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Whether or not to take antidepressants is a personal choice. I respect that choice, but wonder if fewer people would rely on them so much if they were more aware of some of the risks.
You may know friends or colleagues who are on antidepressant drugs. Maybe you also are taking them (or wondering whether or not to start).
Drugs like Prozac and Seroxat have become household names, and yet many people who take them know so little about them. Here we take a closer look at some of the risks associated with antidepressants.
It may surprise you to hear that most antidepressants have been passed for medical use on the basis of trials on people of around 6-8 weeks duration – Prozac was approved after just 6 week trials. Unfortunately, many of the problems with these (and other) drugs only surface when they are prescribed for longer periods
So the fact that a drug has been approved does not mean that it is necessarily as safe or effective as we would like to think. Consider, for example, the high (considerably higher than those in placebo comparison groups) number of suicides and suicide attempts by people taking antidepresssants during the testing trials (Table 1) 1. We now know that many people react badly to antidepressants and becoming suicidal is one of the possible adverse effects.
Eli Lilly, the maker of Prozac, knew about its suicide risks long before it was launched and wanted to keep this information quiet. (More about this in the Guardian here, and from this wise blogger here.)
In addition, drug testing trials (Random Controlled Trials – RCTs) are often much smaller than one might expect: Prozac, for example, gained approval on the basis of just 286 patients finishing the trials 2.
It seems to me that many people have unrealistic expectations when it comes to these drugs and the benefits can be offset by troublesome side effects (such as disturbed sleep, increased agitation and anxiety, sexual problems) and serious health risks (see below). Furthermore, although some people find it quite easy to stop them, others struggle for many years to stop these drugs and attribute permanent damage to their use.
he Andrews study mentioned below gives a helpful overview of some of the risks, but in more depth than is covered here. See study Andrews et al 2012. 3
Don’t make any sudden changes – check with your doctor
Some of the risks associated with antidepressants are alarming. Although some of the adverse effects may be quite rare, others occur more frequently.
If you are taking antidepressants – please don’t rush to change your dose or even stop them – without working closely with a doctor you trust and who understands you. I say this, as medical concerns do sometimes arise. For further safety information and advice please click the warning image to the left. It is widely believed that antidepressant medications are both safe and effective; however, this belief was
formed in the absence of adequate scientific verification. The weight of current evidence suggests that, in general, antidepressants are
neither safe nor effective; they appear to do more harm than good.
Antidepressants come with side effects that are not in the mind – risks of getting hooked, birth defects, impaired sexual functioning, strokes, fractures, suicide and
homicide, and in children stunted growth. Guidelines your doctor should be familiar with: “the use of antidepressants has been linked with suicidal thoughts and behaviour. Where necessary patients should be monitored for suicidal behaviour, self-harm or hostility, particularly at the beginning of treatment or if the dose is changed”. British National Formulary (BNF)
20 Reasons To Be Concerned By Antidepressants
1. Antidepressants can cause depression
Some studies assert that antidepressants can actually cause depression and “antidepressant use appears to increase susceptibility to depression” so that people may be more likely to get further times of depression having been on antidepressants.3, 4, 5, 6,16
2. Antidepressants can cause mania and psychosis
Taking antidepressants can lead to mania 18 and being diagnosed as bipolar as they can have a stimulant effect – this may not just be a temporary change to the brain 4. All types of antidepressants can also lead to psychosis and to auditory and/or visual hallucinations 7.
3. Antidepressants can make people suicidal
Antidepressants can cause both adults and children to become suicidal 8. “Worsening of depression and/or increased suicidal thinking or behavior may always be a possibility in patients treated with antidepressant medications”9. So-called “healthy volunteers” have been tested on antidepressants and become suicidal, so it would be wrong to blame a person’s depression rather than the drugs.
4. Antidepressants can make people violent
Antidepressants have been shown to be associated with a “consistently elevated risk” of violence towards others 10.This means that some people, quite out of character, have become violent, and in some instances committed murder.
5. Antidepressants can cause cancer
Some studies indicate that antidepressant use can lead to an increased risk of breast and ovarian cancer even with low doses and short-term use. Furthermore, researchers with affiliations to the pharmaceutical industry are significantly less likely to conclude that antidepressants increase the risk of breast or ovarian cancer (compared to studies by those not affiliated to the industry) 11.
6. Antidepressants can damage babies during pregnancy, including an increased risk of autism
Selective serotonin reuptake inhibitor antidepressants, SSRIs (like Prozac) are now widely used by pregnant women. Prof Urato writes: “Croen, et al showed that SSRI exposure during pregnancy was associated with a doubling of the risk of autism…Current evidence suggests that use of the SSRI antidepressants during pregnancy is [also] associated with miscarriage, birth defects, preterm births and newborn behavioral syndrome along with other pregnancy complications such as preclampsia and low birth weight.” [Taken from here].
7. Antidepressants damage brain cells
Neuronal (brain cell) damage: Dr Grace Jackson points out that there are indications that antidepressants have the potential to actually change the structure of the brain (reducing dendritic length and dendritic spine density of serotonin nerve cells). In rat studies these changes did not reverse after the drugs were stopped.7 Alarmingly, serotonin “receptors actually die back and disappear. In some regions of the brain, the dieback may result in losses of 40-60% of serotonin receptors.”13
8. Antidepressants can weaken bones
Antidepressants (SSRIs and the older Tricyclic ones) have been associated with the possibility of reducing bone mineral density leading to an increased risk for fractures and osteoporosis 7. According to one study: “The weight of epidemiological evidence suggests that SSRIs are associated with reduced bone mass, increased bone loss, and increased risk of fractures…clinicians should be vigilant about detection of bone disease in patients who are using SSRIs.” 24
9. Antidepressants can increase the risk of diabetes
According to this study: “Long-term use of antidepressants in at least moderate daily doses was associated with an increased risk of diabetes. This association was observed for both tricyclic antidepressants and selective serotonin reuptake inhibitors.”14
10. Antidepressants can cause uncontrollable body movements
SSRI antidepressant drugs are increasingly being associated with serious movement disorders sometimes referred to EPS (Extra Pyramidal Symptoms) which create uncontrollable body and facial movements as well as slowing down the overall functioning of the body and brain. These can become very serious disabilities and socially embarrassing too 13,16.
11. Antidepressants can increase the risk of stroke
The older Tricyclic antidepressants are associated with an increase cardiac risk with an increased risk of stroke 3.“Tricyclic antidepressants have potentially dangerous effects on the functioning of the heart…In high doses they can cause dangerous irregularities of the heartbeat” (arrhythmias) and “even at normal doses they may very occasionally cause sudden death due to the heart malfunctioning 15. SSRI antidepressants are also associated with an increased risk of stroke. 25
12. Antidepressants can increase the risk for dementia
I recognize that many people experience memory problems when taking antidepressants, but these drugs may actually cause cognitive decline and dementia with prolonged use 3.
13. Antidepressants lead to restlessness, nervousness and insomnia
All SSRIs can cause insomnia, anxiety, agitation and nervousness. One study showed 38% of people on Prozac (in short trials) struggled with these adverse effects 13.
14. Antidepressants can cause cell death
Apoptosis – cell death: “there is good evidence from several different lines that antidepressants trigger apoptosis.”3
15. Antidepressants could lead to ongoing weight problems, even after stopping
Antidepressant use may “be a covert, insidious and enduring risk factor for obesity, even after discontinuation of antidepressant treatment” for some people in some circumstances.23
16. Antidepressants can make people apathetic and demotivated (and impair memory)
“Apathy syndrome”. SSRI antidepressants have been associated with impairing memory and leading to people feeling apathetic and demotivated: a marked reduction in blood flow to the frontal lobes of the brain has been noted in connection with this 7,17.
17. Antidepressants often cause sexual problems that may continue even when the drugs are stopped
Although sexual dysfunctions have been played down by drug companies, they are thought to occur in over 50% of people taking antidepressants 9. These problems may persist after stopping the use of these drugs 21. I wonder how many people would start on these drugs if they were warned about this, and the other risks, prior to treatment.
“It is important that patients are informed about the high probability of sexual side effects while on SSRI medications…Patients should also be told that there are indications that in an unknown number of cases, the side effects may not resolve with cessation of the medication, and could be potentially irreversible.”22
18. Antidepressants can (rarely) be life-threatening
Serotonin toxicity is an uncommon but potentially life-threatening effect of SSRI antidperessant use (and also possible from taking L-tryptophan) 19.
19. Antidepressants may reduce the long-term capacity of the brain to self-regulate
A significant body of research suggests that antidepressants may reduce the long-term capacity of the brain to autoregulate (self-regulate) neurotransmitter systems 7.
20. Antidepressants can be seriously addictive and terrible to withdraw from
Although people do not usually crave antidepressants as someone might crave drugs like cocaine or heroin, antidepressants are seriously addictive in the sense that they can cause extreme withdrawal reactions and it can be extremely difficult to stop taking them.9. “Many antidepressants cause people to be hooked to them – it becomes impossible to stop because of how bad the person feels on stopping and the relief from restarting treatment … Companies and their experts refer to discontinuation syndromes – another term for withdrawal or being hooked – in attempt to avoid the stigma of withdrawal. But even national regulators now concede it may be impossible to stop certain antidepressants 20.”
The bottom line
I am not suggesting that people should not take antidepressant drugs. That is a personal decison. However, I do find that people are poorly informed of the risks and so are not making properly informed choices.
In considering the adverse effects and the risks of antidepressants, we also need to bear in mind that there is some variation between the various types of antidepressant. Although in one-to-one work I discuss some of these differences, here I generalise and trust you to check out the details where necessary.
References – Bibliography – Further reading
1 Healy, D and Whitaker, C. Antidepressants and suicide: risk–benefit conundrums. J Psychiatry Neurosci. 2003 September; 28(5): 331–337. Table 1 Full study
2 Breggin, P & Breggin, G. (1994) Talking Back to Prozac. New York: St Martin’s Press.
3 Andrews et al. Primum non nocere: an evolutionary analysis of whether antidepressants do more harm than good. Frontiers in Psychology April 2012 Vol 3 Article 117 Full study
4 Fava, G.A. Can long-term treatment with antidepressant drugs worsen the course of depression? Journal Clinical Psychiatry2003;64123-133). Full study here.
5 Fava, G.A. The mechanisms of tolerance in antidepressant action. Progress in Neuropsychopharmacology & Biological Psychiatry,Aug 2010, Aug 2010
6 Fava, G.A. Long-term treatment with antidepressant drugs: The spectacular achievements of propaganda. Psychotherapy Psychosomatics 2002;71: 127-132. Full study here.
7 Jackson, G. (2005) Rethinking Psychiatric Drugs. USA: Anchor House
8 Healy, D. Lines of Evidence on the Risks of Suicide with Selective Serotonin Reuptake Inhibitors. Psychotherapy & Psychosomatics2003 Full study
9 Healy, D. et al 2012 Data Based Medicine Position Paper: Antidepressants for Takers (RxISK). Full article
10 Prescription Drugs Associated with Reports of Violence Towards Others. Moore, T. et al PLoS ONE 2010. Full study
11Cosgrove, L. et al. Antidepressants and Breast & Ovarian Cancer Risk: A Review of the Literature and Researchers’ Financial Associations with Industry. PLoS ONE 2011. Full study
13 Breggin, P. (2001) The Antidepressant Fact Book. US: Da Capo Press. Breggin, P. (2008) Brain-Disabling Treatments in Psychiatry. New York: Springer Books
14 Andersohn, F. et al. Long-Term Use of Antidepressants for Depressive Disorders and the Risk of Diabetes Mellitus. American Journal Psychiatry 2009. Full study
15 Moncrieff, J. (2009) A Straight Talking Introduction to Psychiatric Drugs. UK: PCCS Books Ltd
16 El-Mallakh, R. et al. Tardive dysphoria: The role of long-term antidepressant use in-inducing chronic depression. Medical Hypotheses2011. Full study
17 Opbroek, A. Emotional blunting associated with SSRI-induced sexual dysfunction. Do SSRIs inhibit emotional responses? Int Journal of Neuropsychopharmacology (2002), 5, 147-151. Full study
18 Preda, A. et al. 2001 Antidepressant-associated mania and psychosis resulting in psychiatric admissions. Journal Clinical Psychiatry62:1, Jan 2001. Full study
19 Talarico, G. et al. Serotonin toxicity: a short review of the literature and two case reports involving citalopram. Neurol Sci. 2011 Jun;32(3):507-9. Epub 2011. Abstract
20 Healy, D et al. Data Based Medicine Position Paper: Antidepressants for Prescribers. PDF available from RxISK
21 Bahrick, A. (2008) Persistence of Sexual Dysfunction Side Effects after Discontinuation of Antidepressant Medications: Emerging Evidence. The Open Psychology Journal, 2008, 1, 42-50. PDF available here.
22 Csoka, A. (2008) Persistent Sexual Dysfunction After Discontinuation of Selective Serotonin Reuptake Inhibitors. J Sex Med2008;5:227–233. Abstract available here.
23 Mastronardi, C. (2011) Long-term body weight outcomes of antidepressant–environment interactions. Mol Psychiatry. 2011 March; 16(3): 265–272. Available here.
24 Bliziotes, M. (2010) Update on serotonin and bone. Journal of Clinical Endocrinology and Metabolism, 95 (9), 2124-4132. Abstracthere.
25 Hackman, D. & Mrkobrada, M. (2012) Selective serotonin reuptake inhibitors and brain hemorrhage – A meta-analysis.
Neurology WNL.0b013e318271f848. Abstract here.