Between and , prescriptions increased in all 29 countries surveyed by the Organisation for Economic Co-operation and Development, on average doubling. For some, the rise in antidepressant use is a welcome sign that the stigma surrounding mental health problems is in decline and more people are prepared to seek medical help.
But not everyone accepts this narrative. The drugs do raise serotonin levels in the junctions between brain cells, but there is no consistent evidence that people with depression have less serotonin than others.
There is even less evidence that SNRIs work by correcting an imbalance of noradrenaline. Even most sceptics agree that antidepressants have psychological effects. These vary from person to person, but many describe a slight dampening of their emotions — a feeling of being chilled out.
Yet strangely, although the flattening happens quickly, within days or sometimes even hours of the first dose, depression itself usually does not abate until several weeks later, as if it takes time for people to relearn their old ways.
One alternative explanation for how antidepressants work is that they boost the growth of new brain cells, which takes weeks. On top of their mysterious mechanism, there is also controversy about just how many people benefit from antidepressants. That stems from work by Irving Kirsch , a psychologist at Harvard Medical School, beginning in the s. He says he initially had nothing against antidepressants and sometimes recommended them to his psychotherapy clients. Kirsch was studying the placebo effect , the mysterious improvement in some cases of illness, apparently by the power of mind over matter, after people take medicines known not to work.
Antidepressants had been known for decades to show a much bigger placebo effect than other commonly prescribed medicines such as antibiotics — a case of mind over mind. When Kirsch and his colleagues pulled together results from many different trials that compared antidepressants with placebo tablets, they found that about a third of people taking placebo pills showed a significant improvement. This was as expected.
Aside from the classic placebo response, it could have been due to things such as the extra time spent talking to doctors as part of the trial, or just spontaneous recoveries. What was surprising was how people on antidepressants were only a little more likely to get better than those on the placebos. They have since been reproduced in several other analyses, by his group and others.
As a result, some clinical guidelines now recommend medication only for those with severe depression, where meta-analyses suggest a bigger benefit.
But these are no panacea, and the wait for such treatment on the NHS can be many months. In practice, pills are often still the first resort in the UK and many other places. For mild or moderate depression, UK, Australian and New Zealand guidelines among others recommend talking therapies such as cognitive behavioural therapy. Lifestyle changes can also help, including cutting down on alcohol , establishing regular sleep patterns and being physically more active.
For people with severe depression, the last resort is electroconvulsive therapy: subjecting the brain to electric shocks under anaesthesia. This is thought to be quite effective, but often causes memory loss. New medicines based on ketamine may become available in the next few years. Although developed as an anaesthetic and snorted as a recreational drug, doctors have found that a single injection can alleviate severe depression, with benefits lasting for many months.
He's constantly smiling, and says he wakes up belly-laughing two or three times a week. Dayton says he's an optimist by nature, and that his daily dose of Wellbutrin makes him feel even better. I don't think it means that I don't ever experience any sadness, but I think it makes me experience sadness in a very healthy way.
Buproprion, the active drug in the antidepressant, helps smokers quit because it partially blocks the brain chemicals which keep them hooked. A recent study by UCLA researchers found that the drug may help break addiction to methamphetamine, too. Buproprion also increases the brain level of dopamine, a chemical linked to excitement, new experience and pleasure.
Psychiatrists tell CNN that Dayton's use of Wellbutrin as a lifestyle drug is potentially dangerous, although little is known about the long-term effects. Peter Kramer, author of "Listening to Prozac. Other doctors believe they might trigger manic-depressive illness in susceptible people, he said. Most antidepressants -- though not Wellbutrin -- are in a group of drugs known as selective serotonin reuptake inhibitors, or SSRIs. They prevent the body from re-absorbing the naturally occurring chemical serotonin, thus increasing serotonin levels in the brain.
It's like plugging up a drain to keep running water in the sink. Serotonin, like dopamine, is linked to good feeling. Those chemicals and others are released during any pleasurable experience, like a kiss, or eating a bar of chocolate. The release of endorphins, another chemical, is linked to the "runner's high" experienced by some endurance athletes.
The researchers did not look at why doctors are prescribing depression drugs for other uses, but they suspect it could be a last-resort measure. It should also be noted that scientists do not fully understand how antidepressants work for depression. While evidence does suggest they work to alleviate some symptoms, how the drugs achieve that is still unclear. The researchers of the new trial say the trend of prescribing for other indications should be more fully explored, to understand the reasons why people are being given the drugs for reasons that are even less clear cut.
Contact us at letters time. By Alexandra Sifferlin. Get our Health Newsletter. Sign up to receive the latest health and science news, plus answers to wellness questions and expert tips. But the process of beginning antidepressants doesn't start with some haphazardly written prescription. Docs frequently recommend therapy first, Tricamo says, which can result in significant improvements for many people with mild to moderate depression.
When she's considering who might benefit from meds, Tricamo evaluates how much depression interferes with a person's daily life. Some people still have hangups about starting meds, even if therapy hasn't helped. Tricamo emphasizes the importance of working through these concerns and making the decision to try antidepressants a collaborative one.
Many of them, like weight gain , insomnia, nausea, low libido , delayed or vanished orgasm, and diarrhea, to name just a few, sound entirely unpleasant.
Certain meds come to have a reputation for one side effect or another, but there's no real way of knowing what you might feel when you start one or how long the side effects will last. Nausea, headaches, or a jittery feeling usually vanish within the first couple of weeks, Tricamo says, but weight gain or a dampened sex drive might be harder to cope with. While the unpredictability is certainly frustrating, it shouldn't be prohibitive. He ended up in the emergency room after what was likely an allergic reaction to Lexapro when he first tried it in He's since tried a handful of others with varying rates of success: Cymbalta and Wellbutrin both made his depressive symptoms worse, he says.
Effexor made him feel something he can only explain as "medicated. He's currently feeling some improvements on Prozac and is about to visit his psychiatrist for the first time in a month. He's stayed away from any antidepressants thought to mess with libido. He guesses everyone has their own threshold for tolerating different side effects.
Some weight gain might not bother one person while it's a deal-breaker for others, for example. But you're not about to become a zombie. The idea that antidepressants totally change your personality is understandable, Tricamo says, since they are tinkering with your brain. The persistent "I won't feel anything " fear, however, is unwarranted. Of course, if you do feel like meds are "flattening" you, talk to your doctor, who can likely suggest another option.
There's usually some trial and error involved before you find the right one. When Shattuck first started medication, she went on Paxil and had horrible nightmares. Zoloft gave her heart palpitations and sent her anxiety through the roof.
But just because one antidepressant makes you, say, sweat profusely, doesn't mean they all will; it's worth giving a few a try if nothing feels quite right at first, Tricamo says. Even if you try one and feel nothing—no uncomfortable or dangerous side effects, but no real improvement either—don't give up.
With dozens on the market, odds are the first one isn't the right one, O'Hare says, and frankly, it could take years to find one that helps.
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