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Antidepressants
 Antidepressants are among the most popular drugs because in addition to depression, antidepressants are also effective in various pain syndromes that can also be stress related. Some people also claim that antidepressants relieve their stress, so it is not surprising to see so many advertisements and TV commercials for antidepressants.
Antidepressants work well for some patients but may have serious side effects and consequences in others, including suicide. Antidepressants vary in terms of their chemical composition and how they are thought to act. The most common are monoamine oxidase inhibitor antidepressants (Tofranil), tricyclic antidepressants (Elavil), and selective serotonin reuptake inhibitor (SSRI) antidepressants (Prozax, Zoloft). These antidepressants require a prescription but there are also non-prescription antidepressants like St. John's wort.
Sales of antidepressants have been escalating in recent years and are estimated to take in close to $12 billion annually. Some attribute the popularity of antidepressants to an increased incidence of depression over the past few decades. Others believe it is much more likely that the use of antidepressants has skyrocketed because direct to consumer TV advertising, which is banned in most other countries.
This is particularly true for SSRI antidepressants, which now dominate the market. SSRI antidepressants have caused concerns because they have been linked with an increase in violent behavior and suicide, especially in younger patients. As a result, these antidepressants are banned for use in children in some countries and the FDA has ordered "black box" warnings explaining this danger to be included on containers and informational literature.
Tens of thousands of law suits have been filed against the makers of SSRI antidepressants like Zoloft, Prozac, Paxil and Effexor believed to be responsible for serious side effects, including deaths due to suicide or violent behavior. Antidepressants can also be dangerous because of severe withdrawal reactions when patients try to stop them. Some of the more than 5000 Paxil suits in the U.S. are for withdrawal side effects for which there were no warnings.
One of the problems is that antidepressants can take weeks to work and it is not clear whether antidepressants caused suicide or if it was due to a steadily worsening of depression during this latent period. In patients with bipolar disorder who suffer from manic as well as depressive episodes, antidepressants can dangerously intensify their mania. Some of the most severe critics of SSRI antidepressants doubt if they work at all since in many clinical trials, they were no better or even worse than placebos. They believe that reports of remarkable improvement from antidepressants may be a placebo effect, especially if this occurs within a week or two of starting the drug. In addition, there is no clear correlation between changes in serotonin and the administration of SSRI antidepressants.
Antidepressants have numerous other annoying and debilitating side effects. Most antidepressants frequently cause feelings of lethargy and fatigue. Some of the other common side effects of antidepressants are drowsiness, nausea, headache and changes in appetite and weight. Patients on SSRI antidepressants also report a significant increase in sexual side effects, including erectile dysfunction, impotency, lack of libido and inability to achieve an orgasm. While patients often do not mention these side effects of antidepressants, studies show that they are present in 41% to 83% of patients taking SSRI antidepressants when physicians specifically ask about these symptoms. A causal relationship seems clear since sexual dysfunction usually disappears when antidepressants are discontinued.
Antidepressants can also interfere with the action of other drugs you are taking. These adverse effects of antidepressants have been emphasized because most patients and some doctors may be unaware of them. There is little doubt that antidepressants can be effective for many patients and some swear by them. The problem is that it is difficult to determine which patients will respond to antidepressants and whether one product is superior to another. In many instances, depression is due to stress and may be temporary and attempts to relieve or reduce stress may be a better option than antidepressants.
People who feel depressed often ask their physicians to prescribe antidepressants because of the impressive testimonials in TV commercials. However, it is essential that both physicians and patients be thoroughly aware of the side effects of antidepressants. You can find much more about antidepressants on Topics Of Interest and other www.stress.org sites.
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