Antidepressants – Not a Science

For 20 years, antidepressants have given some if not entire relief to countless individuals. The word “some” or partial is used here since about 70 percent of people are improved. That leaves another 30 percent (a significant number) who are only getting partial or no help from this medicine: a.k.a. “the treatment resistant group.”

That’s one good reason why the search for new antidepressants continues.

Another reason for the hunt for new antidepressants is side effects-it can be a trade off of whether or not to deal with the depression, weight gain, sex problems and insomnia, to name a few. Thus, one explanation for recurrent depression: People decide the side effects aren’t worth the problem.

Recurrent depression occurs for other reasons as well. In a 1998 study, more than one-third (37 percent) of people treated for depression by primary care physicians suffered recurrent depression within 19 months. Seattle researchers followed 370 adults treated for depression by a large HMO in the Puget Sound area. Relapse was defined as suffering two weeks or more of significantly depressed mood and other symptoms of depression (sleep and appetite changes, lethargy, hopelessness, suicidal thoughts) from seven to 19 months after initial treatment.

The biggest risk factor for relapse was a previous relapse. In quite a few people, depression is a chronic recurring illness characterized by periods of normal moods and major depression. The other risk factor for relapse was low-level depressive symptoms despite treatment, notably, sadness. Compared with participants who did not relapse, those who had relapsed previously and reported sadness despite treatment were three times more likely to relapse again.

The simple truth is that antidepressants are not a science. No one can say, “Oh, you are in mental pain,” take two of these SSRIs and a nap and you’ll be fine again. If it were so easy! Researchers are learning as they go. And in the majority of times, they get it right, if the percentages are correct. The results with Prozac are a good example. Many a person will praise this medication. And for those whom it has helped, it’s a godsend.

However, there’s another side to this issue as well. An article in May 2000 Boston Globe reports, “Just as the 14-year patent on Prozac is about to expire and the drug’s maker, Eli Lilly and Co., is preparing to launch a new version, a body of evidence has come to light revealing the antidepressant’s dark side. The company’s internal documents…indicate that the pharmaceutical giant has known for years that its best-selling drug could cause suicidal reactions in a small but significant number of patients.”

Similarly, a just-published book, “Prozac Backlash,” by a Cambridge psychiatrist, Dr. Joseph Glenmullen, has drawn Lilly’s ire for discussing Prozac’s link to suicide, tics, withdrawal symptoms, and other side effects of Prozac and similar antidepressants. In other words, even Prozac has its problems.

NEUROTRANSMITTERS IN THE BRAIN

It’s no wonder that so many questions remain. Antidepressants work on the brain, a very much unchartered land.

Antidepressants work by slowing the removal of certain chemicals from the brain. These chemicals are called neurotransmitters. Neurotransmitters are needed for normal brain function. Antidepressants help people with depression by making these natural chemicals more available to the brain.

There are many different kinds of antidepressants, including: Tricyclic antidepressants (tricyclics) Selective serotonin reuptake inhibitors (SSRIs) and Monoamine oxidase inhibitors (MAOIs). Each work differently from each other. Each work differently when in combination with each other. And each work differently on one person versus another. The permutations are endless.

And, as noted, the antidepressants can cause decreased sexual drive and loss of ability to reach orgasm. They can also block menstrual periods, although this seems less common. Decreasing the dose of medication or switching to a different antidepressant is sometimes useful in dealing with these problems.

Viagra®, the much-publicized medication for male erectile dysfunction, appears to be effective in quickly treating sexual side-effects experienced by some men taking antidepressant medications. A study involving the University of Arizona Department of Psychiatry, the University of New Mexico and Massachusetts General Hospital, is testing 90 men experiencing antidepressant-related sexual side-effects by giving them Viagra® as a potential antidote. (A similar study designed to treat women also is in the early stages of consideration.). The question is whether or not to take one pill to counteract another.

Taking anti depressants during pregnancy is also getting mixed reviews. A 1999 study of women who took antidepressants during pregnancy reported that neither Prozac, an SSRI, nor tricyclic antidepressants posed a higher than normal risk for birth defects or miscarriage.

According to a June 25, 2000 New York Times article, “few experts deny that antidepressants can alleviate the sadness, confusion, anger, insomnia, self-recrimination, dread and loss of interest in everything of postpartum depression. Yet many mental health professionals and women’s health advocates worry that these drugs are being over subscribed, especially to pregnant and breast-feeding women.”

According to a panel of psychiatrists at the recent National Depressive and Manic Depressive Association Conference, the SRRIs are “incredibly safe” during pregnancy. Effexor is the worst. Lithium’s dangers are overstated while Depakote and Tegretol are dangerous. According to Fredrick Goodwin MD (who co-authored the definitive book on bipolar disorder with Kay Jamison), the anticonvulsants involve a five percent chance of neural tube defects (such as spinal bifida) while lithium runs a one in a thousand chance of heart problem, which is correctable. (McMan’s Depression and Bipolar Weekly2#30

On the flip side, however, you have women who either suffered severe postpartum depression and are concerned about a relapse (which is a logical concern, remember the study quoted above) and want the medication to combat reoccurrence. Or, you have women who have successfully been on an antidepressant and don’t want to take the risk of getting off of it.

Once again, not a very cut and dried situation. For the time being, any woman taking any medication regularly–whether it’s for depression, headaches or a topical crème for skin rashes — should discuss this with her doctor when considering getting pregnant. This gives her the opportunity to weigh the pros and cons of staying on or starting a medication or changing medications based on studies to date. This session with the doctor can also give the mom-to-be the chance to determine whether the doctor is someone she respects, wants to take of her for nine months, and to deliver her baby into the world.