epress<strong>io</strong>n has become very big.A recent (2004) publicat<strong>io</strong>n of theWorld Health Report, produced bythe World Health Organisat<strong>io</strong>n showedthat “ mental and behav<strong>io</strong>ural disordersare common, affecting more than 25% ofall people at some time in their lives”.Strong epidem<strong>io</strong>logical data also show a10% increase in rates of depress<strong>io</strong>n in theUS populat<strong>io</strong>n every decade for the last100 years.Feelings of helplessness, loss of hope,sadness, crying, sleep or appetite disturbancesor difficulty in concentrating for atleast two weeks, are sufficient for the verycommon diagnosis of clinical depress<strong>io</strong>n.But, if you are in the antidepressantdrug business, depress<strong>io</strong>n is anything youwant it to be. The blues, feeling down, outof sorts, bothered, inconvenienced - nolevel of depress<strong>io</strong>n is so trivial that theaverage Joe couldn’t use a sampler pack ofProzac or Zoloft to get started.Selective SerotoninReuptake InhibitorsThe Nat<strong>io</strong>nal Institute for Health andClinical studies recently recommendedthat antidepressants, specifically SSRIs,should be the first line treatment for moderateto severe depress<strong>io</strong>n.The brain uses chemical messengers(neurotransmitters) to enable nerve cellsto talk to each other. For about 30 yearsdepress<strong>io</strong>n has been linked to low levels ofserotonin, a brain chemical that regulatesmood. The drugs called selective serotoninreuptake inhibitors, such as Prozac, aresaid to ease depress<strong>io</strong>n by keeping serorotoninactive within the synapses betweennerve cells, enhancing the chemical’spositive effect.Serotonin is, however, a multifunct<strong>io</strong>nalmessenger, present also in the gut,where it regulates the secret<strong>io</strong>n of digestivejuices and helps control the passage offood.Contemporary neuroscience has fa<strong>ile</strong>dto provide direct proof of seroronin deficiencyin any mental disorder, and has infact provided significant counterevidenceto the explanat<strong>io</strong>n of a simple neurotransmitterdeficiency. (Castren E 2005. Nat.Rev. Neuroscience 6:241) The brain isvastly complex, and poorly understood.“The public is being misinformed aboutthe precis<strong>io</strong>n of these SSRIs when themedical profess<strong>io</strong>n oversimplifies theiract<strong>io</strong>n in the brain, and ignores the body asif it exists merely to carry the head around.In short these molecules of emot<strong>io</strong>nregulate every aspect of our <strong>ph</strong>ys<strong>io</strong>logy” -Professor Candace Pert, neuroscientist.Recent studies (2002) even call intoquest<strong>io</strong>n the very efficacy of these SSRIs.Professor Irving Kirsch and colleaguesgained access to all clinical trials of antidepressantssubmitted to the Food and DrugAdministrat<strong>io</strong>n - the drug watchdog inAmerica - by the <strong>ph</strong>armaceutical companiesfor medicat<strong>io</strong>n approval. When thepublished and unpublished trials werepooled, the placebo (dummy pill ) duplicatedabout 80% of the antidepressantresponses, and 57% of these <strong>ph</strong>armaceuticalcompany funded trials fa<strong>ile</strong>d to show astatistically significant difference betweenantidepressants and inert placebo.The small difference between the drugresponse and the placebo response hasbeen a dirty little secret, known for yearsto researchers who conduct clinical trials.( Kirsch, Moore, et al 2002. Prevent<strong>io</strong>n andTreatment 2002. Vol 5: article 33)Treatment of depress<strong>io</strong>n is based on aflawed paradigm of “abnormal behav<strong>io</strong>ur”being caused by chemical imbalance in thebrain to be “corrected” by tweaking littleunderstood b<strong>io</strong>logical pathways.Side EffctsAlthough all the long-termside-effects of these centralnervous system drugs are still notknown, antidepressants carrysome potentially ser<strong>io</strong>us sideeffects.Long-term use of antidepressantsis controversial andwithdrawal from them can be asdifficult as the disorder itself.AkathisiaAkathisia is a medicat<strong>io</strong>ninduceddisorder consisting ofextreme restlessness, irritabilityand agitat<strong>io</strong>n. It is often associatedwith the withdrawal symptoms ofinsomnia, headaches, nervousness, anxiety,loss of appetite, tremors and nausea.It can be coupled with suicidal ideat<strong>io</strong>n,homicidal thoughts and acts. It may createan inability to control impulses. A study onProzac, reported in the Journal of ClinicalPsychiatry, estimated that the number ofProzac users who experience akathisia isbetween 10-25%.The inescapable truth is that theperpetrators of many of the most horrendousmurder rampages in the US, inrecent years, were taking or coming offprescribed psychiatric drugs.PregnancyThere is evidence linking SSRIs toincreased birth defects, and addit<strong>io</strong>nalevidence of SSRI toxicity in the developingbrain. According to a recent study out ofColumbia University, antidepressants maychange “crucial <strong>ph</strong>ases of brain developmentthat might, paradoxically, predisposechildren to depress<strong>io</strong>n and anxiety disorderslater in life.” One of the researcherswarned that the widespread use of SSRIsis a “ large scale experiment with ournat<strong>io</strong>n’s youth - we don’t know what thelong-term effects are.” Newborns, exposedto SSRIs, can also experience ser<strong>io</strong>us withdrawalsymptomsAddict<strong>io</strong>nSSRI- -discontinuing syndromeincludes symptoms like anxiety, cryingspells, mood lability, tremors and vomitingUp to 25% of patients stopping these drugs,can experience withdrawal symptoms.( Ditto K E ;J. of Postgraduate Medicine2003. 114)Childhood depress<strong>io</strong>nThe editorial in the Lancet (April 2004)pointed out “the story of research intoSSRIs use in childhood depress<strong>io</strong>n is one ofconfus<strong>io</strong>n, manipulat<strong>io</strong>n and institut<strong>io</strong>nalfailure”. The underlying study that sparkedthe strongly worded editorial - alsopublished in Lancet April 2004 - foundantidepressants:panacea orPROBLEM?by Dr Elizna Hanekomthat after a systematic review of publishedversus unpublished antidepressant clinicaltrial data, involving children and adolescents,the published data alone showed afavourable prof<strong>ile</strong>, wh<strong>ile</strong> hidden, unpublisheddata show the risk/benefit prof<strong>ile</strong> asunfavourable.Another article published in theBMJ (April 2004), similarly concluded “Investigators’ conclus<strong>io</strong>ns on the efficacyof newer antidepressants in childhoodhave exaggerated their benefits - adversereact<strong>io</strong>ns have been downplayed. Antidepressantdrugs cannot confidently berecommended as a treatment opt<strong>io</strong>n forchildhood depress<strong>io</strong>n”.The Food and Drug Administrat<strong>io</strong>n(US) issued a warning in 2004, that childrenand young adults who use SSRIs , mayhave an increased risk of suicide. After reanalysingthe results of hundreds of SSRIsstudies, the FDA issued a second warningin August 2005, caut<strong>io</strong>ning doctors andSSRI users to watch closely for signs ofsuicidal behav<strong>io</strong>ur. Studies found that takingantidepressants caused an addit<strong>io</strong>nal36 B<strong>io</strong><strong>ph</strong><strong>ile</strong> <strong>Issu</strong>e <strong>18</strong>
More people suffer from depress<strong>io</strong>ntoday than ever before. Despite the widearray of antidepressant medicat<strong>io</strong>ns onthe market, convent<strong>io</strong>nal psychiatricmedicat<strong>io</strong>n is clearly failingto successfully manage themood disorders that plaguemill<strong>io</strong>ns of adults,teenagers andchildren.14 out ofevery 1000patients underage <strong>18</strong> to havesuicidal thoughtsor behav<strong>io</strong>ur.The use of antidepressants,excludingProzac, for patientsunder <strong>18</strong> has been banned inBritain since 2003.In 2005, the scientific panel of theEuropean Medicines Agency - Europe’sdrug watchdog - banned the use of Prozac,and other modern antidepressants, for usein under <strong>18</strong>s, because of the increase of suicidalthoughts and suicide attempts amongchildren and adolescents on these drugs.Conclus<strong>io</strong>nMore people suffer from depress<strong>io</strong>ntoday than ever before. Despite the widearray of antidepressant medicat<strong>io</strong>ns onthe market, convent<strong>io</strong>nal psychiatricmedicat<strong>io</strong>n is clearly failing to successfullymanage the mood disorders thatplague mill<strong>io</strong>ns of adults, teenagers andchildren. Since the most expensive clinicalstudy ever, sponsored by the US government,showed that popular antidepressantmedicat<strong>io</strong>ns, such as Prozac, Zoloft andPaxil, benefited only 50% of the depressedpatients who used them, many scientistsand medical practit<strong>io</strong>ners believe that it istime to re-evaluate the standard approachto mental health treatment. (Rubinow D R2006 NEJM: March; 23)Without discounting the very ser<strong>io</strong>uscases of depress<strong>io</strong>n that may best betreated <strong>ph</strong>armaceutically, there are moreeffective solut<strong>io</strong>ns to help restore emot<strong>io</strong>nalbalance to life than relying on medicat<strong>io</strong>n,Our emot<strong>io</strong>nal and spiritual needscan not be met by popping a pill - relief isnot just a swallow away.B<strong>io</strong><strong>ph</strong><strong>ile</strong> <strong>Issu</strong>e <strong>18</strong>37
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