When a new antidepressant made the cover of Newsweek over two decades ago, the headline announced: “Prozac: A Breakthrough Drug for Depression.” It was hoped that this medication (and many others to follow) would revolutionize the treatment of mood disorders.
There is now some doubt that these drugs have lived up to the promise, but they have made billions for drug manufacturers. Antidepressants have become one of the most prescribed categories of medicines in the U.S. It is estimated that 10% of Americans takes one of these drugs, and as many as 25% of middle-aged women depend on an antidepressant to stabilize their moods.
What Are the Downsides of Antidepressants?
What was not anticipated when these drugs were approved was the possibility that they would also have some serious side effects. One unexpected complication is hip fracture (Age and Ageing, July, 2013). Norwegian researchers reviewed data from more than 900,000 people born before 1945. They discovered roughly 40,000 hip fractures (4.4%). People taking newer generation antidepressants had a 60 to 80% increased (relative) risk of such breaks.
Antidepressants Linked to Hip Fracture:
- Citalopram (Celexa)
- Duloxetine (Cymbalta)
- Escitalopram (Lexapro)
- Fluoxetine (Prozac)
- Fluvoxamine (Luvox)
- Mirtazepine (Remeron)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
- Venlafaxine (Effexor)
The researchers reached the following conclusions:
“Key Points
- The risk of hip fracture was markedly increased among older people exposed to antidepressant drugs.
- Individuals exposed to SSRIs and other drugs with serotonergic properties were at greatest excess risk.
- About 5% of hip fractures in Norwegian seniors were attributable to antidepressant drug exposure.”
This is a very big deal, since hip fractures are a major cause of disability and death in older people. According to the CDC, nearly 300,000 Americans over the age of 65 are admitted to hospitals each year because of hip fractures. About 1 in 5 will die within one year.
Although it is not clear why antidepressants increase the risk for broken hips, there are two possibilities. One is that drugs with a strong impact on the neurochemical serotonin may reduce bone mineral density and increase the risk for osteoporosis. The other is that antidepressants could make older people more vulnerable to falls. Weaker bones plus unsteadiness is a deadly combination.
Another Serious Complication: Bleeding
On April 29th, 2013, an article in JAMA Internal Medicine reported that SSRI-type antidepressants such as fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft) were linked to an increased risk of post-surgical bleeding. The investigators hypothesize that such medications may affect blood platelets, which are responsible for blood clotting.
Because prior studies suggested that such drugs might pose a bleeding risk if taken around the time of surgery, investigators combed the records of more than half a million patients. Roughly 70,000 (13.7%) had taken one of the mentioned SSRIs or citalopram (Celexa) or escitalopram (Lexapro). The authors noted:
“Although the implications of bleeding clearly differ according to the surgical procedure, SSRI association with adverse outcomes appeared relatively consistent in a range of patient subgroups. Concern for the potential associations of SSRIs with bleeding outcomes has already been incorporated into available clinical practice references, several of which suggest stopping or holding SSRI therapy for 2 or more weeks before surgery, with particular attention to holding SSRI therapy in patients undergoing neurological or orthopedic surgery.”
That seems sensible enough, but what the researchers don’t seem to appreciate is that stopping antidepressants suddenly can trigger terrible withdrawal symptoms. When the FDA approved these drugs, most physicians and patients did not realize that there could be withdrawal symptoms if the drugs were stopped (“sudden discontinuation syndrome“). We have heard from hundreds of people who have experienced unbearable symptoms when they discontinued such drugs. This means that if surgeons tell their patients to stop an antidepressant a week or two prior to surgery, there could be hell to pay.
Sudden Withdrawal Symptoms:
- Brain “zaps” (electric shock-like sensations in the brain)
- Dizziness, light-headedness, vertigo, feeling faint
- Headaches
- Anxiety, irritability, hostility
- Nausea, diarrhea, digestive upset
- Tremor, hands shaking, nerve tingles, strange sensations
- Fatigue, tiredness, lack of energy
- Visual disturbances
Here are just a few stories from people who stopped an antidepressant medication suddenly:
“Due to a change in our insurance and lack of communication from our company, I wasn’t able to refill my prescription of Cymbalta. Saturday was my last dose and as of Monday I felt like I was losing my mind but didn’t know why. Ohhhh, how ignorance is NOT bliss in this situation.
“I’m sitting in my office and I think today was the worst physical and emotional roller coaster ride I have EVER been on. I have literally gone from wanting to scream, throw things or hit someone to crying in a matter of minutes…ALL DAY.
“My head is spinning and every 30 seconds or so, I hear this ‘whoosh, whoosh, whoosh’ in my ears (similar to hearing your pulse when you have a bad migraine). I have this creeping crawling feeling going up the back of my neck when I feel an attack coming and need to quickly excuse myself from normal conversations. These are not stressful conversation by any means. Or, I suddenly just start sweating.
“This is absolute craziness!” Shel
“I took Pristiq for about two years. I tried to taper off as my MD advised. It was over 3 weeks but I experienced terrible brain zaps, anxiety, insomnia and irritability and did not go to work for about 10 days. It was one of the worst experiences I have ever had. I am on a healthier approach to handling life’s stresses: exercise, relaxation, aromatherapy, massage and vitamin support.” Cathy
“I have now been completely sertraline free for over a month, and my withdrawal symptoms are finally gone.
“I had them all: nausea, brain shocks/zaps, vertigo, headaches, digestive problems, numbness/tingling in my hands, feet, and face.
“I’m writing to let you know that it does get better, even on days when you think you cannot possibly survive one more hour of feeling so sick. SSRI withdrawal is painful and scary and, as many others who have commented on this website, if I had known what it would be like to wean off of this drug I would never have taken it.” Jess
Other unexpected complications of antidepressants may include:
Recognized complications of modern antidepressant medications are listed below. There are serious downsides of antidepressants in some cases.
Antidepressant Side Effects:
- Nausea, stomach pain, constipation, diarrhea, decreased appetite, vomiting
- Dry mouth
- Insomnia, anxiety, tremor
- • Dizziness, fatigue, sleepiness
- Sweating, hot flashes
- Blurred vision
- Headache
- Sexual dysfunction, lowered libido, erection difficulties, lack of orgasm
- Liver damage
- Serious skin reactions, rash, hives (requires immediate MD assistance!)
- Glaucoma
- Irregular heart rhythms
- Bleeding problems
- Blood pressure problems
- Interaction with other drugs (leading to serotonin syndrome among other reactions)
- Pneumonia
- Seizures
- Depressed mood, suicidal thoughts and behavior, suicide
For people with major depression, antidepressant medication can be a lifesaver. Such drugs should NEVER be discontinued suddenly or without medical supervision!
Clinical trials have not revealed all the downsides of antidepressants. Paroxetine, for example, interacts dangerously with numerous other medications (Psychopharmacology Bulletin, March 1, 2016). In reviewing these as well as side effects such as problems with male fertility, birth defects, autism, weight gain and suicidality in adolescents, the clinicians titled their article: “Paroxetine-The Antidepressant from Hell? Probably Not, But Caution Required.”
Are Antidepressants Overprescribed?
We do worry that antidepressants have been prescribed too casually. A study (Psychotherapy and Psychosomatics, online, March 27, 2013) revealed that as many as two-thirds of the patients diagnosed with depression did not actually meet criteria for major depression. Older people (over 65) were especially vulnerable to overdiagnosis. When people are inappropriately diagnosed as being seriously depressed, they frequently get psychiatric medicine-not just antidepressants but antipsychotic drugs as well. The author concludes:
“Depression overdiagnosis and overtreatment is common in community settings in the USA. There is a need for improved targeting of diagnosis and treatments of depression and other mental disorders in these settings.”
To read more about the downsides of antidepressants and learn about other ways to treat the blues, you may find our Guide to Dealing with Depression helpful.
We would also like to hear from you. How well have antidepressants worked? Did you experience side effects or withdrawal symptoms? Share your story below.
Revised 10/27/16
