). They also concluded
that antidepressants were only more effective that sugar pills with the severest forms of depression. Based on this evidence, complementary
and alternative medicine (CAM) therapies, represent a viable option for patients that are not be helped by antidepressants.
This body of research is just the latest revelation in a series of investigative research questioning the effectiveness and safety of antidepressants.
In 2004, the FDA demanded that drug manufacturers place a Black Box Warning on their antidepressant products stating that the drugs
could cause suicidal behavior in people 18 to 24 (Cheung, Sacks, Dewa, Pong, & Levitt, 2008). Reports of unusual, severe reactions with selective serotonin reuptake inhibitor
antidepressant drugs (SSRIs) emerged soon after the first SSRI, Prozac, was introduced in 1988. Since that time, doctors have noted that patients
taking SSRIs can exhibit impulsive, violent behavior resulting in self-harm, suicide, and homocide.
Other research on antidepressants and their effect on health have been equally unflattering.
A 2009 study by Harvard researchers found that antidepressants can cause an increased risk of stroke in post-menopausal women (Smoller et al., 2009).
The researchers examined six years of data on 5,500 postmenopausal women who began taking antidepressants after enrolling in the study and
compared their findings to 130,000 women who did not take the drugs. It found that women on SSRIs (such as Celexa, Paxil, Prozac, and Zoloft)
had a 45 percent increase in risk for stroke and a 32 percent increase in risk for death from other causes.
Similar results were found for women on tricyclic antidepressants.
One of most disheartening studies released in 2009 found that breast cancer survivors risk having their disease come back if they use
certain antidepressants while taking the cancer prevention drug tamoxifen, a standard breast cancel protocol (Medco, 2009).
About 500,000 women in the United States take tamoxifen, which cuts in half the chances of a breast cancer recurrence. Many of them also
take antidepressants for hot flashes, because hormone pills aren't considered safe after breast cancer. The researchers found that
using antidepressants, such as Prozac, Paxil or Zoloft, can virtually wipe out the benefit tamoxifen provides.
All of this research paints a dark picture for what doctors and patients had hoped would be a silver bullet for depression.
Instead, scientists and lay people alike have begun to wonder what other problems may be linked to this class of drugs.
Much Needed Alternatives
Depression is a worldwide epidemic. In the United States alone, depression is among the ten most frequently reported medical conditions
and 19 million people are thought to suffer from it (Eisenberg et al., 1993; Eisenberg et al., 1998). Scientists estimate that one third
of the population will experience depression during their lifetime and by 2020, depressive disorders will be the second largest illness
in the world (Moshiri et al., 2006; Rorsman et al., 1990). These are sobering facts, in light of the fact that depression poses a
substantial risk of death and is associated with a high rate of disability. The often-quoted mortality rate is that about 15% of patients
with major depression will eventually die by suicide (Goodwin & Jamison, 1990), a rate confirmed in a large-scale review of 30 studies
(Guze & Robins, 1970).
According to a 2004 report released by the U.S. Department of Health and Human Services, adult use of antidepressants almost tripled
between 1988 and 2000. According ot the report, ten percent of women 18 and older and 4 percent of
men take antidepressants.
While suicide rates have declined since the introduction of selective serotonin reuptake inhibitors (SSRIs) in 1988, approximately 30%
of patients with major depression do not respond to SSRIs (Rosack, 2005; Rosack, 2006). Many end up taking a combination of two or more
antidepressants with minimal results (Rispail et al., 1990). Despite the availability of a wide range of antidepressant drugs, nearly
30% of all depressed patients fail to respond to antidepressant medication of any kind (Kirsch, 2008; Shergill & Katona, 1997).
The use of CAM therapies has gained increased acceptance, making it a feasible alternative to pharmacology. In 1991, 34% of the U.S.
adult population reported using CAM therapy during the previous year (Eisenberg et al., 1993). By 2007, that figure rose to almost 40%
(Barnes, Bloom, & Nahin, 2009). Between 2002 and 2007 increased use was seen among adults for deep breathing exercises, guided visualization,
meditation, naturopathy, and yoga (Barnes, Powell-Griner, McFann, & Nahin, 2004; Barnes at al, 2009).
Based on this body of research, CAM therapies can be a useful alternative for depressed patients who are not helped by antidepressants.
A qualified mental health professional, such as a naturopathic psychotherapist, can help determine the appropriate therapies on
an individual basis. Combining such treatments with psychotherapy can provide a particularly effective treatment protocol.
References (To view, roll mouse over the "References" heading; to hide, click on the heading)
American Psychiatric Association (2000), Diagnostic and statistical manual of mental
disorders. (4th Ed.). Washington, DC: American Psychiatric Association.
Anderson, G. M., Segman, R. H. & King, R. A. (1995). Serotonin and suicidality: the impact of fluoxetine administration. II: Acute neurobiological effects.
Israel Journal of Psychiatry and Related Sciences, 32(1), 44-50.
Barcley, L. (2007). Fighting depression and improving cognition with omega-3 fatty acids. Life Extension, October, 65-71.
Barnes, P. M., Bloom, B., & Nahin, R. L. (2009). Complementary and alternative medicine use among adults and children: United States, 2007. National Health Statistics Reports, 12, 1-23.
Barnes, P. M., Powell-Griner, E., McFann, K., & Nahin, R. L. (2004). Complementary and alternative medicine use among adults: United States, 2002. National Center for Health Statistics, 2004. Advance Data, 343, 1-19.
Cohen, J. (2001). Over dose: The case against the drug companies: Prescription drugs, side effects, and your health. New York: Jeremy P. Tarcher.
Donovan, S., Clayton, A., et al. (2000). Deliberate self-harm and antidepressant drugs. Investigation of a possible link. British Journal of Psychiatry, 177, 551-556.
Eisenberg, D. M., Davis, R. B., Ettner, S. L., Appel, S., Wilkey, S., Van Rompay, M., & Kessler, R. C. (1998). Trends in alternative medicine
use in the United States, 1990-1997: Results of a follow-up national survey. Journal of the American Medical Association, 280(18), 1569-1575.
Eisenberg, D. M., Kessler, R. C., Foster, C., Norlock, F. E., Calkins, D. R., & Delbanco, T. L. (1993). Unconventional medicine in the United States: Prevalence, costs, and patterns of use. New England Journal Medicine, 328, 246-252.
Fredricks, R. (2008). Healing & wholeness: Complementary and alternative therapies for mental health. Bloomington, IN: Author House.
Fournier, J. C., DeRubeis, R. J. , Hollon, S. D., Dimidjian, S., Amsterdam, J. D., Shelton, R. C.,& Fawcett, J. (2010).
Antidepressant drug effects and depression severity: A patient-level meta-analysis. JAMA,303(1),47-53.
Goodwin, F. K., & Jamison, K. R. (19990). Manic-depressive illness. Oxford University Press: New York.
Guze, S. B, & Robins, E. (1970). Suicide and affective disorders. British Journal Psychiatry, 117, 437-438.
Holzman, D. (2009). Tamoxifen, antidepressants, and CYP2D6: The conundrum continues. J Natl Cancer Inst, 101(20), 1370-1371.
Khan, A., Leventhal, R. M., Khan, S., & Brown, W. A. (2002). Severity of depression and response to antidepressants and placebo: An analysis
of the Food and Drug Administration database. Journal of Clinical Psychopharmacology, 22, 40-45.
Kirsch, I. (2008). Challenging received wisdom: Antidepressants and the placebo effect. Mcgill Journal of Medicine, 11(2), 219-222.
Lasser, K. E., Alan, P. D., Woolhandler, S. J., Himmelstein, D. U., Wolfe, S. M., & Bor, D. H. (2002). Timing of new black box warnings and withdrawals for prescription medications. JAMA, 287, 2215-2220.
Medco Health Solutions. (2009). Popular breast cancer drug used with certain antidepressants puts New Jersey women at risk. Retrieved
January 6, 2010 from http://www.medcohealth.com/medco/corporate/home.jsp?ltSess=y&articleID=CorpAlertMedco_tamoxifen_risk
Moshiri, E., Basti, A. A., Noorbala, A. A., Jamshidi, A. H., Hesameddin Abbasi, S., & Akhondzadeh, S. (2006). Crocus sativus L. (petal) in the treatment
of mild-to-moderate depression: A double-blind, randomized and placebo-controlled trial. Phytomedicine, 13, 607-611.
Rispail, Y., Schmitt, L., Berlan, M., Montastruc, J. L., & Montastruc, P. (1990). Yohimbine increases salivary secretion in depressed patients
treated with tricyclic antidepressants. European Journal of Clinical Pharmacology, 39(4), 425-426.
Rosack, J. (2005). Suicide rates began to drop with advent of SSRIs. Psychiatric News, 40(7), 29.
Rosack, J. (2006). MAOI skin patch wins DFA approval for depression. Psychiatric News, 41(7), 31.
Rorsman, B., Gräsbeck, A., Hagnell, O., Lanke, J., Öhman, R., Öjesjö, L., & Otterbeck, L. A. (1990). Prospective study of first-incidence depression: The Lundby Study, 1957-72. British Journal of Psychiatry, 156, 336-342.
Shergill, S. S., & Katona, C. L. (1997). Pharmacological choices after one antidepressant fails: A survey of UK psychiatrists. Journal of Affective Disorders, 43, 19-25.
Smoller, J. W., Allison, M., Cochrane, B. B., Curb, J. D., Perlis, R. H., Robinson, J. G., Rosal, M. C,, Wenger, N. K., & Wassertheil-Smoller, S. (2009).
Antidepressant use and risk of incident cardiovascular morbidity and mortality among postmenopausal women In the women's health initiative study.
Arch Intern Med, 169(22), 2128-2139.
Waechter, F. (2003). Paroxetine must not be given to patients under 18. BMJ, 326, 1282.
San Jose Therapist, San Jose Therapy, San Jose Psychotherapy, San Jose Psychotherapist, San Jose Counselor,
San Jose Counseling, San Jose Marriage Family Therapy, San Jose Marriage Family Therapist