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
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