Recently, a small set of my patients have become discontent with the treatment of their long-standing depression. Their accounts have ranged from previously being on nearly every antidepressant and “hitting a wall “on each, and losing hope, to experiencing unpredictable mood changes on a daily basis that caused them to become fearful and unable to trust themselves. One individual disclosed that following a heated disagreement with her spouse, she felt like killing herself – and saw no other alternative to resolve her frustration. This was her first time to consider such an action and she didn’t know where it had come from.
I must admit, they got my attention and after conferring with my colleagues, I thought I had better do some research to ascertain if my situation was novel, indeed.
Are These Concerns Over Antidepressant Therapy Justified?
Is There An Epidemic of Antidepressant Deficiencies?
About 1 in 8 Americans are on antidepressants – primarily serotonin reuptake inhibitors (SSRI) antidepressants. 1 in 4 among women in their 40s and 50s.
In the U.S. the suicide rate is 38,000 a year – the highest it’s ever been.
So the question becomes, if so many people are treated with prescription medications, why is the national suicide rate so high? Is it possible that the medications are actually contributing to suicide? Is it possible that the medications are actually contributing to worsening and
chronic depression?
Background Of Antidepressants
The side effects of antidepressants run the gamut from sexual dysfunction to lack of emotions or “emotional flatness,” sleep disturbances, brain damage, and even to suicide and homicide.
According to Dr. Joseph Mercola, “Antidepressants have also been shown to increase your chances of worsening depression, turning what is often a temporary condition into a lifelong struggle. One in 20 Americans over the age of 12 struggles with depression and 11 percent of the U.S. population over the age of 12 are on antidepressant medication.”
“Considering the prevalence of depression and the risks associated with antidepressants, we really need to reevaluate how we approach this problem. undoubtedly a serious issue that should not be dismissed, but I urge you to consider your options before taking the drug route.”
Antidepressants Are Not Science-Based Medicine
Studies have repeatedly shown that these drugs work no better than a placebo. As noted in a 2014 paper on antidepressants and the placebo effect:
“Antidepressants are supposed to work by fixing a chemical imbalance, specifically, a lack of serotonin in the brain. Indeed, their supposed effectiveness is the primary evidence for the chemical imbalance theory.
But analyses of the published data and the unpublished data that were hidden by drug companies reveals that most (if not all) of the benefits are due to the placebo effect …
Analyzing the data we had found, we were not surprised to find a substantial placebo effect on depression. What surprised us was how small the drug effect was. Seventy-five percent of the improvement in the drug group also occurred when people were given dummy pills with no active ingredient in them.
The serotonin theory is as close as any theory in the history of science to having been proved wrong. Instead of curing depression, popular antidepressants may induce a biological vulnerability making people more likely to become depressed in the future.”
FDA Data and Unpublished Trials Show Antidepressants Don’t Work
That 2014 paper is well worth reading if you still doubt the claim that antidepressants’ effectiveness is on par with placebo. The author, Irving Kirsch, Ph.D., is a psychotherapist who has performed a number of analyses on antidepressants.
In 2002, his team filed a Freedom of Information Act to request to the Food and Drug Administration (FDA), asking for the trial data provided by drug companies as part of the drug approval process. There were several benefits to using this data:
FDA requires drug companies to provide data on all clinical trials they’ve sponsored, including unpublished trials. As it turned out, nearly half of all clinical trials on antidepressants had never been published.
Only 43 percent of trials (published and unpublished) showed a statistically significant benefit of drugs over placebo. In the majority of trials — 57 percent — the drug showed no clinical benefit over placebo.
Moreover, the placebo response actually accounted for 82 percent of the beneficial response to antidepressants.
These results were reproduced in a 2008 sstudy usinganother, larger, set of FDA trial data. According to Kirsch, “once again, 82 percent of the drug response was duplicated by placebo.”
All of the trials used the same primary measure of depression, the Hamilton depression scale — a 17-item scale with a possible score of 0 to 53 points. The higher your score, the more severe your depression. This made the drug-placebo differences easy to identify, compare and understand. Importantly, the mean difference between drug and placebo was less than two points (1.8) on this scale, which is considered “clinically insignificant.”
To illustrate just how tiny a difference this is, you can score a six-point difference simply by changing sleep patterns without any reported change in other depressive symptoms. As noted by Kirsch, “thus, when published and unpublished data are combined, they fail to show a clinically significant advantage for antidepressant medication over inert placebo.”
The drug company data sent to the FDA is the basis upon which antidepressants were approved, which makes these trials particularly important.
If there were significant flaws in the studies — which is a common complaint when someone doesn’t agree with the results — the FDA should never have approved them in the first place.
Study Suggests ‘No Suicide Link’ Is Not to Be Trusted
Suspicion is high amongst scientists and science writers because of an apparent lack of access to data. Dr. Healy, a professor of psychiatry in North Wales and Great Britain is a former secretary of the British Association for Psychopharmacology and author of over 175 peer-reviewed articles, 200 other pieces, and 20 books, including Let Them Eat Prozac (one of my favorites), and Pharmageddon, another favorite. His time is divided between an active psychiatry practice and research.
Dr. Healy has studied the serotonin-uptake theory in depressed patients, and is adamant that there’s no evidence indicating that depressed patients have something wrong with their serotonin system, which makes selective serotonin reuptake inhibitors (SSRI’s) a dubious treatment for depression. It may even be part of the equation for why some people become suicidal on SSRI’s, even if they’ve never had such tendencies before.
He says “We’ve got 30 to 40 years’ worth of work, and no evidence has come to light that there’s anything wrong with the serotonin system in people who were depressed,”
Suicides Linked to Antidepressants Number in the Thousands
In 1997, drug safety activists launched a website called SSRIstories.com, which archived credible and published reports that cite the role of SSRIs and related antidepressants in suicides and other violent behavior. Rosie Meysenburg, a founder of the website said, “The kind of energy, rage and insanity was not seen before SSRIs appeared.”
Drug companies routinely blame suicides on the depression that was being treated, not the drugs — but the experiences of patients treated with the same drugs for non-mental indications like pain and the experiences of healthy volunteers cannot be written off as the “disease.”
A Dark Side of Cymbalta Is Reported
In 2008, the Journal of Clinical Psychopharmacology describes a 37-year-old man with a stable marriage, stable employment and no history of mental problems trying to kill himself two months after being prescribed Cymbalta for back pain.
“The patient was unable to state exactly why he wanted to commit suicide,” wrote the four physician authors in the report, also noting that the man returned to normal when the drug was stopped.
The Black Box Warnings Added in 2004
In 2004, in response to the outcry over antidepressant-linked suicides, the U.S. Food and Drug Administration (FDA) directed drug makers to add a “Black Box” warning to SSRIs and related psychiatric drugs, highlighting suicide risks and the need for close monitoring of children and adolescents for suicidal thoughts and behavior.
“Today’s actions represent FDA’s conclusions about the increased risk of suicidal thoughts and the necessary actions for physicians prescribing these antidepressant drugs and for the children and adolescents taking them.
Our conclusions are based on the latest and best science. They reflect what we heard from our advisory committee last month, as well as what many members of the public have told us,” said Dr. Lester M. Crawford, acting FDA commissioner at the time.
Unfortunately, drug industry funded doctors have tried to claim that the warnings scare doctors and patients away from the drugs and heighten suicide.
Still, both David Shern, Ph.D., president of Mental Health America, a group investigated by Congress for undisclosed industry funding and Dr. Charles Nemeroff, also investigated by Congress, blamed the Black Box warnings for rising suicides. Speaking to ABC News, Nemeroff said: “I have no doubt that there is such a relationship. The concerns about antidepressant use in children and adolescents have paradoxically resulted in a reduction in their use, and this has contributed to increased suicide rates.”
The CONTROVERSY
I learned in medical school 30 years ago that depression was typically a self-limiting illness. It was supposed to have a duration of approximately 9 months. According to Robert Whitaker, author of the recently released book, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the astonishing Rise of Mental Illness in America, “Even in cases severe enough to require hospitalization, people would get better in six or eight months; they would recover and often never relapse, or if they did it would be years down the road and, again, self-limiting.”
When antidepressants were introduced, it was with the intent that they would help people recover from depression more quickly.
In actuality: since antidepressants were introduced, patients are recovering faster but relapsing more, or recovering only partially and transitioning into a festering state of chronic depression that never really resolves.
But What About Their Long-Term Effectiveness?
Researchers like Giovanni Fava from Italy said, “Hey, listen, the course is changing with antidepressants. We’re changing it from an episodic illness to a chronic illness, and we really need to address this.”
“By the 1990s, this change in the long term course of depression was so pronounced that finally it was addressed by researchers,” says Whitaker.
Not only that, but the depression is sinking into people (on antidepressants) in a deeper way than before.”
The number of disabled mentally ill in the United States tripled over the past two decades. Every day 1,100 adults and children are added to the government disability rolls because they have become newly disabled by mental illness, with this epidemic spreading most rapidly among our nation’s children. What is going on? All drugs have benefit-to-risk ratios, so if a drug is as effective as a placebo in relieving symptoms, it really doesn’t make sense to use them as a first line of defense. The research reflecting short-term trials show that antidepressants do NOT provide any clinically significant benefits for mild to moderate depression, compared to a placebo.
Long-term studies now indicate that of people with major depression, only about 15 percent that are treated with an antidepressant go into remission and stay well for a long period of time. The remaining 85 percent start having continuing relapses and become chronically depressed.
Therefore, instead of subjecting yourself to the serious side effects of mind-altering drugs, you can try the following process that I fully endorse and support for your recovery. These options are safe, inexpensive and best of all remarkably effective! Overcoming Depression Without Drugs Per Dr. Mercola
Research tells us that the composition of your gut flora not only affects your physical health, but also has a significant impact on your brain function and mental state, and your gut microbiome can be quickly impacted by dietary changes — for better or worse.
Research has also revealed there are a number of other safe, effective ways to address depression that do not involve hazardous drugs. So if you suffer from an anxiety- or depression-related disorder, please consider addressing the following diet and lifestyle factors before you resort to drugs:
Eat real food, and avoid all processed foods, sugar (particularly fructose), grains, and GMOs | High sugar and starchy non-fiber carbohydrates lead to excessive insulin release, which can result in falling blood sugar levels, or hypoglycemia. In turn, hypoglycemia causes your brain to secrete glutamate in levels that can cause agitation, depression, anger, anxiety, and panic attacks. Sugar also fans the flames of inflammation in your body. In addition to being high in sugar and grains, processed foods also contain a variety of additives that can affect your brain function and mental state, especially MSG, and artificial sweeteners such as aspartame. Gluten sensitivity is also a common, hidden cause of depression, so going on a gluten-free diet can be part of the answer. Recent research also shows that glyphosate, used in large quantities on genetically engineered crops like corn, soy, and sugar beets, limits your body’s ability to detoxify foreign chemical compounds. As a result, the damaging effects of those toxins are magnified, potentially resulting in a wide variety of diseases, including brain disorders that have both psychological and behavioral effects. |
Increase consumption of traditionally fermented and cultured foods | Reducing gut inflammation is imperative when addressing mental health issues,25 so optimizing your gut flora is a critical piece. To promote healthy gut flora, increase your consumption of probiotic foods, such as fermented vegetables, kimchee, natto, kefir, and others. |
Get adequate vitamin B12 | Vitamin B12 deficiency can contribute to depression and affects one in four people. |
Optimize your vitamin D levels | Vitamin D is very important for your mood. Remember, Seasonal is a type of depression related to sunshine deficiency, so it would make sense that the perfect way to optimize your vitamin D is through UV exposure. Be sure to check your levels (via blood test) at least once or twice a year. You’ll want to be within the therapeutic range of 40 to 60 ng/ml year-round. If you cannot get sufficient sun exposure to maintain this level, taking an oral vitamin D3 supplement would be advisable. Just remember to also increase your vitamin K2 when taking oral vitamin D. |
Get plenty of high-quality animal-based omega-3 fats | Your brain is 60 percent fat, and DHA, an animal-based omega-3 fat, along with EPA, is crucial for good brain function and mental health.26,27 Unfortunately, most people don’t get enough from diet alone, so make sure you take a high-quality omega-3 fat. I recommend krill oil, which has a number of benefits over fish oil, including better absorption.28 |
Beneficial herbs and supplements: SAMe, 5-HTP and St. John’s Wort | SAMe is an amino acid derivative that occurs naturally in all cells. It plays a role in many biological reactions by transferring its methyl group to DNA, proteins, phospholipids and biogenic amines. Several scientific studies indicate that SAMe may be useful in the treatment of depression. 5-Hydroxytryptophan (5-HTP) is another natural alternative to traditional antidepressants. When your body sets about manufacturing serotonin, it first makes 5-HTP. Taking 5-HTP as a supplement may raise serotonin levels. The evidence suggests 5-HTP outperforms a placebo when it comes to alleviating depression29 — more than can be said about antidepressants. One caveat: anxiety and social phobias can worsen with higher levels of serotonin, so it may be contraindicated if your anxiety is already high. St. John’s Wort has also been shown to provide relief from mild depressive symptoms. |
Evaluate your salt intake | Sodium deficiency actually creates symptoms that are very much like those of depression. Make sure you do NOT use processed salt (regular table salt), however. You’ll want to use an all-natural, unprocessed salt like Himalayan salt, which contains more than 80 different micronutrients. |
Get adequate daily exercise | Studies have shown there is a strong correlation between improved mood and aerobic capacity. There’s also a growing acceptance that the mind-body connection is very real, and that maintaining good physical health can significantly lower your risk of developing depression in the first place. Exercising creates new GABA-producing neurons that help induce a natural state of calm. It also boosts your levels of serotonin, dopamine, and norepinephrine, which help buffer the effects of stress. |
Get enough sleep | You can have the best diet and exercise program possible but if you aren’t sleeping well you can easily become depressed. Sleep and depression are so intimately linked that a sleep disorder is actually part of the definition of the symptom complex that gives the label depression. |
Energy psychology | Energy psychology techniques such as the Emotional Freedom Techniques (EFT), can also be very effective for reducing symptoms of depression or anxiety by correcting the bioelectrical short-circuiting that causes your body’s reactions — without adverse effects. Recent research has shown that EFT significantly increases positive emotions, such as hope and enjoyment, and decreases negative emotional states. EFT is particularly powerful for treating stress and anxiety because it specifically targets your amygdala and hippocampus, which are the parts of your brain that help you decide whether or not something is a threat.30,31 For serious or complex issues, seek out a qualified health care professional that is trained in EFT32 to help guide you through the process. |