Frightening side effects, cover-ups on the record, and no reason to believe they do what they are supposed to
Note that recent evidence shows that new generation anti-depressant medications, like escitalopram and sertraline, are probably more safe and more effective than older and better-known SSRIs.1
I believe that I have a professional and moral obligation to question the prescription and widespread use of old-generation (SSRI class) anti-depressant medications such as Prozac, Zoloft, Paxil, Celexa and Luvox. I cannot condemn it: I am not qualified to make that judgement. Condemnation must be left to the credible experts, and their interpretation of the evidence. However, I share my concerns: that the manufacture, marketing, excessive prescription, and sale of these drugs has probably been dangerous and negligent.
This position is well-supported by references to credible and recent scientific opinion and evidence. Credible criticism first came to public attention when David Healy, a professor of psychiatry who lost his job for speaking out about the undeniable risk that SSRIs cause a small percentage of patients to kill themselves, which had not yet been addressed in the scientific literature.2 In January 2008, New England Journal of Medicine reported that drug manufacturers failed to publish every FDA-registered study3 that didn’t make SSRI anti-depressants look good.4 Then PLos Medicine followed up in February with the largest review of SSRI studies to date — including5 all the previously unpublished FDA studies, as discussed byarstechnica.com. The effectiveness of anti-depressants has always been debatable, but this new analysis of all the evidence resulted in a particularly underwhelming picture of the efficacy of these drugs, which appear to be no more effective than sugar pills for most depression6 — though they may be modestly effective for severe depression.7 This is not a new expert opinion, but simply the most recent credible evidence to support an existing opinion. See the footnotes for full details, and please bear in mind the weight of this evidence as you read on.
A personal perspective
I have a personal history with so-called “clinical” depression and bipolar disorder. In 1991, a psychiatrist not only diagnosed me with manic-depression (probably a misdiagnosis), but told me that I would be dead by suicide “within a year” — yikes! — if I did not accept pharmaceutical treatment in the form of SSRI antidepressants. Prozac was three years old then, and had been the most prescribed drug in history as of 1990. I walked out of that psychiatrist’s office, and later cured my own depression and mood swings through personal development.
“Take this mood-altering drug or you’re dead within a year,” was probably not the voice of compassionate wisdom.
Fortunately, I recognized that “take this mood-altering drug or you’re dead within a year” was probably not the voice of compassionate wisdom. But, in fact, it was more dangerous than I knew.
Ely Lily is the manufacturer of Prozac. “The company’s internal documents, some dating to the mid-1980s, as well as government applications and patents, indicate that the pharmaceutical giant has known for years that its best-selling drug [Prozac] could cause suicidal reactions in a small but significant number of patients.”8
Taking Prozac could have induced my suicide rather than preventing it! The same is true for all the millions of people out there ingesting SSRI antidepressants. Scientific controversy about this allegation continues vigorously to this day, as any quick internet search can demonstrate (Google “SSRI suicide”). As long the truth remains elusive, there is a strong “better safe than sorry” case to be made against their use.
Unjustified faith
I have long condemned anti-depressants on the basis of general cynicism. I always knew or suspected that they have numerous alarming side effects, that they are marketed aggressively by some of the most profitable and unaccountable corporations in the world, and that their usage does not have a sound scientific rationale. These have been reason enough to suspect that they are more myth than medicine.
Yet, for all my cynicism, I foolishly had some faith that these drugs could not be all bad. I assumed that their side effects were more or less as reported in drug references, that the manufacturers’ power to obscure the facts is mitigated by government agencies, and that the physiological rationale for the drugs is at least intelligible.
As a health care professional, I have had the opportunity to learn otherwise. I have observed dozens of my own clients struggle with depression both with and without SSRI antidepressants, had numerous conversations with other complementary and conventional health care professionals on the subject, and read many articles and books.
Worse than I’d feared
Contrary to what I once assumed, the side-effects of anti-depressants are actually numerous, severe, potentially life-threatening, and not widely known or even understood. They cause a low but measurable rate of psychotic mania, for instance — equal to millions of people who have been reduced to quivering wrecks, their behaviour drastically altered, careers, marriages and lives lost. Withdrawal symptoms from SSRIs are even more problematic.
The power of the SSRI manufacturers is quite unchecked by government institutions like the American FDA. Indeed, there are documented cases of these companies successfully:
- bribing plaintiffs to make an ineffective case,
- launching dummy lawsuits to create favourable legal precedents, feeding trial subjects Valium to hide severe side effects from the FDA.
This is no surprise given the amount of money and conflicts of interest involved. For instance, President George Bush Sr. was on the board of directors of Eli Lilly & Co. (Prozac), and the head of the FDA during the Prozac approval now works for the pharmaceutical industry as a consultant!
Finally, the scientific rationale for anti-depressants is not, it turns out, very good at all. It is as clumsy as the rationale for electroshock therapy and lobotomy was historically. The popularity of anti-depressants is a continuation of the historical tendency to use “brain-disabling treatments” in psychiatry.9
It is important to understand that SSRIs quite literally just “mess with your head,” specifically interfering with the function of a common messenger molecule (serotonin), one of thousands of others, whose purpose and broad significance to brain function in general is only vaguely understood, and whose particular significance to depression is completely unknown. Consider this 2010 article in New Scientist, emphasizing how recent research has only emphasized our ignorance:
If you thought depression was caused by low serotonin levels, think again. It looks as if the brain chemistry of a depressed person is much more complex, with mounting evidence suggesting that too much serotonin in some brain regions is to blame.
The most sophisticated method known for even measuring serotonin levels in the brain — never mind understanding the significance of these measurements — is to grind up a piece of brain, spin it in a centrifuge, and measure the sum total of serotonin relative to other substances. And how about our ability to measure the amount of serotonin in any given synapse at any time? Exactly zero. Yet the marketing of these drugs would have us believe that they are extremely specific in their effects. It is simply not so.
Despite the commercials — treating depression pharmacologically is not treating something as simple as a low level of a single neurotransmitter. Measuring serotonin levels, even if practical, would likely be of no clinical value. Depression is a result of poor emotional regulation among various brain regions. Drugs are a blunt tool by which we can nudge brain function in a direction which, for some people, can change this regulation and reduce depression. It’s not really about the levels.
Dr. Steven Novella, Yale neurologist, from comments on Antidepressants and Effect Size
Given these limitations, the idea that we can diagnose a “chemical imbalance” in the brain is pure nonsese — even if we could measure it, we don’t know what normal brain chemistry is. Bear in mind also that no psychiatrist actually attempts to measure your brain chemistry before prescribing SSRIs. They don’t do it, of course, because they have not the slightest idea how to diagnose allegedly dysfunctional neurochemistry. They infer the idea of dysfunctional neurochemistry from your subjective symptoms (i.e. depression). That idea has achieved an outrageously disproprotionate credibility, seeming like certain knowledge to the layperson, when it fact the reality is that the nature of sertonin and related neurotransmitters remain almost completely mysterious to medical science.
The concept of a “chemical imbalance” in the human brain is one of the most fantastic oversimplifications in science, and one of the worst legacies of the modern pharmaceutical industry. A bowl of soup could have a chemical imbalance …
— the anonymous neuroscientist blogger Neuroskeptic, from an entertaining essay offering terrific perspective on this topic: The Brain Is Not Made Of Soup
We do not prescribe medicines to “treat” brain chemistry, we prescribe medications that messwith it — to rock the boat, stir the soup — not because we know what to do to brain chemistry, but because it is something that we can do to brain chemistry. The precision is in the mechanism of effect, and not the consequences.
Indeed, the scientific rationale for these drugs is so bankrupt that to even call them “antidepressants” has more to do with marketing than science, and various studies have shown that they simply do not work as advertised.10 Antidepressants are, in fact, closely related to amphetamines like ecstasy and cocaine. Cocaine essentially does exactly the same kinds of things to the brain, only it messes with serotonin plus a few other molecules. You can think of anti-depressants as “simplified cocaine.” And also “legal cocaine.” It’s an incredibly blunt medical instrument that does not do anything except generally interfere with normal brain function.
It is not necessarily a bad thing to carefully “tinker” with your brain. Humans have a long history of finding ways to mess with our own heads. There are times in life when almost any change in mental state feels like an upgrade. But we need to be more realistic and acknowledge that this is what we’re really doing with SSRIs.
My responsibility as a health care professional
If the allegations against them are correct — and they seem to be — the presence and typical usage of these drugs in our society is just as unconsciounable as any snake oil ever was, only worse because of the massive scale. Too often we think of our civilization as scientifically sophisticated in all fields. Yet neurophysiology is still primitive in many ways, lacking in testable theories with the power to explain many mental phenomena — yet touted (marketed) as advanced. Consequently, medical malpractice is still common. It’s my responsibility as a health care professional to raise these concerns, even though there are more credible voices to be heard.
Indeed, please do not take my word for it. Although under-reported in the past, lately all of this information is readily available from other and more credible sources. If you are considering antidepressant medication, please do your homework first. If you are already taking antidepressant medication and want to quit safely, it is not sufficient to simply ask your physician. You must educate yourself.
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