Anti-Depressants - Is the cure worse than the illness? (Part 2 of 2)

Married to antidepressant meds

The author has a wonderful quote on taking meds:

an unexpected relationship will become permanent

He uses this quote (from a fortune cookie) as an analogy to taking meds. He suggests that many people are encouraged to take meds as a temporary measure not realising that for some they will need to be on antidepressants for the rest of their life – either because the illness is too severe or because the withdrawal symptoms of stopping are too painful.

Dr Karp likens the relationship with meds to a marriage:

This process of becoming committed to drugs can be seen as having four stages: desperation, experimentation, engagement and marriage.

I'm not sure I like the analogy, unless you were to describe it is an arranged marriage - for many taking meds is not something they willingly choose.

I can see where he is coming from but I believe the process of becoming wedded to medication is more like that of grieving. Elisabeth Kubler-Ross has defined the five stages of grieving as:

• Denial
• Anger
• Bargaining
• Depression
• Acceptance

I think many depressed people move back and forth between the first four phases before finally reaching acceptance. At that point they acknowledge that they have a psychiatric illness and that medications are a necessary part of the recovery.

For some people acceptance never comes. Instead they form an uneasy alliance with the meds and their health professionals but in their mind it is a temporary arrangement. Even after 15 or 20 years in medications there are many people who long to give them up and fight or question on a regular basis the need for antidepressants.

Doctors encourage patients to take meds likening the antidepressants to treatments for diabetes or headaches. However there is one critical difference - antidepressants are mind altering substances.

In my experience with doctors they are all reading from the same script. They all want you to believe that antidepressants are better than the alternative. I’m not convinced that is always the case. From my own personal experience the side-effects of meds often outweigh the benefits.

Do the drugs really work?

The author points out many of these drugs are relatively new. While they have been tested and found safe this is only within the parameters of their testing. If a drug has only been around for 10 years there is no way to know what it’s long term effect may be on someone who needs to take that med for another 50 years.

For many the improvement from antidepressants is only slightly greater than the placebo effect. According to one study of SSRI antidepressants:

Approximately 80% of the response to medication was duplicated in placebo control groups, and the mean difference between drug and placebo was approximately 2 points on the 17-item (50-point) and 21-item (62-point) Hamilton Depression Scale.

There were many patients interviewed in the book who had little or no relief from the prescribed antidepressants. They also disliked being labelled as someone with a mental illness and found it difficult to tell friends, colleagues and new acquaintances about their diagnosis and the need to take pills.

Dr Karp shines the light on unethical pharmaceutical practises such as:

“commissioning multiple studies to assess a drug’s effectiveness and then reporting only on the research most flattering to their product
“failing to systematically ask study respondents about certain side effects
“Limiting drug trials to short periods of time

He also states that:

rarely does the antidepressant medication far exceed the placebo in effectiveness, and sometimes subjects in the control group actually report greater symptom relief

It makes you wonder why doctors prescribe antidepressants! In reality, I think antidepressants are helpful for many people with depression and anxiety, but for those that don't find them helpful doctors would be wise to stop experimenting and forcing drugs on treatment resistant individuals and focus instead on therapy, cognitive behavioural techniques, positive psychology and lifestyle changes.

What about the side-effects?

Side-effects vary according to the individual biochemistry of the individual taking meds. As we've seen in Part 1, the patient's trust in their doctor is a factor in the efficacy of the meds as well as their attitude towards taking meds for depression.

One of the most contentious risks is the possible increased risk of suicide in children and teens. The US FDA became so concerned about the risk of youth suicide among those taking antidepressants that they asked for a blackbox warning on all antidepressant meds. You can read an analysis of the black box warning issue here

According to the manufacturers of Prozac, the meds may increase the risk of suicidal ideation in children and teens. They also state that there are benefits and risks in using antidepressants.

What are possible side effects of PROZAC?

• Some people experience side effects like nausea, difficulty sleeping, drowsiness, anxiety, nervousness, weakness, loss of appetite, tremors, dry mouth, sweating, decreased sex drive, impotence, or yawning. Most of these tend to go away within a few weeks of starting treatment and, in most cases, aren't serious enough to cause people to stop taking PROZAC.


• PROZAC can cause changes in sexual desire or satisfaction.

Do not drive a car or operate dangerous machinery until you know what effects PROZAC may have on you.

• Contact your doctor or healthcare professional if you get a rash or hives, or other side effects that concern you while taking PROZAC.

While the manufacturers state that ongoing drowsiness and loss of sex drive is relatively uncommon, Dr Karp found in his interviews that the majority of patients experienced these side-effects.

Please don't stop taking your meds without medical supervision

The jury is still out on the effectiveness of antidepressants compared with the placebo effect, and for many the side-effects of meds make them unpalatable. However, the placebo effect does show an improvement, and some patients have found antidepressants a lifeline for depression and anxiety. The results were less clear in the interviews with bipolar patients, possibly due to the fact that many bipolar are prescribed a mix of antidpressants and antipsychotics or mood stabilisers.

If you have any doubts that your meds are working effectively, please see your health professional to fully discuss your options. Sometimes switching to another antidepressant can bring about radical improvements. You may also like to consider therapy and lifestyle changes.

I look forward to your feedback.

Part 2 of our review of Is It Me or My Meds?: Living with Antidepressants by David A. Karp

You can read part 1 here

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