The recent deaths of Anthony Bourdain and Kate Spade have the nation talking about suicides again. It is not clear if they were getting drug treatment for depression. What is clear is that suicide in the U.S. has never been higher even as the use of SSRI antidepressants has also never been higher. One in every eight American adults recently took an antidepressant says the CDC and the number is only rising. Are the drugs working?
The use of antidepressants almost tripled after direct-to-consumer drug advertising began. Only 13.4 million Americans took antidepressants in 1999-2000 ballooning to 34.4 million in 2013-4. In 2015 one in four U.S. women were on psychiatric drugs, usually antidepressants. Antidepressants were once a short-term therapy to help people get over a troubled time but long-term use has doubled since 2010 and tripled since 2000 so that 15.5 million Americans have been taking the medications for at least five years. “By the mid-1990s, drug makers had convinced government regulators that when taken long-term, the medications sharply reduced the risk of relapse in people with chronic, recurrent depression,” reported the New York Times.
Yet many questions remain about the drugs’ safety and efficacy. Studies are only beginning to describe the bone thinning effects of SSRIs leading to osteoporosis and fractures because patients using the drugs for decades is a new phenomenon. SSRI antidepressant tachyphylaxis (when drugs cease working) can be as high as 33 percent. And the dangers of SSRIs during pregnancy are alarming. The antidepressant Paxil is linked to major cardiac and congenital malformations in fetuses and, last month, a study links maternal use of SSRIs to autism in offspring. In the 1980s, one out of every 2,000 children had autism; today that figure is 150.
What is also clear is that some patients feel unable to quit SSRIs because of side effects. They feel “parked” on the drugs.
In April, the New York Times reported that SSRI antidepressants can indeed be very difficult to quit. In fact, the withdrawal from them––which drug makers call a “discontinuation syndrome”––is similar to that of addictive drugs. Many patients are miffed that they were not warmed by their doctors they may be on the drugs indefinitely said the Times thanks to side effects of dizziness, nausea, headache and brain zaps which do not go away quickly when they try to stop the drugs. Brian, a 29-year-old Chicagoan I interviewed who did not want his name used, told me he has remained on a SSRI antidepressant for years despite his wish to quit. “Every time I try to stop, I get something that feels like an electrical current in my head and I can’t do it,” he says.
The Times article drew a huge backlash from psychiatrists. “By amplifying the social media echo chamber, the article creates the unfortunate impression that most patients are forced to continue antidepressants out of fear of withdrawal rather than out of prevention of recurrence,” wrote 39 psychiatrists, terming depression “chronic” and “undertreated.”
Yet, before direct-to-consumer ads, lucrative SSRI antidepressants and doctors paid to promote drugs, “chronic depression” and long-term drug therapy were not the norm.
Finally, the very definition of depression itself, which is not detectable from lab tests, is expanding. Gone are the days when bad or sad moods are attributed to real problems with finance, romance, debt, jobs, housing, careers, family, marriages and health. The antidepressant revolution has created an expectation that people who are not “more than happy” all the time need medication. The climbing suicide rate suggests the drugs are not working very well.