Mental health has become a hot button issue over the past couple of years. Once regarded as taboo, sentiments around the subject have shifted, leading to more open, honest discussions.
This is a good thing. More people are seeking help for depression, anxiety, and other mental health issues than ever before. Up to 90% of suicides occur from untreated mental illness and when people seek treatment, it is an important first step. [i]
In many cases, medication is prescribed and can be helpful, especially for certain illnesses like schizophrenia and bipolar disorder. However, treating depression with medication is more complicated.
Reality Check: We Don’t Know How Antidepressants Work
Antidepressants have been around for decades and have generally been regarded as the gold standard for treating depression and anxiety. As a result, 1 in 6 Americans are on antidepressants today.[ii]
If you do a quick Google search for “How do antidepressants work?”, you will find many claims that these medications increase neurotransmitters. Neurotransmitters are chemicals in the brain, described as mood boosters. For decades, it was believed that people with depression have lower levels of neurotransmitters than the general population. If antidepressants increase neurotransmitters, then it would make sense that a person with depression would receive a boost in their mood along with rising levels of neurotransmitters.
However, the idea that depression is caused by a deficiency in neurotransmitters has been challenged by researchers in recent years. Educational material from Harvard Medical School states, “Research suggests that depression doesn’t spring from simply having too much or too little of certain brain chemicals. Rather, there are many possible causes of depression, including faulty mood regulation by the brain, genetic vulnerability, and stressful life events. It’s believed that several of these forces interact to bring on depression.”[iii]
And it is not just the cause of depression that is being studied more closely, it is the assumption about how antidepressants work. Dr. Chris Palmer, a Harvard psychiatrist and researcher, recently went on the popular podcast Armchair Experts to debunk claims about antidepressant medication. Dr. Palmer discusses how, for those people benefiting from antidepressants, the medication may work differently than simply correcting a chemical imbalance. [iv]
The Latest Data Around Antidepressants: More Questions Than Answers
A report from the National Institute of Health that analyzed efficacy trials submitted to the FDA found that “the effectiveness of antidepressant therapy was probably even lower than the modest one reported by the study authors with an apparent progressively increasing dropout rate across each study phase.”[v] In its conclusion, the study called for a review of current standards of care for antidepressants. This report was released over a decade ago.
Worse than a lack of effectiveness, though, is a more recent study that found a possible link between antidepressants and increased risk of suicide.[vi] Though the study acknowledges that a direct causal link was not established, the statistics need further attention with a more thorough examination of suicide rates for those taking antidepressant medication.
Even as more questions are raised, the accessibility of antidepressant medication is ever increasing. A 2021 article in the Berkeley Political Review explored the phenomenon of antidepressant prescriptions increasingly given to those who aren’t diagnosed with a mental health disorder. Prescriptions of this kind increased from 59.2% to 72.7% from 1997 to 2006.[vii] Antidepressants are also being prescribed to treat health conditions beyond depression, and are commonly prescribed for symptoms of anxiety, insomnia, ADHD, and chronic pain.
This troubling trend calls for closer examination. Dr. Robyn Tamblyn, a professor of epidemiology and biostatistics at McGill University, states “the thing that’s of concern here is that when prescribing for conditions other than depression… it’s unknown whether the drug is going to be effective, because it’s never been studied….These doctors are prescribing in the dark.”[viii]
Bottom Line: Outdated Information Is Negatively Impacting Depression Treatment
If you only take away two things from this article, I want you to consider these two points:
1.) Antidepressant FDA guidelines were created before the availability of SSRI medication.
Antidepressants have come a long way since they were first approved by the FDA. In fact, the FDA guidelines for antidepressants were created a decade before the most common antidepressant type on the market today, SSRIs, were even invented. The FDA needs to be held accountable for updating guidelines and exploring and encouraging alternative treatment options.
2.) We can’t accurately measure if antidepressants are effective.
There is no standardization of how depression is measured, making collecting accurate efficacy data nearly impossible. If we don’t have accurate data showing that antidepressants are effective, then why are they still so widely prescribed? It is time to look at other options for treating depression.
Sources:
[i] Ellis, Mary Ellen, “The Real Cost of Untreated Mental Illness in America,” Constellations Behavioral Health, www.constellationbehavioralhealth.com/blog/the-real-cost-of-untreated-mental-illness-in-america/.
[ii] Pagadua, Megan, “America’s Epidemic of Antidepressants,” Berkeley Political Review, 7 November 2021, bpr.berkeley.edu/2021/11/07/americas-epidemic-of-antidepressants/.
[iii] “What Causes Depression?”, Harvard Health Publishing, Harvard Medical School, 10 January 2022, health.harvard.edu/mind-and-mood/what-causes-depression.
[iv] Shepard, Dax, “Chris Palmer (Harvard psychiatrist on brain energy),” Armchair Expert with Dax Shepard, 2 February 2023, armchairexpertpod.com/pods/chris-palmer.
[v] Pigott, Edmund H., Allen M. Leventhal, Gregory S. Alter, John J. Boren, “Efficacy and Effectiveness of Antidepressants: Current Status of Research,” Psychother Psychosom, vol. 75, no. 5, 2010, pp: 267-79. DOI: 10.1159/000318293.
[vi] Jaeger, Jarryd, “New study shows antidepressant use likely to INCREASE risk of suicide,” The Post Milennial, 18 April 2023, thepostmillennial.com/new-study-shows-antidepressant-use-likely-to-increase-risk-of-suicide.
[vii] Pagadua, Megan, “America’s Epidemic of Antidepressants,” Berkeley Political Review, 7 November 2021, bpr.berkeley.edu/2021/11/07/americas-epidemic-of-antidepressants/.
[viii] Ibid.