This week’s article in my continuing series on depression and antidepressants will examine the physiological, psychological and social consequences of antidepressant use.
Although these drugs are generally considered to be safe by the media and amongst medical professionals and patients, a close look at the evidence suggests otherwise. Antidepressants have serious and potentially fatal adverse effects, cause potentially permanent brain damage, increase the risk of suicide and violent behavior in both children and adults, and increase the frequency and chronicity of depression. Chronic use of antidepressants also promotes dependency on drugs rather than empowering people to make positive life changes, and places a tremendous burden on healthcare systems in the U.S. and abroad – but I will discuss those issues in next week’s article.
Physiological side effects
The adverse effects of antidepressants include movement disorders, agitation, sexual dysfunction, improper bone development, improper brain development, gastrointestinal bleeding, and a variety of other lesser known problems. These are not rare events, but the most significant harm comes only after months or years of use, which leads to the false impression that antidepressants seem quite safe.
More than half of those beginning an antidepressant have one of the more common side effects (Brambilla et al. 2005).
While some side effects may not carry serious health risks, others do. Gastrointestinal bleeding can become a life-threatening condition, and improper bone development in children is a serious problem that can lead to increased skeletal problems and frequent bone fractures as they age. It has been shown that serotonin exposure in young mice impairs their brain’s cerebral development (Esaki et al. 2005), and many researchers believe that the use of SSRI medications in pregnant mothers and young children may predispose children to emotional disorders later in life (Ansorge et al. 2004).
Another problem with the side effects caused by antidepressants that is often not discussed is the likelihood that additional medications will be prescribed to control them. It is well-known that Prozac produces anxiety and agitation, so physicians often prescribe a sedative (typically a benzodiazapene) along with it. Since recent studies have shown that antidepressants cause gastrointestinal bleeding, doctors are starting to prescribe acid-inhibiting drugs such as Nexium to prevent this side effect. These drugs also inevitably cause side effects, which may lead to the prescription of even more drugs. (This is not uncommon, as I pointed out in last week’s article.)
Psychological side effects
Perhaps the best known psychological side effect of SSRIs is “amotivational syndrome”, a condition with symptoms that are clinically similar to those that develop when the frontal lobes of the brain are damaged. The syndrome is characterized by apathy, disinhibited behavior, demotivation and a personality change similar to the effects of lobotomy (Marangell et al. 2001, p.1059). All psychoactive drugs, including antidepressants, are known to blunt our emotional responses to some extent.
Clinical studies of SSRIs report that agitation is a common side effect. When Yale University’s Department of Psychiatry analyzed the admissions to their hospital’s psychiatric unit, they found that 8.1% of the patients were “found to have been admitted owing to antidepressant mania or psychosis” (Preda et al. 2001). Agitation is such a common side effect with SSRIs that the drug companies have consistently sought to hide it during clinical trials by prescribing a tranquilizer or sedative along with the antidepressant. Studies by Eli Lilly employees found that between 21% and 28% of patients taking Prozac experienced insomnia, agitation, anxiety, nervousness and restlessness, with the highest rates among people taking the highest doses (Beasley et al. 2001).
From their inception, antidepressants have been recognized as having a worrisome capacity to incite changes between episodes of depression (characterized by dysphoria, insomnia, low energy, poor concentration, reduced appetite and diminished libido) and episodes of mania (characterized by euphoria, increased activity, rapid speech, racing thoughts, diminished need for sleep, hypersexuality and diminished impulse control).
Several reports suggest that SSRIs are associated with movement disorders such as akathisia, Parkinson’s disease, dystonia (acute rigidity), dyskinesia (abnormal involuntary choreic movements) and tardive dyskiniesia (Gerber & Lynd 1998).
These movement disorders are serious enough on their own. However, what is even more alarming is the potential for akathisia to induce aggression and suicide. Akathisia, a condition of inner restlessness or severe agitation, is the most commonly occurring movement disorder associated with psychoactive drug use. Akathisia-related violence receives specific attention in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Akathisia has been shown to increase violent behavior and suicide, and antidepressants are known to cause akathisia.
Suicide
After years of foot-dragging and thousands of excess suicides, the FDA finally admitted that “two to three children out of every hundred” could be expected to develop suicidal thoughts or actions as a result of antidepressant therapy (Harris 2004). The risk of suicide events for children receiving SSRIs has been three times higher than placebo. (Healy 2005). Amazingly, no bans or restrictions have been placed on their use in children in the U.S.
While the increased risk of suicide in children has become better known, most people are unaware that a similar risk exists for adults. When adult antidepressant trials were re-analyzed to compensate for erroneous methodologies, SSRIs have consistently revealed a risk of suicide (completed or attempted) that is two to four times higher than placebo (Healy 2005).
Turning short-term suffering into long-term misery
A growing body of research supports the hypothesis that antidepressants worsen the chronicity, if not severity, of depressive features in many subjects. Antidepressant therapy is often associated with the poorest outcomes. In a large, retrospective study in the Netherlands of more than 12,000 patients, antidepressant exposure was associated with the worst long term results. 72-79% of the patients who relapsed received antidepressants during their initial episode of depression. In contrast, only one of the patients who did not relapse received no antidepressants during or following the initial episode. (Weel-Baumgarten 2000)
Longitudinal (long-term) follow-up stuides show very poor outcomes for people treated for depression in both hospital and outpatient settings, and the overall prevalence of depression is rising despite increased use of antidepressants (Moncrieff & Kirsch 2006).
Epidemiological observations have long held that most episodes of depression end after three to six months. However, almost half of all Americans treated with antidepressants have remained on medication for more than a year (Antonuccio et al. 2004).
Long-term effects of antidepressants
Antidepressants have been shown to produce long-term, and in some cases, irreversible chemical and structural changes to the body and brain.
The administration of Prozac and Paxil raises cortisol levels in human subjects (Jackson 2005, p.90). Given the fact that elevated cortisol levels are associated with depression, weight gain, immune dysfunction, and memory problems, the possibility that antidepressants may contribute to prolonged elevations in cortisol is alarming to say the least.
In a study designed to investigate the anatomic effects of serotonergenic compounds, researchers at Thomas Jefferson University found that high-dose, short-term exposure to SSRIs in rats was sufficient to produce swelling and kinking in the serotonin nerve fibers (Kalia 2000). Research performed by a different team of investigators demonstrated a reduction in dendritic length and dendritic spine density, and in contrast to the previous study, these changes did not reverse even after a prolonged recovery period. The results were interpreted to suggest that chronic exposure to SSRIs may arrest the normal development of neurons.
I want to emphasize that what I’ve covered here is only the beginning of the story when it comes to the adverse effects of antidepressants. There are volumes of published research and many books which present this information with much more detail. I recommend Peter Breggin’s landmark “Brain Disabling Treatments in Psychiatry” and Grace Jackson’s “Rethinking Psychiatric Drugs” as resources if you are interested in pursuing this further.
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{ 30 comments… read them below or add one }
Read the book, “The Dark Side of Mania” by Amy and William Dunn. It’s deftly constructed at 67 pages. It’s about a manic depressive and his dark moments iin mania and what his wife felt living with him. Great read.
Thanks, Bob. I’ll check it out – sounds like a great read.
Chris
I’m having psicological and psysiological symptoms some of the ones you write of Effexor withdrawal, i’m now with 18 g I started taking last november with 2 capsules, but i had two other epiodes of depression with cold turkey in last 2 years.
I don’t like how antidepressants change my power and self confidence.
I was doing acupuncture for the last two monyhs but i had to quit because i felt going crazy.
A Ph. Dr. told me about a supplement with Griffonia simplicifolia extract, quelate magnesium, malic acid and apple extract.
I wrote to the laboratories that prepare them and told me that i can take it when i stop completely the antidepressants.
I don’t feel completely fine, i’m afraid to quit Effexor because of another depresive episode, and as you say each time my depression goes chronical and feel less power in myself.
It’s good time to leave Effexor and switch for this supplement it seems can help me enhance my self power and confidence? and maybe continue with Acupuncture.
I also made a SCIO and ORION test who made me feel a little better with my withdrawal. But i don’t live no more, i’m afraid to get a job, i’m semiparalyzed i lost my feelings and goals,i don’t now what to do. I also try positive thougts and meditation. But i want to be myself again! my baddest feelings are in the morning.
Thank you for your comment, i am pretty deseperate
I hope you can answer me soon
After years of migraines (from The Pill), then quitting smoking, severe Candidiasis, hypoglycemia, severe depression, type 2 diabetes, at least a decade of antidepressants including Effexor, I awoke in 2000 with severe incapacitating chills. After several years (normal TSH) I was finally able to get enough thyroid desiccated hormone to bring my Free T3/T4 to the top of the range and start on bioidentical hormone replacement. I still have low temperature (average 95.5 am) and chills and severe depression. I quit Effexor about 3 years ago when it seemed more negative than positive. The low thyroid I thought was from many things BUT if it’s from antidepressants is it permanent? Can anything be done to repair the damage? Thanks.
And what about the GI bleeding? I had severe gutaches with Candida, thought it was cured with a year of nystatin, but my digestion has been worse and worse ever since and I am only able to eat few foods and digest few supplements. How do you know if you have GI bleeding?
I didn’t realize at the time (08) when I quit Effexor that the panic walking I had which resulted in Plantar Fasciitis was from withdrawal. My depression did not change except perhaps to get worse. I think I need a lot of a variety of hormones to try to get better.
Thank you. This is quite a helpful post. But lacks credability. It is very easy to generalize when talking about psychiatric drugs and their side effects. But the fact that so many millions of people find them useful and improve their quality of life mean that you need to qualify broad statements with more quality evidence and be specific and inclusive. For example, the experiments on mice were using doses of antidepressants 10 times that used on humans. In fact, it is now known that antidepressant drugs promote neurogenisis in the hippocampus and this has been suggested as the reason why antidepressants commonly take 4-6 weeks to work fully even though they raise synaptic serotinin levels within hours or days. Perhaps a more balanced view including all data and accurate statistics would be more useful for everybody since antidepressants are not going to go away in the near future and are very useful. Have you ever suffered from depression? It doesn`t sound like it. Show me the good quality evidence base that accupunture works for depression… There isn`t any..
Thank you for saying so eloquently my exact thoughts – there are a lot of holes in this study, including the fact that people taking higher levels of antidepressants are more likely to have more severe symptoms – how is it possible to differentiate between depressive symptoms and depressive symptoms apparently caused by antidepressants?
“Have you ever suffered from depression? It doesn`t sound like it.”
One of the hardest things about being clinically depressed is that most people don’t understand the depths of agony it brings so they criticize the fact that some people do actually need antidepressants to help them. Not to say that people without MDD have never felt depressed, as it is human emotion, but it is ENTIRELY different. Its hard to accept the fact that I really do have a disease for this very reason– most of society just cannot understand. I would rather live a short, normal, and “happy” life on antidepressants than a long, miserable one without.
This great information, I hope your message is received. I am just an ordinary person who’s watched her family (sister, niece) deteriorate from drugs. I believe the long term use of Psychiatric Medications (and migraine medicine) is the cause. However it is too late to convince them and may be too late for them to pull out of it to live a normal life. My sister cannot work anymore due to joint, foot, and back pain and has sicne been diagnosed with Pageants Disease too. Her daughter (on anti-depressants as an adolescent) went to a gifted High School and studied foreign langue. After one semester of college (also studying foreign langue) had a mental break down and now is 20 and acts like an 8 year old now still trying to recover from it. Does not go to school, does not work, and instead stays at home and plays with toys. I don’t know how much we can do to get this message across but would be willing to help if I knew how. Preventative medicine, diet, exercise, and vitamin/herb therapy is the safest way to begin treatment of many mental and physical ailments.
Chris, have you written any books? I’d love to read them!
I agree with Anonymous. There are many who are quick to bash the use of antidepressants, as well as medication in general without any empirical evidence. These are usually the people who do not know how debilitating depression can be. If it not were my antidepressants, I would be unable to get out of bed, wash or feed myself. With the help of modern medicine, I am able to function as a productive member of society, make sound decisions, and carry on a meaningful life. Just because a substance is “unnatural” does not mean it’s bad for you; conversely, just because something is natural doesn’t mean it is good for you. Arsenic is natural, and so is lead. Without the assistance of these “evil pharmaceutical companies”, I would be in an institution. And also, I am not a “sheeple” type. I am a medical professional myself.
Excellent post, Omega. It seems the SSRI alarmists have a very one-sided view.
Glad it worked for you, but it didn’t work for me and I’ve felt worse ever since taking them.
Thank you. Excellent comment! I, too, am able to function well in society and in my personal life because of Lexapro. Without it, I would probably have killed myself. The dark veil of depression is horrific.
I was put on antidepressants and antipsychotics as early as age 6 due to a visit with a psychiatrist as the result of a divorce. Up to age 17 I was prescribed almost everything in the book, and was hospitalized due to withdrawal symptoms on one occasion. My doctor retired and the doctor that replaced him was able to ween me off of everything. I can tell you that I am a different person without them. It was difficult initially and my moods were very unstable for a few months after, but looking back it was worth it. I can feel things. In the beginning it was amazing because I had honestly forgotten what it was like to feel human. Yes, I have been depressed since. It happens. Life happens. But I’d rather be depressed occasionally with a legitimate reason than depressed all the time and not know why. The feeling of not being truly in control of your emotions is terrifying. I felt terrible on the medication… all the time. My entire childhood was consumed by it. I slept all the time, never felt like doing anything. I barely made it to school. I’m just glad I was strong enough to get through the withdrawal symptoms. Alot of people end up hooked for life. I think the reasons behind my negative view of these substances are more than justified and I have more than enough experience to back them up. I have medical records (that I have copies of) That do not state a diagnosis but provide a record of medication prescribed. I was a child. What was done to me was wrong both ethically and scientifically. I’m lucky that I was able to learn to cope with life as well as I do, since I grew up strapped into an emotional wheelchair of sorts. And they wonder why more and more adults can’t deal with the stress of daily life. I understand that there are people that may legitimately need this stuff, but there are many who are on antidepressants that don’t need them. And it doesn’t take a medical professional to figure out basic chemistry concepts. When you screw with chemical balance in a person’s brain and the person’s doesn’t have a prior imbalance, it’s going to throw everything off kilter. There needs to be more preliminary testing before the prescription is written. And I mean real, concrete, science based testing with real results; Sitting there at a desk and nodding as you say something along the lines of “well since you’re sitting in my office crying because your dog died yesterday you’re obviously clinically depressed” doesn’t count.
Thankyou Ash for your strong advice against these drugs. My doc doesn’t think twice of putting me on depressants. Once I was on Effexor and I just about lost my mind,seriously.. I felt like I was going crazy. I was only on it for a month,due to “feeling like i was phyco” then when I withdrew from them I had “zappy” sensations threw my body for two months after. I’ve had vertigo ever since-it’s been 12 years!! I’m not the same. I was put on Effexor due to my dads death,I couldn’t cope. But now I would never go back on them no matter how hard life is,I will deal with my problems head on,not being in control of your emotions or body movements is a feeling of helplessness that doctors take lightly. These drugs can throw your body chemistry off like you said- everything you said is true. I hope your feeling better,you are a VERY strong person for what you have been through. Thankyou for your post, very helpful
I am not at all convinced that your conclusions are sound. Your comments are anecdotal and may or not be a fair representation of the cases you discuss. I take Zoloft and have not experienced any mania whatsoever, and the drug eliminates my anxiety, it does not agitate it. I think you are reacting to either very small percentages of adverse reactions in proportion to the whole, or there are other factors involved besides SSRI’s.
A group of highly qualified psychiatrists from places like Harvard discuss the benefits of SSRIs and rebut a lot of the alarmist claims here:
http://www.nybooks.com/articles/archives/2011/aug/18/illusions-psychiatry-exchange/
I’d like to point out that my hospitalization was due to being ordered to stop effexor immediately by a supposedly “qualified psychiatrist” because he decided one day that he wanted to switch it out with welbutrin. As you can imagine, my trust in “highly qualified” psychiatrists is pretty much non existent. They’re kind of like highly qualified philosophers. Qualified in what, you’re not exactly sure… but hey, he’s got a Ph.D. hanging on his wall so he must know everything, right?
I can attest the truthfulness of the side effects of ADs because I’ve LIVED it. I innocently was first prescribed Prozac and a few years later Paxil for depression and then anxiety, when I was 28. That was 18 years ago. I gradually went from a highly intelligent graduate student in architecture to a complete IDIOT and almost homeless. It wasn’t until I came to my senses about 6 years ago and tried to get off of Paxil (very gradually) that I realiized that my brain literally could not function without it. I could not return to my old brain. After accepting this painful truth, I now am on the lowest dose I can manage and am functioning but I am NOT the person I used to be. Interestingly, when I reduced the dosage of Paxil, my cognitive abilities (that got me through a very difficult graduate school program) began to come back. However, I am nowhere near what I used to be. I miss myself…and so does my family. My memory is completely shot and I am crippled in my profession. I make all kind of excuses as to why I cannot remember this or that. Anyway, I am a survivor and will make the best of the life I have left to live and am committed to telling others about these horrible (evil) drugs. CSC
Zoe, I am so sad to hear your story:( you are so right with antidepressants being connected to brain injury- it is scary,I know because being on Effexor ruined my ability to concentrate,I have to really slow down when I read or the words get all combined,I have dizzy spells,vertigo and tremors in my body (un controlled movements) almost like Parkinson’s. It’s not fun living like this,and I will never let my doctor prescribe these again. They wanted to put my daughter on them just because she has stomach issues! They will prescribe them to “anyone” beware people,get thorough testing before you go on these.
Robert,
Weening off a psych drug has to be done very slowly! Believe me I lived through hell weening quickly off of Paxil after 14 years on the drug. Very painful experience-unbelievable! Your brain has to readjust to normal settings and this takes time. It effects almost every system in your body. You need lots of support/monitoring from family, friends and, if you have an understanding doctor that would help, but many doctors have no idea what the effect of drugs is in the long run (or the short run). Stay calm and do not overreact to withdrawal symptons and if you need to go back on meds and then ween more slowly, you should do it. God bless you and hang in there. CSC
Chris,
I am enjoying this series but I think there is some information missing, specifically what effects SSRIs have on the body, brain chemicals, hormones, etc. You are quick to discredit the drugs by comparison to placebos and to point out the negative side effects but you don’t discuss at all how these drugs work from a biochemical standpoint. I see you question the method of measuring how well they increase seratonin but you don’t explain what effects increases in seratonin would have on a person. I would love a more thorough overview of these drugs from your perspective but unlike most of your work this series seems to skip over the biochemistry part and jump straight to discrediting the drug on only a few points (placebo and side effects). It is obvious that you have a vendetta against antidepressants but you are usually better at presenting the whole picture/myth which is why I am having a hard time buying in to your conclusions on this topic.
Hi Doctor, Do you know much about the SSRI Citalopram? I was taking it for 6 years.
Do you have much info about this drug? And its effects on the brain, body etc?
Also Doctor do know much about the anti convulsive drug Lamotrigine? I was also taking this for over 5 years as It helped my Depersonalization disorder but I am not sure what damage I have done to my brain.
I very worried about this long term damage I have caused from these drugs
Chris,
I wanted to ask how I can remove my question or paraphrase it. I think expounded on your forum in too much detail about the extent of everything without sending you a private email an I realize people can read that on a public forum. I was recovering from a procedure and was in allot of pain and going over allot of exposures and my past experience with those medications. Can you delete it? Or is there a way I can delete it?
It’s been taken care of.
Stogie,
I would like to respond to your comment about Psychiastrists. Psychiatry and especially psychology are useful more so psychology then psychiatry unless its related to neurology. I find that before advancements inmedicine be it pediatrics to infectious disease, neuroscience and everything in between people were turning to psychiatry as an explanation for ilnesses An conditions they had not discoveredand have yet or are just discovering now. now there is the reality of psychological changes and fundamentally and even as an applied field that’s justified but I find that the medical community hastely turns to psychiatry for a variety of reasons. The first being a quick easy approach to treating someone without clinical observation or other clinical medical evaluations and avenues of approach in various specialities and body systems. Also I find the pharmecutical aspect to be a big reason. Also treating the piblic with antidepressants has become a way of avoding giving people proper medical care and treatment. its far easier cost wise to put someone on a drug like an antideressant that has nothing to do with their medical condition then it is to give that person extensive treatment. ive seen enough to know that we are now giving out antidepressants fir stomach aches and to young children especially then we are exploring the full extent of medicine. Thats not to say paychiatry isnt useful it is but making correlations with psychiatry neurological biochemistry and neurology and disease. In fact it can be said for allot of conflicts in medicine arise because we try to compartamentalize the body’s systems too much, and not accepting the fact that its all interrelated. Even in emergency situations. there is the ideological aspect, of control. Now there are a whole host of other reasons which then become more narrow and on a patient to patient basis. So my interpretation is that there must be a global view on the human body as well as a narrow view of the different systems and also a much more thorough investigation and inquiry into a patients causes an exposures. If someone leaves in a moldy house if say the chances of them developing a psychiatric or chemical deviation in the brain are great but what good is it if we’re drugging people without taking into account everything this person has been exposed to. From tick bites to undiscovered illness to diet. And that 9/10 we are exposed to so much that disease develops from infection and if related to the brain, and psychological symptoms or symptomatic coditions disease and conditions is responsible.
I would like to say psychiatry is useful but not without the accompanying of neurology and infectious disease. But even from a purely psychiatric basis, you can’t determine solely by looking at someone that they should be put on an antidepressant. How can you thoroughly or indefinitely determine whether a person needs some type of medication to control a “chemical imbalance” in the brain that is if its organic if you don’t measure the chemicals or the displacement or depletion of chemicals or a diagnostic for monitoring and measuring neurophysiological impairment and to me psychiatry needs to join forces with neuroscience, in fact psychiatry is neuroscience to me. It involves the brain. But Chris is right, these drugs are complicated and it can mimic the symptoms you had before. Now I’m not satin we should do away with psychiatry if anything I’m calling for expanding it but with more accessible diagnostic tools for determining whether people actually need them. And that is where research comes in. Same thing with cancer. Think of all those people who couldn’t the follow up care to determine whether they had it or not. And then the type of treatment they receive. First thing you learn in medicine. Do no harm.
I was and have been on citalopram for 6 years. I can say with all honesty, it helped with my depression to some extent, but only while I was on them, so if it was correcting a so called imbalance or improving my neurons or helping my brain in any way, then why I am I all of a sudden 6 months off the drug and suffering depression once again? If they were so magical they would have fixed something
I can also tell everyone that, I was not as bad before I went on them, now I am off them, I am worse much more. with increased anxiety.
I’m against psychiatry. When I said expanding I meant tools for measuring brain activity and chemical in the Brain. Which gives credence to the expansion of neurophysiology and neurobiology. Disproving the discipline of psychiatry. I think psychiatry will become obsolete when professionals realize that brain function is a neuro problem.
Barbara,
I’m sorry to hear you’ve had such a hard time. As you are well aware, it can be very difficult to withdraw from these medications and the withdrawal symptoms often mimic the original symptoms of depression. My suggestion is to find a medical professional to supervise you through this process if possible. Pick up a copy of Peter Breggin’s book “Your Drug May Be Your Problem: How and Why to Stop Taking Your Psychiatric Drug“, and see if you can find a doctor or psychiatrist that will follow those principles. Good luck, Barbara.
Chris
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