Treating Depression Safely
Issues Surrounding Prescription Antidepressants
Depression is often misdiagnosed. Some medications may actually make depression worse in children and benefit fewer patients than previously believed.
Selective serotonin reuptake inhibitors (SSRIs) have been on the market as antidepressants for almost 20 years. This category of pharmaceuticals includes Lilly’s Prozac, generic name fluoxetine; GlaxoSmithKline’s Paxil, generic name paroxetine; Pfizer’s Zoloft, generic name setraline; and Bristol-Myers Squibb’s Serzone, generic name nefazodone.
Concerns About AntiDepressant Side Effects
Squibb took Serzone off the market in May 2004 over concerns of hepatitis and liver failure as well as being linked to at least 20 patient deaths, though the generic form is still available amidst pending lawsuits. The other three drugs have side effects involving sexual dysfunction and 25% of patients on Paxil report withdrawal symptoms. There is also a high rate of relapse, approximately 40%, once the medications are discontinued; it is advised to taper off taking the prescription drugs due to the side effects of ceasing cold turkey.
The most troublesome side effect of those SSRIs still on the market is an increase in suicidal tendencies in children and adolescents with major depressive disorder. Reported in the August/September 2007 edition of Scientific American Mind, a 2007 study found that the risk of increased suicidal thoughts due to the medication was present up to the age of 24. The risk usually occurred in the first days or weeks of starting medication and there were no completed suicides during the course of the study.
According to Scientific American Mind many studies have found that short-term psychotherapy (12-16 sessions) with or without medication is as effective as medication for depression, maintains patient improvement better in the long run than medication alone, and carries little or no associated risk of suicide. In 2003 British authorities in 2003 to attempt to block further childhood SSRI prescriptions. The U.S. Federal Drug Administration (FDA) added a black box warning to the antidepressants in 2004, a label on the package indicating serious adverse effects of the medication contained within. It has been established, as discussed by Bailly in the Jan 2008 issue of Expert Opinion on Drug Safety, that Prozac is the most effective SSRI for children and adolescents when observing the risk to benefit ratio, although some antidepressants are no more effective than placebo.
Marketing Antidepressants
Antidepressant prescriptions tripled during the 1990s making them one of the top selling categories of pharmaceuticals. The drugs generated combined sales of more than $20 billion in 2003, according to market reports published at that time. According to IMS Global Insights, an international market information firm, Zoloft was the 10th top selling drug in 2003; Prozac and Paxil lost their previous places in the 2002 top 10 due to loss of exclusivity when their patents rolled over.
Antidepressants were a $10.9 billion industry in the U.S. alone in 2004. The continued growth in prescriptions has occurred despite the fact that SSRIs work for less than a quarter of patients suffering from a major depressive disorder. Some researchers and doctors contend that the idea that depression is caused by a deficiency of serotonin is simplistic and outdated and that the theory has been overplayed to help sell SSRIs.
According to Ray Moynihan and Alan Cassels in their book “Selling Sickness” published in the United States by Nation Books in 2005, drug company spending on sales representatives and free samples is the biggest component of the roughly $25 billion paid annually in the U.S. for promotion. Also, since the FDA relies on industry funds for much of its drug review work, there have been questions raised about bias and conflicts of interest.
Misdiagnosis of Depression
Various research studies estimating the number of people suffering from depression, nearly 30% of the population, are flawed. Much depression will be relatively mild and can pass within a matter of months, yet according to some estimates millions of people are prescribed antidepressants for several years or more. The Bristol-Myers Squibb-funded education program created to be used by family doctors to diagnose patients is a simple screening test made up of a checklist of questions. Researchers from Monash Medical Center in Melbourne, Australia, examined the screening test and pointed to major problems. The researchers found the test to be so broad that it classifies 49% of people as having a mental disorder, half of those having a “level 1” disorder, the most serious. According to their calculation most of the people diagnosed by the test likely did not have a mental disorder at all.
Who Should Take SSRIs
Some individuals, even children, may benefit from taking selective serotonin reuptake inhibitors, but for others dealing with depression there are alternatives to taking SSRIs. Other classes of drugs include monoamine oxidase inhibitors (MAOIs) and tricyclics, which act on similar brain chemistries, but may work better for certain individuals. Ask a doctor what the correct treatment is for any individual case of depression. Read FDA warning labels carefully. Report any adverse side effects and visit a doctor for treatment if necessary. Seek help immediately if thoughts of suicide increase. Watch children on the medications closely for alterations in behavior or mood.
