People’s Pharmacy | Antidepressant medications remain controversial
Nearly 50 million Americans take antidepressant medications. These include sertraline (Zoloft), escitalopram (Lexapro), bupropion (Wellbutrin), trazodone (Desyrel), fluoxetine (Prozac) and duloxetine (Cymbalta). Health and Human Services (HHS) Secretary, Robert F. Kennedy, Jr., would like to see many physicians “deprescribe” such drugs. That goal has created consternation among both psychiatrists and patients.
The effectiveness of these drugs has been controversial for decades. Twenty years ago, psychiatrists conducted a ground-breaking study they called STAR*D (New England Journal of Medicine, March 23, 2006). The researchers assigned patients who had not responded to the antidepressant citalopram to take bupropion, sertraline or venlafaxine. The results: “After unsuccessful treatment with an SSRI, approximately one in four patients had a remission of symptoms after switching to another antidepressant.”
Such results are not impressive. After all, it means that 3 out of 4 depressed patients did not get benefit from an antidepressant medication.
On the other hand, many people do find an antidepressant helpful. Catherine wrote that after years on sertraline it seemed to lose effectiveness. “Six months ago, I went to see my doctor. She prescribed citalopram and the effects are remarkable. I haven’t felt this good in years.”
It is almost impossible to predict who will benefit from which medication. Some people respond well to fluoxetine or sertraline while others get better results from bupropion or duloxetine.
It is equally difficult to anticipate who will experience adverse reactions. According to one reader, “I was on an antidepressant for a few months during a very stressful time. It flattened my emotions–no highs no lows. Zombie town.
“And then it dawned on me–sexual dysfunction, lowered libido, erection difficulties, lack of orgasm. That’s it! I developed other coping skills that allow me to deal with life in healthier ways.”
Sexual difficulties are common among people taking an SSRI antidepressant. Some individuals experience even more serious complications, like this reader: “While I was navigating a painful divorce, my PCP prescribed an antidepressant which I later found out had a known side effect of suicidal ideation. She was trying to be helpful and honestly had no way of knowing that I would experience that adverse effect. (Doctors thought only teenagers were susceptible to that reaction.) The fact that I was a psychology student AND worked in pharmaceutical research tipped me off when I wondered ‘Where are all of these self-destructive thoughts coming from?’ Thankfully, the bleak, morbid, brooding mood vanished when I stopped the drug.
“I was very lucky. Over the next few months, I met the mothers of four young adults who had taken the same drug. They had succumbed to suicidal impulses and killed themselves. Antidepressants can have SERIOUS side effects.”
The bottom line is rather simplistic. Some people benefit from antidepressants while others can be harmed. That’s true for almost every medication.
Deprescribing, a goal of the HHS Secretary, can be challenging. Many physicians have not been well trained in how to help patients phase off antidepressants. Stopping too quickly can lead to unbearable withdrawal symptoms, including brain “zaps,” dizziness, anxiety, nausea, headaches and fatigue. Developing safe strategies for tapering antidepressants when necessary is crucial.
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In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of this newspaper or e-mail them via their Web site: www.peoplespharmacy.com. Their newest book is Top Screwups Doctors Make and How to Avoid Them (Crown).