Depression: Opposition to Medical Treatment

Antidepressants became the most prescribed drug category in the United States in 2005.³ Many question if the number of prescriptions being written (speculated as being as many as 200 million a year) are a sign of our preference for a quick fix and desire for one-stop treatment regime.¹Though the use of depression medications can help relieve the symptoms of major depressive disorder for some individuals, it is argued that antidepressants do not actually treat the cause of depression, are not appropriate for the of treatment all types of depression, and may not be worth the risk of side effects if other, less severe, treatments are an option.¹

Efficacy of Antidepressants:

Dr. James S. Gordon, psychiatrist and practitioner of integrative medicine states that antidepressants allegedly work to increase neurotransmitter levels in the brain but "we don't know if those neurotransmitters are actually decreased in depression; and it's not even clear that the drugs act primarily by increasing neurotransmitters. The major effect of those drugs is to protect the brain against the effects of stress. But in any case, they're dealing with a symptom rather than the cause."¹

Additionally, while some studies show the efficacy of depression medications to be far greater than placebo pills, others show the difference between the two to be negligible.⁴ This is especially true when placebo pills were made to mimic the side effects of antidepressant drugs.⁵

A recent study published in the Journal of Clinical Psychiatry found that patients reported a mean number of side effects was up to 20 higher than was reported by the psychiatrists. They conclude that psychiatrists may not be aware of or may be neglecting to note the side effects experienced by their patients while on pharmaceutical drugs.¹⁰

Many reputable sources question the efficacy of these drugs including a review of 74 FDA conducted studies on 12 depression medications, published in the New England Journal of Medicine. The review found that the FDA published the results of 37 studies that had positive outcomes and only 3 that had negative or questionable results on the beneficial effects of antidepressant drugs.² The same review notes that only 1 study supporting the beneficial effects of antidepressants was withheld while 22 studies concluding negative or questionable results were either not published or, according to the authors of the NEJM review, skewed to convey a positive outcome.²

Side Effects:

The FDA, as of 2007, requires that all antidepressant medications include black box warning stating verbatim "Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of [Insert established name] or any other depression medications in a child, adolescent, or young adult must balance this risk with the clinical need."7 (Being the FDA's black box warning is generic, the "Insert established name" clause would change to indicate each pharmaceutical company's specific drug.)

Though less severe than suicidality, antidepressant medications have additional potential side effects including: Insomnia, anxiety, nausea, decreased libido, tremors, sleepiness, weight loss or gain, fatigue, diarrhea, constipation, headaches, sweating and dizziness.⁷

In 2004, the Food and Drug Administration (FDA) conducted a review which revealed that 4% of those taking a specific antidepressant contemplated or attempted suicide versus 2% of those receiving placebos.⁶

Pharmaceutical Marketing:

While some see the rise in antidepressant prescriptions as a sign that patients are getting the treatment they need, others see these rising rates as a result of pharmaceutical marketing to both doctors and patients.³

Pharmaceutical companies market their drugs to two main groups: health care practitioners and direct to consumers themselves.³ Marketing to health care providers is usually done through gifting, detailing, drug samples, and sponsoring of continuing medical education. Directly advertising to consumers is usually done through the use of television commercials, print and online ad campaigns.

As of 2008, the United States and New Zealand were the only two countries who allow direct to consumer advertising for drug companies.⁸ A study done by researchers at New York University found that the U.S. pharmaceutical industry spends more than twice on the promotion (advertising) than on research and development of its drugs.⁹Some people believe directly marketing drugs to consumers may cause individuals to desire a prescription drug not congruent to their doctor's recommended treatment to their diagnosis, while others see the advertising as a means of transparency and education around drug treatments.

Conclusion:

Whether antidepressant medication is the right treatment for depression is contingent upon each individual's specific condition, personal constitution and physician guided treatment plan. It is important to note that antidepressant medications can be extremely useful in treating depression symptoms for some individuals, but may not be necessary if other, less severe, interventions can alleviate the symptoms or cure the cause of an individual's depression.

References:

1. Caruso, D. (2008) A Drug-Free Cure for Depression. Life Extension Magazine. Retrieved from http://www.lef.org/
2. Turner EH, Matthews AM, Linardatos E, Tell RA, Rosenthal R (January 2008). "Selective publication of antidepressant trials and its influence on apparent efficacy". N. Engl. J. Med. 358 (3): 252–60. doi:10.1056/NEJMsa065779. PMID 18199864.
3. "CDC: Antidepressants most prescribed drugs in U.S. - CNN.com". Cnn.com. http://www.cnn.com/2007/HEALTH/07/09/antidepressants/index.html. Retrieved 2008-11-06.
4. Kirsch, I; Moore, Thomas J.; Scoboria, Alan; Nicholls, Sarah S. (July 2002). "The emperor's new drugs: An analysis of antidepressant medication data submitted to the U.S. Food and Drug Administration". Prevention & Treatment retrieved from http://psycnet.apa.org/?&fa=main.doiLanding&doi=10.1037/1522-3736.5.1.528c
5. Moncrieff J, Wessely S, Hardy R. (2004) Active placebos versus antidepressants for depression. Cochrane Database Syst Rev. (1):CD003012.
6. National Institute of Mental Health(2005). Antidepressant Medication for Children and Adolescents: Information for Parents and Caregivers. National Institute of Health. Retrieved from http://www.nimh.nih.gov/about/updates/2005/antidepressant-medications-for-children-and-adolescents-information-for-parents-and-caregivers.shtml
7. USDA Food and Drug Administration(2010). Antidepressant Use in Children, Adolescents, and Adults. U.S. Department of Health and Human Services. Retrieved from http://www.fda.gov/drugs/drugsafety/informationbydrugclass/ucm096273.htm
8. Sufrin CB, Ross JS (September 2008). "Pharmaceutical industry marketing: understanding its impact on women's health". Obstet Gynecol Surv 63 (9): 585–96.doi (http://en.wikipedia.org/wiki/Digital_object_identifier):10.1097/OGX.0b013e31817f1585 (http://dx.doi.org/10.1097%2FOGX.0b013e31817f1585). PMID (http://en.wikipedia.org/wiki/PubMed_Identifier) 18713478 (http://www.ncbi.nlm.nih.gov/pubmed/18713478).
9. York University (2008, January 7). Big Pharma Spends More On Advertising Than Research And Development, Study Finds. ScienceDaily
10. Zimmerman, M., Galione, J.N., Attiullah, N., Friendman, M., Toba, C., Boerescu, D.A. & Ragheb, M. (2010). Underrecognition of clinically significant side effects in depressed outpatients. Journal of Clinical Psychiatry 71(4), 484-90.