27 Apr 2022

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Antidepressants Should not be Prescribed

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Antidepressants are psychiatric medications which are used to treat or relieve the symptoms of depression. Some of the medications are also prescribed for conditions such as anxiety, drug addictions, phobias, post-traumatic stress and obsessive-compulsive disorders, chronic pain syndromes as well eating disorders. According to the Royal College of Psychiatrists (UK), antidepressants work by enhancing or extending the working of specific chemicals in the brain, such as serotonin and noradrenaline. These chemicals are called neurotransmitters and they act as messengers between nerve cells in the brain, and also pass messages between nerves and particular organs in the body. These chemicals are believed to regulate and affect mood as well as social behavior. They are also thought to affect appetite and digestion, memory, sleep and sexual desire. There are several types of antidepressants. The most common type is the selective serotonin reuptake inhibitors (SSRIs). Prozac is arguably the most used of the SSRIs. Other types of antidepressants are serotonin and noradrenaline reuptake inhibitors (SNRIs) such as Pristiq, Noradrenaline and Specific Serotoninergic Antidepressants (NASSAs) like Aptazapine , tricyclics and tricyclic-related drugs, monoamine oxidase inhibitors (MAOIs) among others. With the proliferation these drugs, antidepressant prescriptions have increased. However, it is increasing clear that antidepressants are not a panacea to the conditions they are prescribed for. Therefore, they should not be prescribed so freely. 

As already stated, antidepressants are increasing being prescribed; their prescription comes second to that of cholesterol-lowering drugs in the US. According to Piers (2014) the National Center for Health Statistics (NCHS) reported that from 1988 to 1994, and similarly from 2005 to 2008, antidepressant use in the United States escalated by approximately 400% across all ages. Smith (2012) notes that the use of antidepressants rose tremendously after Prozac entered the American market in 1987. This drug had fewer side effects as compared to other antidepressants in use at the time. Smith goes on to say that since the introduction of Prozac in the American market, the use of antidepressant use has risen by about four times.

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Derrow (2015) consults psychiatrist Ronald Elson who proposes five more reasons why the use of antidepressants has proliferated in the US. The first is because diagnosis of depression has increased considerably, probably because of improvement in diagnosis or social and economic factors that give rise to more cases of depression. He further notes that the American culture and society favors quick fixes. Therapy is time consuming and cannot be compared to popping a pill in to the mouth and swallowing it. This is compounded by the reason already given by Smith (2012); availability of medication such as Prozac which has fewer side effects. 

Another reason why antidepressants are increasingly being prescribed is that primary care doctors who have no training in psychiatry are the main prescribers. According to Smith (2012), these physicians account for about four out of five prescriptions for antidepressants in the US. A consultation of about twenty minutes is all it takes for a patient to get a prescription. Yet this short consultation is not enough to explore all issues to do with such a prescription; proper diagnosis, a look at the side effects, other alternatives to medication such as therapy and so on. In short, antidepressants are being prescribed by primary-care doctors who are ill-equipped to do it. The percentage of patients visiting non-psychiatrist doctor where such drugs were prescribed without a recorded psychiatric diagnosis rose to 72.7% from 59.5 % in the period between 1996 and 2007 (Mann, 2011).

Another reason has to do with health insurance. Insurance companies, ever looking for cheaper options prefer monthly prescriptions as opposed to longer-term therapy; many antidepressants are readily available, especially the less expensive generics. So reimbursements from health insurance companies are more easily obtained for prescription treatment than therapy. They are also higher. This has contributed to increased prescription of antidepressants. Psychiatry has shifted towards psychopharmacology as Mann (2012) notes. 

An escalation of consumer advertising of prescription drugs on all media has led to the belief that whenever one is sad, a pill will make them feel better in no time. Many patients increasingly demand for antidepressants as a result of the proliferation of advertisements that persuade them to try them as a panacea to a myriad of modern day problems. Such advertising is a boon to the sales of such drugs and the pharmaceutical companies get huge profits as a result. 

Of the five reasons discussed only one is legitimate; the increased diagnosis of conditions requiring antidepressants. But even that reason is diluted by another reason; the main prescribers are primary-care doctors who have little or no training in psychiatry and therefore could even be misdiagnosing or wrongfully prescribing these drugs. The other reasons point to ignorance of the general public as well the greed of health insurance companies as well as the pharmaceutical industry. All these reasons show that antidepressants should not be prescribed as freely as they are today.

Are antidepressants really effective? Several studies point to the contrary, all the more reason why they should not be prescribed. Many people believe depression is caused by chemical imbalance in the brain yet as Smith, Robinson, and Segal (2017). point out, depression isn’t just an issue of having too little serotonin circulating in the body. Researchers in mental health are in agreement that depression is brought about by much more complex issues than the theory of chemical imbalance implies. Research has shown physiological factors such as infection, immune system suppression, increase of stress hormones, anomalous activity in particular sections of the brain, dietary deficiencies, as well as the shrinking of brain cells are biological factors that can result in depression. There are also social and psychosomatic factors that can cause depression. Factors such as inactivity, loneliness, low self-esteem as well as poor diet can lead to depression. If antidepressants are prescribed, can they treat depression that arises due to biological as well as social and psychosomatic factors? It has already been shown that there is a dearth of scientific proof that depression is indeed caused by chemical imbalances in the brain which can be fixed by taking antidepressants. So are antidepressants really necessary? Do they work?

Smith (2012) indicates that antidepressants are not entirely necessary; an increasing bulk of research shows that they are not as effective as they were believed to be. A study of FDA clinical tests for four SSRI antidepressants indicated that the medications did not fare considerably better than placebos when used to treat minor or moderate cases of depression. Even more damaging were the results that indicated that the benefits of the medications were rather slight even for the patients who were severely depressed. These assertions are partly supported by the Royal Academy of Psychiatrists (2017) who state that some of the benefits of antidepressants are due to the placebo effect; after three months’ treatment, 50% to 65% of the patients will improve if given an antidepressant compared with 25 to 30% who will improve if given a placebo. Furthermore, Smith et al., (2007) assert that studies show that very few patients will no longer have the symptoms of depression when on antidepressants; for some, they become more severe. Moreover, many who at the beginning of the treatment respond to treatment soon become depressed again, despite following the treatment regimen religiously.

The belief that antidepressants work is also fueled by skewed reporting of the results of various studies. According to Smith (2012), such selective publication of the results of clinical trials could lead to a bias concerning their perceived efficacy. A study carried out at the Portland Veterans Affairs Medical Center indicated that most trials with negative findings went unpublished or were published in a way that suggested a positive result; half of the drug trials examined had positive findings yet 94 percent of the trials mentioned in publications were positive. This skewed publishing makes people wrongly believe antidepressants are always effective. 

In addition, antidepressants have withdrawal symptoms which can last between 2 weeks and 2 months (Royal Academy of Psychiatrists, 2017). For many people, the side effects are serious enough to make them stop taking the medication. Dizziness and blurred vision, stomach upsets, nausea, flu like symptoms, anxiety, insomnia or the converse - sleepiness, restlessness, decreased sex drive, weight gain are examples of the withdrawal symptoms experienced by patients on antidepressants. Looking at these withdrawal symptoms, it is clear that antidepressants will result in the very conditions they were initially prescribed for if withdrawn. 

Furthermore, antidepressants come with a suicide risk which is high in the first and second months after treatment commences. This made the U.S. Food and Drug Administration to demand that all depression medications should include a warning label indicating the increased risk of suicide especially among children and youth (Smith et al., 2007). Suicide is both a symptom and a result of depression, so such antidepressants are not helping the patients but rather drag them deeper into the quagmire they are facing. 

Now that antidepressants are not the panacea to depression, which is the way forward? Since medication may only treat some symptoms of depression and cannot can’t change the underlying causes, it is better to rely on more interventions that will treat the causes, not camouflage them. As indicated earlier, depression is caused by biological as well social and psychosomatic factors. Such causes can be remedied by therapy, exercise, meditation, social support and other lifestyle changes (Smith et al., 2007). These non-drug treatments do not have side effects or withdrawal symptoms as such and can provide lasting changes and long-term relief from depression, unlike antidepressants. 

Cognitive behavioral therapy has been proven to have positive results yet few are opting for that. The reasons why this is not happening are already established; over prescription of antidepressants which are thought to fix the problem quickly and the health insurance companies discouraging therapy by preferring to cover medication. As a result, very few pursue this safe and effective route in treating depression whether solely or in combination with medication. By 2005, only one-fifth of patients taking antidepressants also received therapy as compared to 1996 where one-third received it (Smith, 2012).

Psychotherapy is effective in treating depression and has no side effects. The chances of relapse are very low. According to Smith (2012) patients who respond to psychotherapy are more unlikely to suffer another occurrence of major depression compared to patients who are withdrawn from antidepressants after responding to them. So this is actually a safer route as compared to antidepressants. 

Given that most antidepressants are not prescribed by psychiatrists and the popularity of the prescriptions is higher due to the greed of insurance and pharmaceutical companies, I feel that they are should not be prescribed. Studies have indicated that they are not very effective in treating depression. Furthermore, they have serious side effects and withdrawal symptoms that may end up making the patient worse than they were before. As an alternative to antidepressants, I feel cognitive therapy and other non-medical interventions will work better. They have had success, have no side effects and withdrawal symptoms. Similarly, the chances of relapse are minimal. Instead of prescribing antidepressants, these alternatives should be pursued to deal with depression.

References

Derrow, P. (2015). Are antidepressants overprescribed? http://www.berkeleywellness.com/healthy-mind/mood/article/are-antidepressants- overprescribed

Mann, D. (2011). Antidepressants prescribed without psychiatric diagnosis. http://www.webmd.com/depression/news/20110804/antidepressants-prescribed-without- psychiatric-diagnosis#1

Pies, R. W. 2014. Are antidepressants really “over-prescribed” in the US? http://www.psychiatrictimes.com/blogs/are-antidepressants-really-%E2%80%9Cover- prescribed%E2%80%9D-us

Royal College of Psychiatrists (2017). Antidepressants. http://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/antidepressants.aspx

Smith, B. L. (2012). Inappropriate prescribing. http://www.apa.org/monitor/2012/06/prescribing.aspx

Smith, M., Robinson, L. & Segal, J. (2017). Antidepressant medication: What you need to know to make an informed treatment decision. https://www.helpguide.org/articles/depression/antidepressants-depression- medication.htm

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