Saturday, April 14, 2018

Antidepressants: is the cure worse than the disease?


Two recent articles have raised questions over the safety of long-term antidepressant use.

First, the New York Post reports on a lady who claims that antidepressants both saved her life, and destroyed it.

By the time Lauren Slater was 24, she had been hospitalized five times for attempted suicide. She was deeply depressed, she cut herself and she obsessive-compulsively tapped objects to calm her overtaxed nervous system. So when Prozac came on the market in 1988, her psychiatrist recommended she try it.

. . .

She filled her prescription, and the result was “the most miraculous thing that ever happened to me,” she says. Within three days, her obsessive-compulsive symptoms began to recede, and within five days, they were gone. By day 10, she was actually feeling good.

. . .

Now, 30 years and a dozen different psychotropic medicines later, Slater has learned that the pills she took presented something of a Sophie’s choice — her body or her mind.

In her new book, “Blue Dreams: The Science and the Story of the Drugs That Changed Our Minds,” Slater, who is both a science writer and psychologist, describes how the medicines that allowed her to lead a relatively normal life for many years — marriage, babies, books — robbed her of her physical health.



At 54, she finds herself with the body of an “octogenarian with issues,” she writes. She has failing kidneys, diabetes, is overweight and is losing her memory.

“My lifetime now seems seriously foreshortened, not because of a psychiatric illness but because of the drugs I have taken to treat it.”

There's more at the link.

Next, the New York Times notes that "Many People Taking Antidepressants Discover They Cannot Quit".

Nearly 25 million adults ... have been on antidepressants for at least two years, a 60 percent increase since 2010.

The drugs have helped millions of people ease depression and anxiety, and are widely regarded as milestones in psychiatric treatment. Many, perhaps most, people stop the medications without significant trouble. But the rise in longtime use is also the result of an unanticipated and growing problem: Many who try to quit say they cannot because of withdrawal symptoms they were never warned about.

. . .

The drugs initially were approved for short-term use, following studies typically lasting about two months. Even today, there is little data about their effects on people taking them for years, although there are now millions of such users.

. . .

In New Zealand, where prescriptions are also at historic highs, a survey of long-term users found that withdrawal was the most common complaint, cited by three-quarters of long-term users.

Yet the medical profession has no good answer for people struggling to stop taking the drugs — no scientifically backed guidelines, no means to determine who’s at highest risk, no way to tailor appropriate strategies to individuals.

“Some people are essentially being parked on these drugs for convenience’s sake because it’s difficult to tackle the issue of taking them off,” said Dr. Anthony Kendrick, a professor of primary care at the University of Southampton in Britain.

Again, more at the link.

I have very limited experience with antidepressants.  Some years ago, following a period of intense job-related stress, magnified by the tragic sudden death of a very close friend, I felt overwhelmed.  My physician suggested I try a common antidepressant, but I soon found that it made me feel as if a sort of fuzzy blanket was spread over my ability to think.  I was more comfortable, but also not myself, and not able to respond to things (and people) around me as I usually did.  (Some, of course, might have considered that an improvement, but we won't go there . . .)  I stopped taking them, deciding it would be better to deal with the problems out of my own resources and not rely on a chemical crutch.  I've never used them since then.

On the other hand, I can understand their utility for people with serious chemical imbalances in their brain, as Ms. Slater appears to be afflicted.  Unfortunately, while they seem to solve that problem, no-one appears to have thought about the other side of the coin - their side effects, particularly long-term, and their addictive nature.

Where to now?  I suppose it'll be impractical to simply cut off antidepressant prescriptions, for fear of sparking a massive health crisis and social backlash.  It's a problem we've made for ourselves.  How do we get out of it?  Your guess is as good as mine.

Peter

24 comments:

lpdbw said...

I was on Welbutrin for 18 months. It enabled me to listen to my counselor and use her therapy to get better. My doctor kept me on it 6 months longer, because he thought weaning off antidepressants during the dark days of winter is bad.

OTOH, I have seen the correlation with antidepressants and mass murderers, and it is alarming.

Depression sucks. We need some good way to identify and treat it.

NITZAKHON said...

The change in my wife pre-antidepressants and now is night and day.

Without them I was preparing to divorce her and seek full custody of our children... on a couple of different occasions. Once I'd actually gotten a divorce petition drafted, with documentation on her behavior towards me and the kids.

Tregonsee said...

I think part of the issue that there are
1) Lots of variation in the nature of depressions
2) More variation in the response to the SSRI class of drugs than expected

Before the '90s there was almost nothing to prescribe for depression, and what there was was REALLY nasty. With the advent of the SSRI's all of a sudden the doctors had a tool that worked. In many cases the change was dramatic. So like a man with a hammer everything began looking like a nail and the docs went straight to SSRIs for ANYTHING that even vaguely looked like depression. For some patients it worked wonders, for others the side effects were bad but not worse than say suicidal depression. For some all they got was the side effects and no relief, they'd have been better off with a placebo.

Because the only feedback is really the patient's report of their state getting dosage and result sorted out is very hard. There was some thought that fMRI could help as a diagnostic tool, but it is very expensive and still kind of flaky.
Please note I am Not A Doctor, nor do I play one on TV. It has just been my lot to interact with several depressives of various types and see the range of results.

Old NFO said...

That is truly scary... And typical of the medical profession today. Wonder drug+money=prescribe the hell out of them... No longer the doctor's problem... Oh wait... What do you mean, you want OFF that miracle drug?

ASM826 said...

If the drug gave her 30 good years, it's worth it. Consider her disease like it's diabetes. The treatment isn't a cure, the treatment doesn't prevent the side effects. What the treatment does is allow you to live, as fully as possible, as long as possible, which is all any of us can hope to do.

I lost a child to suicide after a decade of depression and anxiety, on again, off again use of anti-depressants, and a sense that his life was being stolen from him. If there had been a drug that had given him 30 years of better life, it would have been a miracle.

iDungeonCrawl said...

Pharmacogenetics is going to be what we need to fix this. We're learning more and more that once you start getting out of the realm of "common and minor issues everyone deals with" that each individual person responds to medications in all sorts of different ways, and everything from your diet, to the other meds you take to your own genetic code can mean the difference between a drug that saves your life and a drug that ruins it.

In fact, having seen this very thing with some close people to me, I now always strongly recommend that if anyone needs to go on anti-depressants, they get a genetics test done to see which meds they process correctly in that category. Anti-depressants is already a "trial and error" thing, getting a genetics test done, even at a high cost can save you months of trial and tell you if taking a particular drug might just kill you because you don't process that drug properly and a normal dosing schedule will cause you to overdose.

NITZAKHON said...

@iDungeonCrawl:

Mixed feelings. On one hand, definitely... writing as someone who takes a "cocktail" of hypertension meds, there was definitely a trial and error period to get the particulars right. (E.g., I was, initially, put on "Norvasc" which, it turned out, caused depression to the point where I almost killed myself - other factors in my life didn't help, like being married to someone who I hated.)

But on the other hand, there has to be some kind of anonymizing. I don't like the idea that my genetics are out there.

Odysseus said...

I've worried for a while at the sheer hubris we as a civilization display to our own minds. Especially when it seems when anti-depressants are in the equivalent of a quick-draw prescription pad for not just psychological physicians but for general family practice and internists.

I've also had to wonder how much earlier generations we well served by nicotine as a mild anti-depressant in-spite of it's horrible physiological side effects both directly and from it's delivery vector?

NITZAKHON said...

@Odysseus:

As I noted above, without these meds my wife is actually dangerous. And finally she's grasped that. (She's also started therapy; for years I've told her she has a corrosive pool of bubbling black anger deep inside, eating at her... and like the medication, she's started to see improvement. E.g., the therapist told her to ask the kids if they're scared of her. To the older's credit, they said "Yes" which my wife said was like a dagger in her heart.)

But like most tools, it's overprescribed / overused.

Apropos nothing, I've added you to my blogroll, and thanks for your comment on my redpilljew essay.

AJ said...

30 good extra years granted to person who otherwise may have been dead by age 25. Plenty of people die from natural (and unnatural) causes well before that. I'd call that a Win, not a problem.

Miriam123 said...

Two things:

1) Law of thirds: one third will get better (time, placebo, meds), one third will get worse (meds, the illness, life), one third will stay the same.

2) Most modern anti-depressants are only effective (in the best of circumstances) for people with serotonin/norepinephrine imbalances. People with dopamine/natural-opioid imbalances are generally not helped. This is a big issue.

LSWCHP said...

I was married to an abusive narcissist and became deeply depressed and suicidal as I saw no way out.

Antidepressants enabled me to break out of my despair and regain my life. Without them, I'm pretty sure I'd be dead.

Your mileage may vary, but they saved my life.

justthinkin said...

I went out of town for a few days and had forgotten to bring my Wellbutrin. After just a day or two without it, I would get strange sensations when I turned my head, like a glitch in the matrix or something. I got off of Wellbutrin ASAP.

NITZAKHON said...

@Miriam123: Let me ask - short of trial-and-error, is there a way to tell the difference?

As I said, my wife is definitely a very different - AND BETTER - person on them than not (she once lost it when my older kid couldn't find their rain gear... spitting mad, throwing things; being in PMS didn't help - I learned to keep track of her cycle to predict such outbursts).

So given what you've said, it's serotonin/norepinephrine.

urbane legend said...

Nothing works the same way for everyone. I have discussed this my neurologist about seizure meds. The first one I took gave me all of the downside problems. I told her it was so bad I thought it ought be outlawed. She says she has many patients who have no problems with it. She said, " I would like to be able to keep 25 of my patients in one place for 3 months to observe the effects of a particular drug on them. The variation in results is surprising. "

So it is with antidepressants. It simply proves we are all different. If a drug gives a person 30 usable years, that seems a good result to me.

SDN said...

The comparison with diabetes is apt. You are treating a more or less permanent imbalance in body chemistry.

McChuck said...

I have severe migraines with "aura", to the extent that I am on disability retirement. (I'm a veteran. I'm disabled. I'm not a disabled veteran.) I am (un)lucky enough to be in the top 1% of sufferers, and get all but one of the symptoms. (Oddly enough, the one I don't get is the most common. Go figure.) Doctors think that this sort of migraine might be related to epilepsy.

None of the meds work for me. Not one. Some do nothing at all, some make things worse, and some do completely weird things. I am in the top (bottom?) 1% of people for this, too. (Actually, less than 0.1%, but who's counting.) The neurologist has given up on me. Like several doctors before, she told me, "You're just weird."

Medicine is a game of statistics. The drugs are supposed to do the most good with the least harm. That doesn't mean universal good, and complete absence of harm.

Sorry if this was somewhat incoherent. One is kicking in now, and the world is starting to recede and get wavy around the edges. I can feel it, Dave. I can feel it. "Daisy, Daisy..."

Eric Rasmusen said...

Mr. Blogger,
You've got by far the most sensible and useful set of commenters I've ever seen after a blog post on a medical issue. Congratulations to you all!

The diabetes one is best. People don't seem to realize that if you've got a permanent condition, bad things happen after you stop taking the medication.

Anil Petra said...

Lots of people in their mid 50s have kidney issues, diabetes, obesity, cognitive problems. What's her evidence this has anything to do with her psychotropics?

SQT said...

I had postpartum depression and anti-depressants were hugely helpful in getting past that. But I didn’t feel like myself and weaned off after 6 months. I think they can be a great tool but I’m afraid doctors don’t monitor the effects as much as they should. In fact, I have had doctors try to put me on anti-depressants when my health issues have nothing to do with my state of mind.

urbane legend said...

McChuck,
when I was a teenager I had migraines like you describe. An aura at the beginning, which told me it was starting, nausea, couldn't tolerate light, paralysis on one side, could not function for 24 hours. A neurologist prescribed psilocybin. It proved to be a miracle drug; stopped the migraine cold. What happened? In 1970, the feds made it a Schedule 1 drug, a controlled substance with no known therapeutic effect. Fortunately for me, I had my last headache in 1970.

Just for information, possession of psilocybin mushrooms is illegal in the US. Apparently, though, possession of the spores is not in most states.

Clayton Wrobel said...

I am one of the people that have benefitted from SSRI's. I suffered from low grade depression from the ages of 7 to my mid-30's. After 6 months of therapy I was convinced to try Paxil. 10 days later I woke up happy for no apparent reason. Did you know that is supposed to be your default state? I didn't.

If the Paxil gives me 30+ years of happiness, I'll take it. Life was barely worth living before the meds.

Luke said...

Exercise has a moderate to large anti-depressant effect, comparable to common anti-depressant medications. That's from "Exercise and Pharmacotherapy in the Treatment of Major Depressive Disorder" in the Journal of Phsychosomatic Medicine." Here's a short video summarizing this and related studies: https://nutritionfacts.org/video/exercise-vs-drugs-for-depression/. The side effects of exercise are a lot better, too.

My wife has suffered from depression, and she has found jogging to be very helpful.

Peter, I've enjoyed your blog for years, so I'm glad for the chance to share something that may help. I regret that my comment is so late. Maybe this topic would be worth a follow-up post.

The Overgrown Hobbit said...

Since I'm active, but clumsy, I've spent considerable time with blown knees, twisted ankles and even the odd fracture. So I find it helpful to think of anti-depressants et al. as a crutch. And consider myself blessed to live in a time and place where such crutches are available.

To continue the analogy, it'd be a tragedy, if all orthopaedic research, treatment and so on were limited to crutches however. And the occasional wheelchair. Some time ago, on City Journal, one of the writers was lamenting that all the funding for mental illness was going towards "raising awareness" and "removing stigma" and lobbying. Some group counselling services.

Buildings with beds, doctors and support staff? Not so much.