Depression: Do the benefits of anti-depressants outweigh the risks?

BlogHer Original Post

Anti-depressants have been in the news a lot recently.  There are new questions about anti-depressant use and the risk of suicide.  Questions about why anti-depressant use seems to be on the rise.  Questions about the risks of using anti-depressants during pregnancy.  And questions about the safety of using anti-depressants in adolescence.  Unfortunately, there are more questions than answers.

For me, these types of questions boil down to...Do the benefits outweigh the risks? And there is no right or wrong answer, I believe these questions need to be addressed on a case by case basis.

As with everything in life - Knowledge is power.  So in this post we will take a look at the latest news surrounding anti-depressant use, as well as links to information on diagnosis and treatment of depression.

From NPR - FDA Considers Fresh Warning on Anti-Depressants...

We know depression can cause suicide, but can antidepressants do the same thing? Today the Food and Drug Administration is taking up one of the toughest questions facing the agency, whether certain types of anti-depressants known as SSRIs are dangerous.

NPR's Joanne Silberner reports that a panel convened by the FDA may have a hard time making a recommendation on what to do about this class of popular drugs, which includes Zoloft, Prozac and Paxil.

From USA Today - Depression Diagnoses Fell After FDA Antidepressant Warnings...

It was already known that antidepressant use among young people had fallen since the drugs began carrying a so-called "black box" warning about risks. But the data showing an extended decline in the level of depression diagnoses are new.

In some cases, untreated depression can be more dangerous than suicidal feelings when starting antidepressants and a spike in teenage suicides in 2004 worried some experts that could be another unintended result of the FDA warnings. Then, teen suicides fell slightly the following year, offering hope that the suicide increase was just a blip.

From The Examiner - Are Antidepressants Linked to Suicide...

There has been a long standing debate on the safety of antidepressants since the U. S. Food and Drug Administration (FDA) issued its "black box" alert in 2004. This alert was printed on all antidepressant packaging warning patients and parents that children and adolescents have an increased risk of suicidal thoughts and behavior. (www.webmd.com)

Since then, depression diagnoses have fallen in all age groups and people who need help are not receiving treatment because they are afraid of treatment. When the warning came out, the public overreacted thus keeping people from seeking help and possibly committing suicide. Depression is not only a serious illness but it is also fatal.

From L.A. Times Health - Older Antidepressant Spurs More Suicidal Thinking In Men Than Newer Medications...

The largest clinical trial to date comparing an older, tricyclic antidepressant with a newer antidepressant of the selective serotonin reuptake inhibitor (SSRI) class has found that the emergence of suicidal thinking was almost 10 times more common in men taking the older drug than in those taking the newer medication.

The study also found that for men and women taking either medication, suicidal thinking was spread over the first six weeks of treatment, but peaked at roughly the fifth week before declining significantly after week six. Taking place at academic medical institutions across Europe, the trial, called Genome-Based Therapeutic Drugs for Depression--or GENDEP--gauged the responses to antidepressants of 811 persons ranging from 18 to 72 with depression.

From World News - Antidepressant Use During Pregnancy Linked With Some Adverse Outcomes In Newborn...

Exposure to a certain class of antidepressant medications during pregnancy may be associated with an increased risk of preterm birth, a low five-minute Apgar score (a measure of overall health of the baby) and admission to the neonatal intensive care unit, according to a report in the October issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. More than one in ten pregnant women are estimated to have depression,...

From Furious Seasons - Study: SSRIs Linked To Pre-Term Deliveries...

A Danish study out in the Archives of Pediatric & Adolescent Medicine asserts that women taking an SSRI anti-depressant while pregnant had double the risk of having a pre-term baby and had almost two and one-half times the risk of having their baby wind up admitted to a neo-natal ICU.

The study comes on the heels of an earlier study this year linking anti-depressant use during pregnancy to premature births.

From Neuroskeptic - U.S. Antidepressant Use Doubled In A Decade...

That means about 15 million more Americans were medicated in '05 than a decade previously. A huge increase in anyone's book. But the doubling in antidepressant use is not the only interesting result in this paper. In no particular order, here are some other fun facts -

Women are twice as likely to use antidepressants as men (female 13.4% vs male 6.7% in 2005); the ratio was the same in 1996. Studies consistently find that Western women are about twice as likely to report suffering from depression and anxiety disorders as men are. But these kinds of studies rely on self-report so this could merely mean that women are more willing to talk about their problems. This data suggests that they also seek treatment about twice as often.

From Dr. Andrew Weil - Are You Depressed, Or Just Human?

It's possible that more people today are truly depressed than they were a decade ago. Urbanized, sedentary lifestyles; nutrient-poor processed food; synthetic but unsatisfying entertainments and other negative trends, all of which are accelerating, may be driving up the rate of true depression. But I doubt the impact of these trends has nearly doubled in just ten years.

So here's another possibility. The pharmaceutical industry is cashing in.

In 1996, the industry spent $32 million on direct-to-consumer (DTC) antidepressant advertising. By 2005, that nearly quadrupled, to $122 million. It seems to have worked. More than 164 million antidepressant prescriptions were written in 2008, totaling $9.6 billion in U.S. sales. Today, the television commercial is ubiquitous:

. . .

The message -- all sadness is depression, depression is a chemical imbalance in the brain, this pill will make you happy, your doctor will get it for you -- could not be clearer. The fact that the ad appears on television, the ultimate mass medium, also implies that depression is extremely common.

I totally agree that it is a bad idea to allow pharmaceutical companies to advertise anti-depressants (or any prescription medications) on television. Doctors need to address a patient's medical history and symptoms to make a proper diagnosis...Only then should the doctor recommend a particular medication.  It's never a good idea for a patient to walk into their doctor's office and insist they be prescribed a medication because they saw it in a commercial.  Seriously.  Do you tell your plumber how to fix your sink?  Do you tell your mechanic how to fix your car?  Do you tell your vet how to heal your pet? 

From Coping With Life - Testing for Depression...

An influential government-appointed medical panel is urging doctors to routinely screen all American teens for depression — a bold step that acknowledges that nearly 2 million teens are affected by this debilitating condition, according to The Associated Press.

Most are undiagnosed and untreated, said the panel, the U.S. Preventive Services Task Force, which sets guidelines for doctors on a host of health issues.

From Postpartum Progress - Did Research Find Taking Antidepressants In Pregnancy Really Cause 500% Increase In Heart Defects?

The researchers also broke the data down further by taking a look at the increase in risk for specific SSRI antidepressants. They found no increase at all in risk for septal heart defects for women taking fluoxetine (Prozac) or paroxetine (Paxil). The risk went up one-half of a percentage point for those taking citalopram (Celexa), and one percentage point for those taking sertraline (Zoloft).

Is there an increase in risk of septal heart defect with certain medications? Yes. Do the researchers know why? No.

Links to Depression Information and Support:

From WebMD - Symptoms of Depression...

* persistently sad, anxious, or empty moods
* loss of pleasure in usual activities (anhedonia)
* feelings of helplessness, guilt, or worthlessness
* crying, hopelessness, or persistent pessimism
* fatigue or decreased energy
* loss of memory, concentration, or decision-making capability
* restlessness, irritability
* sleep disturbances
* change in appetite or weight
* physical symptoms that defy diagnosis and do not respond to treatment (especially pain and gastrointestinal complaints)
* thoughts of suicide or death, or suicide attempts
* poor self-image or self-esteem (as illustrated, for example, by verbal self-reproach)

About.com has a Teen Depression Quiz...

This teen depression quiz, although it uses accurate teen depression symptoms, should only be a start. If you really feel your teen is depressed, please take him/her to his/her doctor as soon as possible.

The American Academy of Child and Adolescent Psychiatry...

The AACAP developed Facts for Families to provide concise and up-to-date information on issues that affect children, teenagers, and their families.

American Society for Adolescent Psychiatry...

The American Society for Adolescent Psychiatry has served the psychiatric profession since 1967. Focusing on teen, adolescence, and young adult issues, ASAP acts both as a professional network for its members and a specialized community dedicated to education development and advocacy of adolescents and the adolescent psychiatric field.

Teen Depression - A Guide For Parents and Teachers...

Teenage depression isn’t just bad moods and occasional melancholy. Depression is a serious problem that impacts every aspect of a teen’s life. Left untreated, teen depression can lead to problems at home and school, drug abuse, self-loathing—even irreversible tragedy such as homicidal violence or suicide. Fortunately, teenage depression can be treated, and as a concerned parent, teacher, or friend, there are many things you can do to help.

From iVillage - Don't Miss Signs of Teen Depression...

All teens can be irritable, want to be secretive, and appear and even act alien- like. But when should a parent worry--really worry about their child? Did you know that one in 12 teens suffered at least one episode of major depression in the last year? Of those, a full 60 percent are not getting treatment.

That question has caused many a sleepless night for moms and dads. The more you understand typical adolescent behavior and the signs of depression, the better you'll be at tailoring your parenting to this "new tenant" of yours and getting your teen the help he or she may need.

Also See:

How do you feel about anti-depressant use?  Let me know in comments.

Contributing Editor Catherine Morgan
at Catherine-Morgan.com and Women4Hope

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