SSRI's - The Evidence For And Against

[upstream]

I'd like to debate the current evidence regarding the effectiveness and safety of SSRI's (Celexa, Zoloft, Prozac, Lexapro, Paxil, Luvox, dapoxetine, etc). I am rather biased against these things, because of my own personal experiences with the drugs over a decade ago. I'll put forth the evidence against. If someone has some evidence for them, I welcome you to post it in response.

Effectiveness:
A few months ago, a meta-analysis of nearly 50 studies on SSRI's was completed. The results show that SSRI's are no more effective than a sugar pill in all but the most severly depressed patients. This suggests that benefits from SSRI's are nothing more than a placebo affectin the majority of patients. It has been suggested that the drug's amphetamine affects profile is what helps the severe cases.
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050045

"There seems little reason to prescribe antidepressant medication to any but the most severely depressed patients, unless alternative treatments have failed to provide a benefit," says study researcher Irving Kirsch, PhD, of England's University of Hull.

Studies have shown that aerobic exercise is more effective than anti-depressants. It has also shown that exercise alone is more effective than exercising while taking anti-depressants.
http://www.pponline.co.uk/encyc/0898.htm

Safety:
In 2004 a study was released that shows that Prozac (an SSRI) significantly increases the occurance of suicide ideation in children.
http://www.naturalnews.com/002606.html

Studies and findings also show that SSRI's more than double the occurance of suicide in adults, and increase the occurance of violent behavior:
http://www.naturalnews.com/019342.html
http://www.nytimes.com/2004/09/18/opinion/18abramson_.html?_r=1&oref=slogin

The most disturbing finding was that more than twice as many depressed adults on new antidepressants kill themselves than those taking placeboes. The difference was 8.4 versus 3.6 suicides per 1,000 patients a year, respectively.

Confessions of an Rx Drug Pusher, and her experiences with SSRI's:
http://www.gwenolsen.com/

Footage of an FDA hearing on adverse reactions to Prozac:
http://www.youtube.com/watch?v=FxJomeak4V4

The drugs have other side effects, including sexual dysfunction:
http://www.antidepressantsfacts.com/LongTermSSRI.htm
http://www.health.harvard.edu/press_releases/ssri_side_effects.htm

 

[linasmom]

I'm at the point where I truly believe that the SSRI's are causing my current major depressive episode. I have not had a depressive episode like this in 2 and a half years which just so happened to be the last time I was on an SSRI. :mad:

 

[Roo]

I think a key statement is that these drugs can be of help in severe depression. That has been the case with me. There have been side effects, and I am constantly tracking my symptoms and experiences. I recently agreed to an increase in my med (Paxil) because I have been in a severe depression since January. The increase is making a positive difference.

The medication is not the only tool, though. That is something always to remember. I have to do many proactive things to take care of myself...and it's easy to think that the "little pink pills" are doing everything. Nada!

I would love to be able to stop taking this medication, but evidence from eleven years' use -- specific symptoms being significantly reduced when nothing else affected them, even after a decade of psychotherapy -- tells me that I do need this medication. I was very lucky in that the first medication I tried worked. I recall waking up on the 16th day after starting Paxil, and feeling something utterly new --> a certain weight was simply gone.

I have experienced two major depressive episodes since then; both have been accompanied by huge stresses, and my traumas date from birth (and before) so I know that my brain and nervous system have been permanently hard-wired for a "freeze" reaction...

My doctor said to me once, when I told him that I wanted to stop taking Paxil (and he is very prudent about prescribing anything), that I could consider my situation to be like that of a person who has diabetes. "If you told me that you wanted to stop taking insulin in that case, what do you think I would say?"

I think that SSRIs and similar drugs are too easily doled out to people whose chemistry will not be significantly altered in a positive way.

I recall, during the three-month period in 1996 when I had the Paxil Rx in my purse and was agonizing about whether to fill it, that my decision to try the drug was "tipped" by seeing the effects of new medications on people who suffered from schizophrenia. I was working in the developmental services field at the time -- several people I worked with had both developmental handicaps and psychiatric disorders. Two people with schizophrenia had huge, positive changes in symptoms -- changes that lasted. One young man's mother simply cried with relief...and told me that her son (who was in his early 20s) had hugged her recently...for the first time ever.

That was the pivot point on which I turned to the medication. I don't regret the decision. There have been side effects, and I have to keep watch on myself. But a balanced approach, which may include psychotropic medication, can make a real difference when symptoms are more intrinsic (i.e., like my medical traumas as an infant) rather than situational.

I had a friend/colleague who started taking Prozac about three weeks before he killed himself. This was in 1994, when the SSRI drugs were still quite new. The debate was raging even then, and those of us who knew B. wondered if the drug had tipped him over the edge. Of course, we will never know. But it is one thing that I remain mindful of.

I see the choice to try a new medication (SSRI) as a crap-shoot (as in gambling). It's a risk; a venture into the unknown. Anything is possible. It's not an easy choice to make. I weigh the pros and cons regularly and am willing to live with the consequences.

This thread is a great one -- very informative and will no doubt spark lots of conversation. Thanks for starting it :smile:

Roo

 

[upstream]

Roo,

I loved reading your post and your perspective, but I have to take issue with your doctor.

My doctor said to me once, when I told him that I wanted to stop taking Paxil (and he is very prudent about prescribing anything), that I could consider my situation to be like that of a person who has diabetes. "If you told me that you wanted to stop taking insulin in that case, what do you think I would say?"

There is a difference between a physical disease and a mental disorder, and I believe it is inappropriate to compare the two. Dr. Jeffrey Schaler put it this way:

Think of how when people get angry with one another they inevitably resort to some sort of diagnosis. They say 'You're crazy!' 'You're mentaly ill!' You're paranoid!' Can you imagine someone getting angry with someone and saying 'You have diabetes!' 'You have Parkinson's disease!'

In a physical illness a biological function is breaking down and it is medically proven through bloodwork. In a mental disorder someone is judging and labeling your feelings, thoughts, and behaviors to be a disorder. Big difference.

 

[Roo]

Thanks, Upstream, for your thoughts. I find myself both agreeing and disagreeing with your perspective.

There are so many factors to take into account when considering an individual's illness -- whatever its root/base. In my own case, major depression has been a lifelong challenge and a direct result of trauma in infancy, which included necessary medical interventions to keep me alive. Unfortunately, this was also 1959, when neonatal intensive care units did not allow parents or "holders" to physically connect with babies. I spent my first three months in a box, literally --> an incubator.

There is concrete and continually mounting evidence that physical bonding, holding, mirroring, gazing, etc. (or lack thereof) will have a major impact on the infant's developing brain and immune/endocrine systems. I've recently studied two excellent books that you might want to look into: A General Theory of Love, by Lewis Thomas MD et. al, and The Trauma Spectrum: Hidden Wounds and Human Resiliency, by Robert Scaer.

The depression, PTSD, and other "mental" symptoms in my case have, in part, a definite physiological root. Later abuse that I experienced just seemed to cement the earlier patterns.

I can't see the body and the mind as entirely separate -- everything in us is connected with everything else. Our culture is still struggling to arise from centuries of mistaken beliefs about illness that is primarily of the mind. Demonic possession ... fallen moral character ... witchcraft ... laziness ... you name it, the label's been slapped on. Unfortunately, many people still choose to remain ignorant, and that's where the nasty judgments come in. I've been called every name in the book, from lazy to crazy, stupid, filthy, etc. ... by people who didn't know any better, and didn't want to know any better.

It's been pointed out in many ways that every thought and emotion has a biochemical equivalent (Candace Pert writes about this in her book, Molecules of Emotion). Likewise, every physical experience or symptom is marked on the brain and interpreted by the mind. Illness that people think of as only "mental" has its physical corelations.

The thing that breaks my heart is the ignorance and cruelty that other people can heap upon those with psychological disorders. There are no easy answers or simple responses for the disorders we experience. Every symptom ultimately makes sense, I think...it may take a long, long time to make the sense...but it is there.

Compassion is so important. Basic awareness, decency, and respect, regardless of a person's presenting symptoms. There's a beating heart and a wounded soul beneath all the crap, whatever it is. I make it part of my own healing to help others to understand the realities of depression, PTSD, etc. Our society/culture only aggravates these illnesses with its frenzied expectations, violence, noise, etc.

Thanks again for starting this thread -- I appreciate the dialogue; it's very thought-provoking. :smile:

Roo

 

[Lucky Laser]

I tend to think that they help some and don't help others; it depends on the person. I am one for the "not helped" category. I've tried some different SSRI's and each one hurt more than it helped. Yet I know some people who do very well with them.

 

[becvan]

Effectiveness:
A few months ago, a meta-analysis of nearly 50 studies on SSRI's was completed. The results show that SSRI's are no more effective than a sugar pill in all but the most severly depressed patients. This suggests that benefits from SSRI's are nothing more than a placebo affectin the majority of patients. It has been suggested that the drug's amphetamine affects profile is what helps the severe cases.
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050045

I would like to point out something. This study is only within a six week time frame. It has it's limitations. The efficacy of long term use has never been studied. This is not a be all, end all study of knowledge. On top of that.. it is only one study. Suggestions are just that suggestions, not proof by any stretch of the term.

I personally don't like SSRI's. However the plain and simple fact is that some people do need them and do very well on them. It is.. as with all things, very individual.

bec

 

[2quilt]

The antidepressant I am taking is a new drug, Cymbalta, and it works on Norepinefrin as well as something else i can't remember right now. It was first created for Diabetics with neuropathy pain, then they learned that it helped the diabetics' depression. Bingo, (clapping hands) the newest antidepressant, which also works to kill pain. i am more normal now than I have ever been in my life, and that is saying a hell of alot.

Older antidepressants never worked for me at all.
Trazadone, Paxil, Elevil = Amytriptiline, Serzone, Nefazadone, Welbutrin...

 

[anthony]

I have to add here though; Upstream your outline of SSRI's only included anti-depressants, where as an SSRI covers several functional categories, not just depression. SSRI's are classified for anxiety only also.... which some of these do work. I totally agree with you that the SSRI's for depression have something like a 90% plus failure rate or worse, they actually increase the thoughts of suicidal ideation. What is a doctors next move for this? Usually they decide that anti-physcotics are then required and try labelling a person with some physcotic disorder also.

People are lazy, lets face it. There are a good majority of people on this very forum who are taking pills in the belief that they will solve all their problems over having to actually face their fears, work through their trauma and then do some exposure therapy to relearn how to become social and practicable again. People think they can achieve all this with a medication.... so doctors will take their money and cater this need.

Its not only a good proportion of doctors who are idiots, money hungry twits, but also the sufferers who are lazy and ignorant of the true facts required to actually get better from something like PTSD. People would rather believe they can pop a pill than get out of bed at the same time every day (routine), walk or exercise daily for a minimum of one hour (physical activity) and then find a hobby or interest to occupy their mind during the majority of the day (activity). Instead they believe they can sit on the lounge and watch TV all day, pop a pill, do nothing and it will all be good. Then... they go back to the doctor telling them how they are getting worse, when likely the doctor told them to get off their arse and get out of the house, but people once again find it easier to lie to the doctor and tell them nonsense, make the doctor look like an idiot, and use these lies (denial) as an excuse for their behaviour.

Medication has a purpose, it is limited from all my knowledge reading through journals about them, piecing together all the for and againsts matters to determine a commonsense approach.... it is often abused as a money making technique by physicians or ignored in other areas by the patient taking them. A pill will not fix everything, EVER.

Great topic Upstream.... maybe some may just learn to wakeup to themselves and get their finger out of their backside and into action.... because a pill isn't going to fix it for you.

 

[linasmom]

People would rather believe they can pop a pill than get out of bed at the same time every day (routine), walk or exercise daily for a minimum of one hour (physical activity) and then find a hobby or interest to occupy their mind during the majority of the day (activity). Instead they believe they can sit on the lounge and watch TV all day, pop a pill, do nothing and it will all be good. Then... they go back to the doctor telling them how they are getting worse, when likely the doctor told them to get off their arse and get out of the house, but people once again find it easier to lie to the doctor and tell them nonsense, make the doctor look like an idiot, and use these lies (denial) as an excuse for their behaviour.

Wow, but don't you think it would be easier to do the things you just listed instead of suffering through side-effects? And if yes, then why are people not doing it? You make it sound so easy, Anthony.

Best,
Rachel

 

[anthony]

I may make it sound easy, but I never express that here or face to face. In fact I express quite the opposite to people, in that it will be harder than living the trauma in the first place... but lets be honest here, it is short term pain for long term gain. That is a fact.

 

[linasmom]

I know, so therein lies the conundrum.


People in the past, prior to anti-depressants, didn't stick their heads in an oven or hang themselves in a closet because they refused to take a walk once a day and have a routine.