Betty W. Phillips, Ph.D., Psychology
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The Antidepressant Nightmare

       

                                                THE ANTIDEPRESSANT NIGHTMARE    

“Help! A number of people have asked me to look into the problems with antidepressants and withdrawing from these drugs. “What’s wrong with me? I'm a wreck! I'm crying all the time. My moods are going up and down. I tried to get off my antidepressant but I can't. I'm even getting shocks in my brain. I read on the Internet about brain zaps but I really can't find how to get rid of them. My doctor said I need to go back on a higher level of antidepressants. I feel trapped!"  The problem is indeed serious. But help is on the way. The press is starting to take notice of the issue. A recent Newsweek headline (2-8-10) heralded, "ANTIDEPRESSANT DON'T WORK" The inside headline stated, "STUDIES SUGGEST THAT THE POPULAR DRUGS ARE NO MORE EFFECTIVE THAN A PLACEBO." In bold the headline continued, "IN FACT THEY MAY BE WORSE." 

 

A number of recent serious, scholarly, research-based books are summarizing the results of scientific studies of the issues involved. It's about time. The amount of money we spend on psychiatric drugs in this country is more than the Gross National Products of two-thirds of the world's countries. The most recent book, "Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America" (Robert Whitaker, Crown) was just published April 13, 2010. Whitaker analyzed the results of long-term studies demonstrating that depression and other forms of mental illness are becoming increasingly prevalent in our country…

up to 20% of Americans. Astonishingly, Whitaker also discovered that antidepressant drugs are actually causing an increase in depression. It had been known for a long time that untreated depression is episodic and will remit on its own. For example, in 1974 the head of the depression section at the National Institute of Mental Health, Dean Schuyler, stated that most depressive episodes "will run their course and terminate with virtually complete recovery without specific intervention."  But now the statistics have changed for the population which has increasingly been treated with antidepressant medication. Now, 85% of individuals with major depression treated with an antidepressant start having continuing relapses and become chronically depressed. Only about 15% go into remission and avoid a recurrence of depression.

 

All this is quite confusing because of the popular belief that depression is caused by a chemical imbalance in the brain requiring remediation by drugs. As Whitaker states, "The story that people with mental disorders have known chemical imbalances-- that's a lie."  Whitaker explained that the antidepressants increase serotonin levels in the brain over a short period of time. Then, however, the brain stops producing serotonin in the normal way and actually reduces the number of serotonin receptors in the brain. After a period of time, an individual taking an antidepressant will end up with the brain producing less serotonin than before and dependent upon receiving serotonin artificially.  Whitaker explained that the drugs disrupt normal brain chemistry and he quotes neuroscientists who state that these drugs are actually inducing a "pathological state." A website, www.neuroassist.com, from NeuroResearch Clinics, provides additional information about the neurological mechanisms in a paper entitled, "Antidepressants Delete Neurotransmitters." This then is the explanation for the increase in severity of symptoms and chronicity of depression in individuals who are prescribed these drugs. It is true that antidepressant drugs do decrease depression initially for a number of people, although the research continues to show that the positive effects are only marginally better than placebos and virtually identical to active placebos (placebos which cause physiological changes.)

 

Even more serious than chronic depression, Whitaker describes other possible negative effects of long-term antidepressant use. The increased risk of suicide has been described in the press and was finally accepted by the FDA.  Prozac, the first of the new antidepressants, was approved in 1987 and within a decade there were 39,000 adverse reports about Prozac sent to the FDA's Medwatch (an estimated 4 million Americans based on this type of complaint.) The adverse reactions reported to the FDA years ago included delirium, hallucinations, convulsions, violent hostility, psychosis, suicide and other drug related deaths. Whitaker’s book describes two additional very serious effects of antidepressants which are now being studied but rarely reported in the press. The first side effect is the risk of conversion from unipolar depression to bipolar depression, a very serious debilitating long-term illness, for about 25% of long-term adult users of antidepressants. Whitaker also discusses a risk of cognitive decline associated with long-term use of antidepressants. These negative effects occur in adults but are also seen with increasing frequency as adolescents and younger children are given more psychiatric drugs. Their developing brains are even more sensitive and more easily shaped by chemicals in drugs.

 

Whitaker is not the only author completing recent comprehensive analyses of antidepressants and other drugs.  Another book published in 2010 is "The Emperor's New Drugs," Joseph Kirsch, Basic Books, and the final months of 2009 included "The Myth Of the Chemical Cure: A Critique of Psychiatric Drug Treatment," Joanna Moncrieff, Macmillan, and "Medication Madness" by Peter Breggin, Griffin Books. Another book worthy of note was published in 2006, "America Fooled: The Truth about Antidepressants, Antipsychotics and How We've Been Deceived," by Timothy Scott, Argo Pub.

 

To add to the bad news, long-term studies are documenting additional medical risks due to long-term antidepressant use. Despite the popular perception that the new SSRI antidepressant drugs are safer than the older tricyclic drugs, the Women's Health Initiative (a study of around 136,000 women over a period of 15 years) found that the 5500 women who started taking antidepressants had more deaths from any cause and more deaths from stroke than the rest of the group members who were not taking anti-depressant drugs. Another example of the kind of findings that are being reported is the risk of serious gastrointestinal bleeding with antidepressant drugs.  Studied over an 11 year period, patients in Denmark exhibited black and blue spots, bruises, nosebleeds, localized hemorrhages as well as life-threatening hemorrhages, with the risk increased when antidepressants were combined with NSAID painkillers.

 

The public may not be aware that almost half of the people starting antidepressant medication discontinue the prescription within the first three months because of "side effects." Others describe these “side effects” as drug effects because they are direct results of adding additional chemicals into the brain and body instead of occurring on the "side." Most of these initial adverse effects can be grouped into fatigue, anxiety, insomnia, headaches and nausea. A number of other antidepressant users discontinue their drugs later because the drugs stop producing positive effects and/or they produce concerning and persistent long-term negative effects such as weight gain, low energy, chronic insomnia, flat affect, “spacey” thinking and relationship problems due to low libido.

 

As you know the Food and Drug Administration is responsible for the safety of prescription drugs as well as providing information to protect the public from negative drug effects.  Watchdog groups are highly critical of the lack of protection that we are receiving. The Medication Guide for individuals taking antidepressant drugs has not been updated by the FDA since 2007.

 

How does this information compare to the popular perception that antidepressants work? Well, many people do feel better (approximately 40% of individuals in clinical studies.) As described above, however, many people experience negative effects of the drugs either initially or in the longer-term. Even those people who benefit from the drugs will tell you about the side effects they had to endure during the initial weeks of taking the drug. While they tell you they benefit from a feeling of numbness to the problems that may have caused the depression, they also complain about blunted affect.  It's important to understand that drugs such as LSD and Ecstasy also interact with the serotonergic systems of the brain. Yes, people taking drugs may feel “happier,” but are the risks worth it? And if someone begins to taper off the drugs, the withdrawal problems begin.

 

This is where I started my article. How to withdraw from these drugs? Unanticipated symptoms include electrical shocks described as "brain zaps" but also anxiety, crying spells, insomnia, irritability, agitation, mood swings, difficulty with concentration and memory, impulsive aggression, dizziness, headaches, vertigo, tremors, nausea, vomiting, diarrhea, chills, fatigue, lethargy, pains, excessive sweating, and yes, even depression.  If you consult the Internet, you will find many descriptions of antidepressant withdrawal symptoms but little to no information about ways to cope. The psychiatric and pharmaceutical industries are noticeably absent in addressing these issues on the Internet. I was able to find one Mayo Clinic psychiatrist who discussed this issue on their website. The establishment prefers to downplay the problems with antidepressant withdrawal, even reclassifying the withdrawal symptoms as evidence of another problem, the "antidepressant discontinuation syndrome." The advice typically given is to consult your doctor who "may recommend gradually tapering off the dosage... if necessary, your doctor may recommend resuming antidepressant therapy."  The Mayo Clinic found it important to address the fact that "antidepressants aren't considered addictive substance. The Mayo Clinic website echoed the established pharmaceutical explanation that: " Withdrawal from an addictive substance is a very different phenomenon from withdrawal from antidepressants-- which are simply drugs designed to restore normal chemical balance in the brain."

 

On Amazon.com I did find two books written by medical doctors which provide information and some assistance in withdrawal from antidepressants: "The Antidepressant Solution: A Step-By-Step Guide To Safely Overcoming Antidepressant Withdrawal, Dependence, and Addiction" by Joseph Glenmullen, Free Press, 2006, and "Your Drug May Be Your Problem, Revised Edition: How and Why to Stop Taking Psychiatric Medications," by Peter Breggin and David Cohen, Da Capo Press, 2007.  Dr. Breggin’s book has an interesting chapter "Why Doctors Tell Their Patients so Little," stating that "Physicians are encouraged not to tell their patients the known dangers of psychiatric drugs." Dr. Glenmullen’s book concentrates on withdrawal from antidepressants while Dr. Breggin’s book is more general. While all printed matter tells you to consult your doctor, your doctor may in fact know very little about discontinuing psychiatric drugs.

 

You may find it interesting to consult a recent book, "Into Fear and Back" by Susie Macomber, Xlibris, 2009, which describes her battles with generalized anxiety disorder and depression, the multiple failures of medication and her extensive research efforts which finally helped her turn the corner away from her serious symptoms. Admitted to a mental hospital she was told that her "brain chemicals were out of whack" but she experienced only temporary relief even when she was prescribed a "boatload of medications." When she found herself regressing to the same condition and worse even with medication, she was readmitted to a psychiatric hospital only to be put on more heavy-duty medications which made her "feel like a zombie." While attempting to be readmitted to a third hospital, the psychiatrists would agree to treat her only if her husband would sign "a paper allowing them to have full control over me for an indefinite period of time." But her husband "had already seen that they were unable to find out just what was wrong, and he wasn't about to leave me at the mercy of people who didn't seem to really care whether I lived or died. Thankfully, he didn't sign the paper."  She was left to suffer and eventually to research solutions on her own. While you will want to empathize with her experiences, the conclusions she reached are her own and do not necessarily generalize to others. It is important to understand that her results were related to her study of her own body and her past history.

 

The most helpful book I have found so far is "The Mood Cure" (Penguin, 2003) by Julia Ross, a nationally known specialist in nutritional psychotherapy. You can obtain additional information about Julia Ross and her approach on her website www.moodcure.com.  Chapter 11 discusses natural alternatives to antidepressant drugs and provides specific suggestions for withdrawal from these drugs. She wisely states the obvious, "What does it mean when a drug cannot be terminated without withdrawal symptoms? It means that the drug is addictive." She has found that "research supports our clinic’s experience of over 15 years that natural methods can easily meet or exceed the benefits of SSRIs for many, perhaps most, people… They typically do much better off SSRIs than on them."

 

You will find some information on the Internet and a few books about the relationship between supplements and prescription medications. There is a good deal of information to document the fact that medications often deplete nutrients from the body, especially drugs that must be taken on a long-term basis. Some of this information relates to antidepressants. If you are currently taking antidepressants or other medications, you may want to research this information. I did find an article on www.alive.com, "Common Drugs Deplete Nutrients” by Dr Daniel Wagner, pharmacist and nutritionist, which stated that B-complex vitamins (B12, folic acid and perhaps riboflavin), selenium, zinc, glutathione, vitamin C and magnesium/calcium may be depleted when using antidepressants. (Note that glutathione capsules are not effective in raising this important amino acid, but supplements can be helpful in raising glutathione.) NeuroResearch Clinics, mentioned above, does provide additional information about the severity of the problem in discontinuing antidepressants (based on the type of drug, dosage of the drug and length of time the drug has been used) and mentions withdrawal management using supplements which balance neurotransmitters naturally in the same way as is described in the Mood Cure.

  

There are many options for coping with depression other than a magic pill that turns into a nightmare. Because depression is a life condition not merely some sort of brain chemical imbalance, improving your life in any way, increasing happiness and managing stress, will make major inroads into reducing depression. In this endeavor you will have to develop strategies to improve both mind and body.  You may find a holistic psychiatrist or practitioner of natural medicine to assist you. You may also receive practical advice from a therapist who is experienced in utilizing holistic as well as cognitive-behavioral approaches to life improvement. You can make use of the resources listed in this article and other articles on my website. If you are trying to withdraw from antidepressants, I send you my best wishes for success.


IMPORTANT NOTICE to out of area readers.  I am not able to respond to inquiries from out of area individuals about this or other topics.  As a therapist, personal advice must be limited to those I can see in person.  I have been receiving many emails from people throughout the world distressed about  this issue and I regret that I am not able to be of assistance personally.  You might consult Whitaker's website, MAD IN AMERICA, Resources section, which has information about practitioners  throughout the country.  BEST  WISHES TO ALL OF YOU!