sad and depressed young woman crying

Americans love antidepressants. It is estimated that between one in eight and one in ten takes an antidepressant medication. People take SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) to treat depression, anxiety, OCD (obsessive compulsive disorder, fibromyalgia, nerve pain, ADHD and symptoms of menopause. How well do patients understand the dangers of antidepressants?

The Stats and Startling!

The last time we searched we discovered some fascinating numbers. Here are some annual statistics for popular antidepressants:

  • Sertraline (Zoloft)             6.7 million patients and 38 million prescriptions
  • Fluoxetine (Prozac)         4.4 million patients and 24 million prescriptions
  • Escitalopram (Lexapro)  3.5 million patients and 20 million prescriptions
  • Venlafaxine (Effexor)      3.0 million patients and 17 million prescriptions
  • Duloxetine (Cymbalta)   2.5 million patients and 15 million prescriptions
  • Paroxetine (Paxil)            2.5 million patients and 15 million prescriptions
  • Trazodone (Desyrel) is a serotonin modulator and works a bit differently. It is also very popular with 4.6 million patients and 26 million prescriptions

That does not include antidepressants such as bupropion (Wellbutrin), citalopram (Celexa), desvenlafaxine (Pristiq) and levomilnacipran (Fetzima). Nor does it include older antidepressants called tricyclics such as amitriptyline, desipramine, doxepin, imipramine, nortriptyline and protriptyline.

The FDA and Antidepressant Approvals:

Most people assume that antidepressant medications are quite safe. After all, these drugs have all been approved by the FDA and one condition for such approval is that the medicine must be proven “safe and effective.” The trouble is that the FDA’s definition of safe and effective is relative. The agency routinely approves medications that have potentially serious or even life-threatening side effects.

It is not uncommon for the FDA to approve a drug that is barely better than placebo. In other words, if a sugar pill relieved depression in 30% of patients with depression and a new drug relieved depression in 40% of patients with depression, The FDA might well consider it effective. That, despite an absolute benefit that may only be 10% better than nothing at all.

If you think we pulled those numbers out of a hat, check this research. Studies have reported placebo response rates of 31-45% in the treatment of depression. That compares to a roughly 50% response rate with antidepressant medications (Walsh et al, JAMA, April 10, 2002; Stolk et al, Annals of Pharmacotherapy, Dec. 2003; Kirsch et al, PLoS Medicine, Feb. 2008).

Serotonin and the Dangers of Antidepressants:

Many people, including a lot of health professionals, think that antidepressants primarily affect the brain. That is where the neurotransmitter serotonin is found. But serotonin is found throughout the body and plays an important, but little understood role in many physiological processes.

Did you know?

Did you know that most of the serotonin that is made in your body is made in your digestive tract? That’s right, the gut makes a substantial amount of serotonin and it circulates around your body through the blood stream. The sticky part of your blood (platelets) take up serotonin. It plays an important role in blood clotting. A new study into the dangers of antidepressants notes that:

“Indeed, serotonin regulates growth, development, reproduction, thermoregulation, tissue repair, maintenance, electrolyte balance, mitochondrial function, and the storage, mobilization and distribution of energetic resources. By blocking the transporter in the brain and the periphery, selective serotonin reuptake inhibitors (SSRIs), which are the most widely prescribed ADs [antidepressants], could potentially degrade many adaptive processes.”

(Psychotherapy and Psychosomatics, online, Sept. 14, 2017)

The new study suggests that antidepressants may not be as innocuous as they seem. Researchers conducted a meta-analysis of 17 studies comparing people using antidepressants to those on placebo. They found that those taking antidepressants were 33% more likely to die during the study time frame and 14% more likely to have a heart attack, stroke or other cardiovascular event. People who already had cardiovascular disease, however, were at no higher risk if they took an antidepressant.

The type of antidepressant did not seem to make a difference. The authors of the new research point out that:

“although each AD [antidepressant] has unique pharmacological effects, they all interact with evolutionarily ancient biochemical systems that regulate multiple adaptive processes throughout the brain and the periphery. Thus, while each AD probably has a distinct symptom profile, there is good reason to suspect that they all degrade the functioning of some adaptive processes in the body.”

The People’s Pharmacy Perspective:

Antidepressants can be life savers for some people. The benefits for certain individuals far outweigh the risks. We have heard repeatedly from readers that antidepressants made life worth living. But we must not forget that the dangers of antidepressants can also be significant. The authors of the latest research suggest that both older and newer antidepressants can have “negative cardiovascular effects.” They point out that the new awareness “urges greater caution in their use.”

They conclude:

“The rates of AD use are high and appear to be increasing, and most ADs are prescribed by primary-care practitioners in the absence of a formal psychiatric diagnosis. Our results suggest that health care providers should take greater care in evaluating the relative costs and benefits of ADs for each individual patient, including an assessment of cardiovascular status. ADs may be relatively safe for patients with known cardiovascular disease. However, when the patient has no cardiovascular disease, our results should give the prescriber pause because they suggest ADs increase health risks, including the risk of death.”

NEVER Stop an Antidepressant Suddenly!

We cannot emphasize enough that no one should ever stop an antidepressant without careful discussion with a health care professional. And no one should ever stop an antidepressant suddenly. The withdrawal symptoms can be intolerable.

If you would like to learn more about the benefits and the dangers of antidepressants please check out this comprehensive article:

“Balancing the Benefits and Risks of Antidepressants”

This was written by Amy Beausang, Doctor of Pharmacy (PharmD)

You may also find our interviews with Dr. Samantha Boardman and Dr. Peter Gotzsche of great interest. Here is a link:

Show 1075: Are Drugs for Mental Illness Safe and Effective?

The podcast, mp3 file, and streaming audio are free!

Our bottom line: The new findings appear to suggest that doctors and patients need to evaluate benefits and risks for antidepressants just as they do for other medications.

[Psychotherapy and Psychosomatics, Sept. 14, 2017]

Share your own thoughts and stories about antidepressant medications below in the comment section.

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  1. JO

    Started Effexor in 2000 due to depression after taking tamoxifin for 5 yearsl. Effexor changed to ZANAX in 2008. Xanax changed to Escitalopram in 2013. All low dose (.05 m) No energy-constant fatigue and noticeable weight gain. Decided to wean myself off. Took half – every other day (2 weeks) – took half of half -every other day (2 weeks) – took half of half *as needed (2 weeks) – took tiny piece as needed occassionally. Totally off AD – mentally sound – full focus, regained total mind focus. Mind–body-spirit-mental focus regained. Never take AD – TOO MUCH TO LOSE.

  2. Carol
    Ninety Six, SC

    My psychiatrist and I believe that my taking serotonin-producing antidepressants caused my akathisia. I don’t know what percentage of people’s taking antidepressants leads to this condition, but it certainly should be part of the discussion when considering antidepressants.

  3. Stephen
    Anaheim, CA

    The best antidepressant is a walk through the fresh air.

  4. Mal
    Bay County FL

    The very best antidepressant and one I have discovered to work in my daughter and the daughter of a good friend and in and neighbor, a man, is sunshine or if that is not convenient due to working nights, Vitamin D-3 supplements. I have a dozen “anecdotal” cases that I know of intimately that are all successes.

  5. Catherine

    My doctor said I should be the “poster person” for Zoloft. I went through a major depression in 1996, to the point of being hospitalized.
    Food and the thoughts of food, sent me to an unrealistic trauma.
    In the hospital, my food intake was monitored and gradually, I began to eat.
    With the physicians’ help plus Zoloft, I have returned to a normal life and have not needed mental help since.
    I still take 100 mg every day and don’t intend to ever stop taking it. If I have built an immunity to it, it is an unanswered question. If you are wondering if I think my lifespan is affected….I don’t know; however, I am coming up on 83 years old and feel really good. I hope this will help someone who needs to make a decision.

  6. Lorraine

    I was diagnosed with rheumatoid arthritis two years ago. My first treatment was a DMARD in pill form, which helped somewhat but not enough to make me feel fully functional. I was then placed on a biologic of my choice, and it took about nine months before it made me feel about “75% normal.” I started on cymbalta about two months ago, and it has notably helped my RA by decreasing any remaining pain, improving my outlook (fewer to no panic attacks about my RA) and increased my energy level. I was well aware of the side effects and refused to take it for a long time.

    But, after a major panic attack, daily feelings of being sick, tired and unable to function, I relented and began the treatment. Although still fearful of the side effects, it helps me! Additionally, was having digestive problems, and the GI MD told me that cymbalta may also help with this problem. I am on a short course of a PPI (also has a bad reputation that scares me…), and combined with the cymbalta, even my digestive problems have become less severe. Hopefully, the day will come when I can be weaned off of the meds.

    I was always healthy and medicine-free prior to RA–but I can only think about my present and what is working to make me functional. To note, I also take turmeric, tart cherry juice and several other alternatives, but I cannot be sure how they are contributing to my healing.

  7. Mary B.
    austin, tx 78759

    Please do not stop using any psychiatric medicines suddenly. I did stop suddenly because I didn’t think I needed them anymore.. (I had been diagnosed with Unipolar Depression years before, and had a manic episode after stopping suddenly, frightened my family members terribly, wound up in a mental hospital, now being d I agnosed as Bi-polar and on even more medicines than I had been on before!!!

    All I really needed, in my opinion, was to have my original medicines restored to me, as I was in withdrawal…So PLEASE BELIEVE THAT IT CAN HAPPEN TO YOU!!

  8. Dyan

    Reading this is frightening. I am on 20 mgs of Paxil for 2 years. Could not take Zoloft which was first prescribed. I had been using Xanax to help sleep ( only ) and it was working…but the new doctor said I can’t have any more and put me on Zoloft. It almost drove me insane for weeks getting used to the Zoloft but my digestive issues never went away…they changed me to Paxil.

    Here is what scares me. Two doctors that are involved in giving me Paxil make light of the withdrawing symptoms and the doctor that put me on at first did not warn me much about the symptoms when starting them. I had left over Xanax which I took when I could not stand how awful I felt getting used to the antidepressants.

    And also…I fought with the doctor to not get on them or anything that I had to take every day. They would rather me get hooked on antidepressants than take an occasional Xanax when needed. I do believer to this day that they helped me…but I wish I did not take them.

  9. Larry

    As you’ve published in the past, SSRIs will affect male sexual function, making ejaculation difficult or completely absent. Worry about this can cause erectile difficulties. And these problems do not cease when the drug is discontinued. Male function will be changed for life.

    Psychiatrists do not tell patients this when the drug is prescribed. When the patients ask, they minimize the problem or turn the discussion to how the depression has been reduced.

  10. Elizabeth
    North Carolina

    Hello! A year ago this time, I was weaning (with doctor’s directions) off of .10 mg Cymbalta. It went okay, but still had side effects of increased muscle activity when sleeping, agitated and angry, and, whether related or not, had/have what feels like neuropathy in my feet (I am not diabetic).

    Looking back, I think that drug lost its effectiveness several years ago, and I should not have been re-upped on it as long as I was. I also had to wean off clonazepam, low dose, but side effects still pretty dramatic.

    I think we as individuals are the only ones who can determine if the drugs’ benefits outweigh dangerous side effects. That conversation should take place every 6 months with primary-care
    doc or whoever prescribed it/them.

    Also, on the People’s Pharmacy, they had several physicians on who theorized that weaning off this family of drugs can cause funky nerves operation, such as feet not responding to brain’s signals. Apparently there’s a lot more research needed on these drugs. My sister could not function without them, with bipolarism, but I am determined to live quite well without them. So far so good!

  11. Patty

    At these numbers, these drugs are prescribed carelessly and recklessly. Also, they are addictive and that does not make them safe and effective.

  12. Fran

    Because of a Gastro problem, a Gastro doctor at UNC explained to me that a nerve connected my colon to the brain. That is why I had so much anxiety. He suggested I go to a geriatric psychiatrist. I did, and paid $500 a visit, as she did not take medicare. She tried on me one anti-depressant after another. With each one, I went through the ceiling. I finally talked her into prescribing valium (not generic but the real thing.) She would only give me 2 mg per day, it helps but I really need 3 mg per day. This costs me $70 per month. Doctors are so slow to learn the latest research. I suppose they don’t have time.

  13. Martin D
    New York

    Americans don’t love antidepressants! Dr’s do.

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