Americans love antidepressants. It is estimated that between one in eight and one in ten takes an antidepressant medication. People take SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) to treat depression, anxiety, OCD (obsessive compulsive disorder, fibromyalgia, nerve pain, ADHD and symptoms of menopause. How well do patients understand the dangers of antidepressants?
The Stats Are Startling!
The last time we searched we discovered some fascinating numbers. Here are some annual statistics for popular antidepressants:
- Sertraline (Zoloft) 6.7 million patients and 38 million prescriptions
- Fluoxetine (Prozac) 4.4 million patients and 24 million prescriptions
- Escitalopram (Lexapro) 3.5 million patients and 20 million prescriptions
- Venlafaxine (Effexor) 3.0 million patients and 17 million prescriptions
- Duloxetine (Cymbalta) 2.5 million patients and 15 million prescriptions
- Paroxetine (Paxil) 2.5 million patients and 15 million prescriptions
- Trazodone (Desyrel) is a serotonin modulator and works a bit differently. It is also very popular with 4.6 million patients and 26 million prescriptions
That does not include antidepressants such as bupropion (Wellbutrin), citalopram (Celexa), desvenlafaxine (Pristiq) and levomilnacipran (Fetzima). Nor does it include older antidepressants called tricyclics such as amitriptyline, desipramine, doxepin, imipramine, nortriptyline and protriptyline.
The FDA and Antidepressant Approvals:
Most people assume that antidepressant medications are quite safe. After all, these drugs have all been approved by the FDA and one condition for such approval is that the medicine must be proven “safe and effective.” The trouble is that the FDA’s definition of safe and effective is relative. The agency routinely approves medications that have potentially serious or even life-threatening side effects.
It is not uncommon for the FDA to approve a drug that is barely better than placebo. In other words, if a sugar pill relieved depression in 30% of patients with depression and a new drug relieved depression in 40% of patients with depression, The FDA might well consider it effective. That, despite an absolute benefit that may only be 10% better than nothing at all.
If you think we pulled those numbers out of a hat, check this research. Studies have reported placebo response rates of 31-45% in the treatment of depression. That compares to a roughly 50% response rate with antidepressant medications (Walsh et al, JAMA, April 10, 2002; Stolk et al, Annals of Pharmacotherapy, Dec. 2003; Kirsch et al, PLoS Medicine, Feb. 2008).
Serotonin and the Dangers of Antidepressants:
Many people, including a lot of health professionals, think that antidepressants primarily affect the brain. That is where the neurotransmitter serotonin is found. But serotonin is found throughout the body and plays an important, but little understood role in many physiological processes.
Did you know?
Did you know that most of the serotonin that is made in your body is made in your digestive tract? That’s right, the gut makes a substantial amount of serotonin and it circulates around your body through the blood stream. The sticky part of your blood (platelets) take up serotonin. It plays an important role in blood clotting. A new study into the dangers of antidepressants notes that:
“Indeed, serotonin regulates growth, development, reproduction, thermoregulation, tissue repair, maintenance, electrolyte balance, mitochondrial function, and the storage, mobilization and distribution of energetic resources. By blocking the transporter in the brain and the periphery, selective serotonin reuptake inhibitors (SSRIs), which are the most widely prescribed ADs [antidepressants], could potentially degrade many adaptive processes.”
(Psychotherapy and Psychosomatics, online, Sept. 14, 2017)
The new study suggests that antidepressants may not be as innocuous as they seem. Researchers conducted a meta-analysis of 17 studies comparing people using antidepressants to those on placebo. They found that those taking antidepressants were 33% more likely to die during the study time frame and 14% more likely to have a heart attack, stroke or other cardiovascular event. People who already had cardiovascular disease, however, were at no higher risk if they took an antidepressant.
The type of antidepressant did not seem to make a difference. The authors of the new research point out that:
“although each AD [antidepressant] has unique pharmacological effects, they all interact with evolutionarily ancient biochemical systems that regulate multiple adaptive processes throughout the brain and the periphery. Thus, while each AD probably has a distinct symptom profile, there is good reason to suspect that they all degrade the functioning of some adaptive processes in the body.”
The People’s Pharmacy Perspective:
Antidepressants can be life savers for some people. The benefits for certain individuals far outweigh the risks. We have heard repeatedly from readers that antidepressants made life worth living. But we must not forget that the dangers of antidepressants can also be significant. The authors of the latest research suggest that both older and newer antidepressants can have “negative cardiovascular effects.” They point out that the new awareness “urges greater caution in their use.”
They conclude:
“The rates of AD use are high and appear to be increasing, and most ADs are prescribed by primary-care practitioners in the absence of a formal psychiatric diagnosis. Our results suggest that health care providers should take greater care in evaluating the relative costs and benefits of ADs for each individual patient, including an assessment of cardiovascular status. ADs may be relatively safe for patients with known cardiovascular disease. However, when the patient has no cardiovascular disease, our results should give the prescriber pause because they suggest ADs increase health risks, including the risk of death.”
NEVER Stop an Antidepressant Suddenly!
We cannot emphasize enough that no one should ever stop an antidepressant without careful discussion with a health care professional. And no one should ever stop an antidepressant suddenly. The withdrawal symptoms can be intolerable.
If you would like to learn more about the benefits and the dangers of antidepressants please check out this comprehensive article:
“Balancing the Benefits and Risks of Antidepressants”
This was written by Amy Beausang, Doctor of Pharmacy (PharmD)
You may also find our interviews with Dr. Samantha Boardman and Dr. Peter Gotzsche of great interest. Here is a link:
Show 1075: Are Drugs for Mental Illness Safe and Effective?
The podcast, mp3 file, and streaming audio are free!
Our bottom line: The new findings appear to suggest that doctors and patients need to evaluate benefits and risks for antidepressants just as they do for other medications.
[Psychotherapy and Psychosomatics, Sept. 14, 2017]
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