When of the tragic death of 28-year-old “Brokeback Mountain” star Heath Ledger broke out, many people were aghast when the medical examiner’s findings revealed the accidental overdose of prescription drugs Xanax, Valium, and other antidepressants as cause of his untimely death. Countless other cases of non-celebrity victims of such drugs are happening worldwide. The danger is real, as mortality rates from side effects and adverse outcome from intake of antidepressants would show. In the US alone, a report pointed out that in any given year, 18 percent of Americans suffer from an anxiety disorder, while scores more feel stressed by work or family demands (Toews 54). Attributed mainly to rising social tensions of the modern age, depression is usually triggered by the unrealistically high expectations heaped by society on individuals, including those who have reaped a measure of success. In some cases, depression can be triggered by the disintegration of society’s basic unit — the family, making an individual cling to drugs as a form of quick relief,. The latter is illustrated in the 2004 flick starring Zach Braff and Natalie Portman, in which a young man facing his long-suffering mother’s demise experiences depression and self-doubt, and is prescribed with antidepressant medicines for many years upon his father’s prodding; he is able to reconnect with the world only when he willfully gets off the antidepressant drugs and gets human solace. (Garden State). In other instances, a simple erosion of trust may lead a person to despair, making him go for antidepressants which he may consider as a safe palliative measures. Even people who have reached their goals, and whose lives may look perfect to other people, turn to antidepressants without foreseeing the harmful effects.
What exactly do people wrestling with depression feel? Paul Gottlieb, a publisher in the art world who suffered from depression, shared that he never really tried to commit suicide, but came close to dong it It feels “as if your inner core is being squeezed in such a way that it hurts. You feel as if your tissue has been wounded.” Rodolfo Palma-Lulión, a college graduate, recalled his own battle with the disorder: “I didn’t feel any emotions. My real feeling was just pure numbness. It was almost like I was underwater with my eyes and my ears all shut off, and I was just there.” Rene Ruballo, a retired police officer, said: “It started with my loss of interest in basically everything that I like doing. I just felt like giving up sometimes. Sometimes I didn’t even want to get out of bed. I am thinking there’s got to be something wrong because I’m waking up and I feel like nothing matters. My children, my family … nothing matters” (Rovner 33).
General practitioners actually have a slew of antidepressant medications to offer, including Paxil and Valium, “But these drugs are not just ineffective, they are also rife with side effects (Toews 54) that create greater depression. “It’s almost a misnomer at this point to call them antidepressants,” says Dr. Joseph Glenmullen, a clinical instructor in psychiatry at Harvard Medical School. “They are used for anxiety, obsessive-compulsive disorders, gambling, even nail biting. They’re sort of all-purpose ‘feel better’ medications.”
Robert Bazell, in his online article, “Antidepressants not as Good, or Evil, as Believed,” cited Harvard Medical School Clinical Instructor in Psychiatry Dr. Joseph Glenmullen, who said “It’s almost a misnomer at this point to call them antidepressants,” referring to how the medications are used for anxiety, obsessive-compulsive disorders, and other anti-social tendencies. They may be regarded as all-purpose ‘feel better’ medications, but they are laden with side effects. What few people also fail to realize is the lethal combo of anti-anxiety drugs, antidepressants, pain killers and other chemical innovations. There are some discerning pill-poppers, though, who know when it is time to cease taking antidepressants. In his online article, Bazell pointed out how most patients simply stop taking the medications because they do not experience benefits and cannot stand the side effects… SSRIs (Selective Serotonin Reuptake Inhibitors, widely believed to be designed from a firm understanding of the brain chemistry of depression, and defined by the Online Medical Dictionary as drugs that can be dangerous if mixed with other drugs such as other antidepressants, illicit drugs and other chemical substances, with side effects as lethargy, confusion, sweating, and muscle spasms) drugs are neither the evil that many believe, nor the magical solution that many hoped. The fact remains that many prescriptions tend to be obtained for frivolous uses, connoting that both general practitioners and the consuming public, in tandem with other institutions or support systems, need to do a far better job of treating depression, “with and without the medicines” (Bazell).
In discussing depression and the drugs people take with the hope that these will help them cope with the disorder, it is best to make a distinction between a normal mood state and a depressive disorder. It is very easy for people to say they are depressed when in fact they are not; they may just be feeling the blues, and certainly require no medication. They may simply be experiencing a very mild case of depression. In contrast to a depressed mood state, depressive disorders are more severe. The three types of depression are non-melancholic depression, melancholic depression, and psychotic melancholia. The latter two are characterized by a psychomotor disturbance, and it is most severe in psychotic melancholia (Parker 17). For the more severe case, or chronic depression, medical practitioners have, time and again, noted that it is complicated by borderline personality disorders or substance abuse. Real world clinical studies will show that different classes of antidepressants vary considerably in their effects on different types of depression (Parker 90)
In general, though, depression is defined in an online treatment site, “Anxiety, Addiction and Depression Treatments” as a serious medical illness caused by imbalances in the brain chemicals that regulate mood. It affects one in six people at some time during their life, making them feel hopeless. The feelings of loneliness, weariness, irritability or numbness may last for months or years and interfere with daily life. Most self-empowerment books dealing with depression say that patients afflicted with it can stabilize and lead fulfilling lives if they accept their condition and proactively address it.
In a February 2008 cover story by Sophie Rovner in the newsmagazine, The Chemical & Engineering News, the mechanics of depression is clearly explained. It explained, “Depression interferes with the balance of neurotransmitters such as serotonin, norepinephrine, and dopamine–though this is only part of the story. They have determined that the medications used to treat depression work by increasing the availability of neurotransmitters or by changing the sensitivity of the receptors for these chemical messengers.”
Indeed, antidepressant drugs have been the subject of the most contentious and longest-running confrontations in the history of medicine.
Tracing the history of antidepressants which eventually sparked the controversy and heated debates, Robert Bazell articulated in his online article, “Antidepressants not as Good, or Evil, as Believed” how the saga began in December 1987, when Prozac hit the market. He recapitulated that Prozac was the first in the class of drugs called SSRIs that now includes Zoloft, Paxil, Effexor, Luvox and Lexapro, whose mode of action resembles cocaine, ecstasy and methamphetamine, although they do not cause rapid euphoria or the difficult crash. The major advantage of the SSRIs over earlier antidepressants, he explained, is that it is almost impossible to overdose on them. They lack other severe side effects of earlier drugs such as toxic interactions with certain types of foods. This is why SSRIs were relied on by many people to effectively relieve depression. Bazell further noted that in 1989, Newsweek featured a Prozac capsule on its cover; and in his 1993 bestseller Listening to Prozac, psychiatrist Peter Kramer described patients who underwent transformations of their personalities and felt `better than well’ on the drug. “In response to this groundswell of enthusiasm — as well as drug-company marketing — the uses for the SSRIs rapidly expanded far beyond depression.”
By 2002, many US psychiatrists, including pediatricians, were writing amillions of antidepressant prescriptions for kids ranging in age from one to 17.
On the other hand, other reports indicated that among the wide range of antidepressants that hit the market, those linked to an increase in suicidal tendencies were all SSRIs. The controversy raged on about the dangers of this class of antidepressants, and the unfavorable effects they brought.
In recent years, Bazell reported that since October 2004 the FDA has required black-box warnings, the strongest alert of danger, on the medicines, recognizing a potential for young people taking antidepressants to have suicidal thoughts and behavior. Bazell’s report also said that with its latest move, the agency extended the warning to include 18- to 24-year-olds, but not to those age 25 and over. At the same time, the agency altered the label to note that “depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide.”
After years of study raised the possibility that antidepressants may elevate the risk of suicidal thoughts, especially among young people, many other antidepressant users crept out of the woodwork, most of them posting online entries, on just how thy have been held back by their antidepressant medicine, to the point of making them feel depressed and unsure of themselves.
Should patients, in collaboration with their doctors, decide to use an antidepressant, they can actually choose from a wide array of treatments. Options include tricyclics, monoamine oxidase inhibitors (MAOIs), SSRIs, serotonin and norepinephrine reuptake inhibitors (SNRIs), and norepinephrine and dopamine reuptake inhibitors (NDRIs). Among the tricyclic antidepressants are Elavil (amitriptyline), Norpramine (desipramine), Sinequan (doxepine hydrochloride), Tofranil (imipramine hydrochloride), Pamelor (nortriptyline hydrochloride), and Vivactil (protriptyline hy- drochloride). These drugs initially block reuptake of both norepinephrine and serotonin, which is also called 5 hydroxytryptamine (5-HT). Continued treatment also downregulates postsynaptic 1-adrenergic receptors. MAOI treatments include Nardil (phenelzine sulfate), Parnate (tranylcypromine sulfate), and Marplan (isocarboxazid). MAOIs block the oxidative deamination of norepinephrine, dopamine, and serotonin, thus effectively increasing concentrations of those neurotransmitters. SSRIs include Prozac, Zoloft (sertraline hydrochloride), Paxil, Celexa (citalopram hydrobromide), Lexapro (escitalopram oxalate), and Luvox (fluvoxamine). SSRIs block reuptake of serotonin, leaving more of the neurotransmitter available for pickup by postsynaptic receptors. SNRIs behave similarly to SSRIs. In retrospect, tricyclics and MAOIs were used primarily from the 1960s through the 1980s; they have since fallen out of favor because of their side effects. Tricyclics cause dry mouth, constipation, bladder problems, sexual problems, blurred vision, dizziness, and drowsiness (Rovner 38).
To sum up a major point, antidepressants create more depression because of the side effects they trigger. Some of the common intolerable side effects shared by antidepressant users in various instances have been emotional distress, diminished function, greater stigma, and so on. Certain drugs and some diseases, as pointed out in the book, Dealing with Depression, can “act like environmental stressors, in that they have the capacity to disrupt the brain’s neural circuit linking the basal ganglia and prefrontal cortex” (Parker 53). The slew of antidepressants prescribed by primary care doctors , including Paxil and Valium, pose side effects such as addiction, sedation and sexual disfunction, as cautioned by Dr. JacobTeitelbaum, medical director of the Fibromyalgia and Fatigue Centers of America (Toews 54). Owing to their negative effects, some physicians have grown wary of easily prescribing antidepressants. “I believe that any antidepressant medication should have a pretty profound and dramatic effect to justify use” (Burns 475). Dr. David Burns, author of the book, Feeling Good – The New Mood Therapy, recommended psychotherapy along with antidepressant medicine to better treat what ails much of America. In a study posted in February 2008 in a treatment online site on “Anxiety, Addiction and Depression Treatments” it was revealed that the new-generation antidepressants do not produce clinically significant improvements in depression in patients who initially have moderate or even very severe depression, but show significant effects only in the most severely depressed patients. The researchers concluded that there is little reason to prescribe new-generation antidepressant medications to any but the most severely depressed patients unless alternative treatments have been ineffective.
Moreover, a 2002 study published in the online Journal of psychiatry & neuroscience entitled “Prevalence and outcome of partial remission in depression” by Tranter R, O’Donovan C, Chandarana P, Kennedy S. revealed: Residual depressive symptoms are common, even where there has been a robust response to antidepressant therapy. In clinical studies, approximately one-third of patients achieve a full remission, one-third experience a response and one-third are nonresponders. Partial remission is characterized by the presence of poorly defined residual symptoms. These symptoms typically include depressed mood, psychic anxiety, sleep disturbance, fatigue and diminished interest or pleasure.
Another major point that must be stressed is that the correct choice of initial antidepressant treatment should provide the greatest chance of achieving full remission (Tranter 1). However, for an increasing number of individuals who opt for quick relief to their depressive moods by getting hold of antidepressant medicines, the wrong choice of treatment is clear, and thy end up suffering the harmful effects of the drug not exactly suited for them.
In essence, antidepressants push those who take them into conditions beyond their control. Aside from side effects from SSRIs that include headache, nausea, nervousness, insomnia, agitation, and sexual problems. bipolar disorder (which runs in families and combines episodes of depression with mania), patients must take mood stabilizers; Otherwise, their antidepressant treatment may push them into a manic episode or into rapid cycling between mania and depression (Rovner 38).
Another major point on how antidepressants trigger greater depression is related to the patient’s withdrawal from the medication. “Suddenly ceasing all medication without decreasing the dose can lead to severe emotional and physical reactions, including anxiety, agitation, insomnia, severe sweats and racing heart” (Parker 100). A medical opinion confirmsed that getting more depressed when tapering off antidepressant medication is “actually pretty common” (Burns 491)
From another medical standpoint, the very drugs that numb feelings prevent people from experiencing anxiety and therefore block their wearing off. “Once the drug is withdrawn, the suppressed anxiety returns” (Glenmullen 299). People on antidepressants who decide to get off the medication will also experience that as they withdraw on a drug they feel dependent on, they will feel even ore anxious than they were at the start (Glenmullen 300). This is one of the backlashes on Prozac, in particular. I the long run, though, certain medical practitioners, as they opine in their books and other media, advise that in the long run, people are better off overcoming the dangers of Prozac, Zoloft, Paxil and other antidepressants. In their place, depression sufferers may go for other powerful tools and remedies that are safe and effective.
One other important point worth mulling over is that while physicians do rely on their experience and knowledge to count on the benefits or relief that medications may provide, there are indications various pharmaceutical companies with the hidden agenda to generate recordbreaking sales, at the expense of the consuming public, deserve censure.
Generally, antidepressants may not be pure goodness, or evil personified, as many are wont to believe, based on reports that have circulated. Greater research and evidence will have to surface, to prove that antidepressants alone, extraneous to other lifestyle factors and other medications being taken, do significantly hamper quality life or shorten their life span. The combination approach advocated by many well-meaning psychologists and holistic physicians just maybe worth trying. Studies comparing exercise with psychotherapy and drugs show that, overall, it is at least effective in alleviating mild to moderate clinical depression. “When you first start exercising, you feel a marvelous head-clearing relief and calm afterwards,” says psychologist Keith Johnsgard, PhD, who authored Conquering Depression ; Anxiety Through Exercise. Scientists believe that exercise may activate neurotransmitters associated with pleasure and tension relief, such as serotonin, norepinephrine and dopamine. Regular exercise creates a brain cocktail that puts us in a state I which we feel alert, not tired, and calm, not tense (Fraser 176).
It goes without saying that every case is different, and a professional must always be consulted to deter any unwanted or unfavorable effects on health that may be created by antidepressants. Some antidepressant users who posted their stories on how they successfully got off antidepressant medication shared that regular exercise and premium quality vitamins, among other techniques they employed, helped dispel the dizziness and other after-effects of the drugs . More importantly, they relied on the support of family and friends, or nurturing relationships, plus an amazing will power to regain confidence, take control of their lives, and enjoy life to the fullest without the deleterious effects of drugs, something illustrated in the 2004 movie of Zach Braff and Natalie Portman (Garden State).
Works Cited
Anonymous. “Antidepressants Not Significantly Better Than Placebo for Some Patients.” Weblog entry. 28 February 2008. 19 April 2008. ;http://treatmentonline.com/treatments.php?id=2165;.
Bazell, Robert. “Antidepressants not as Good, or Evil, as Believed.” msnbc.com. 8 May 2007. 20 April 2008 ;http://www.msnbc.msn.com/id/18533399/;.
Burns, David D. Feeling Good – The New Mood Therapy. New York: HarperCollins Publishers, Inc., 1980.
Fraser, Laura. “Running from Depression.” MORE June 2006: 174-178.
Garden State. Dir. Zach Braff. Perf. Zach Braff, Natalie Portman, and Peter Sarsgaard. Miramax, 2004.
Glenmullen, Joseph. Prozac Backlash – Overcoming the Dangers of Prozac, Zoloft, Paxil, and Other Antidepressants with Safe, Effective Alternatives. New York: Simon ; Schuster, 2000.
Parker, Gordon. Dealing with Depression – A Common Sense Guide to Mood Disorders. 2nd ed. NSW, Australia: Allen ; Unwin, 2004.
Rovner, Sophie L. “Depression.” Chemical ; Engineering News. 09 February 2004. 20 April 2008 ;http://pubs.acs.org/cen/coverstory/8206/8206depression.html;.
Toews, Victoria D. “Nature’s Scrip Pad – Gentler Alternatives for 3 Prescription Drugs.”
Alternative Medicine. September 2007: 54.
Tranter, R., O’Donovan, C., Chandarana , P and S. Kennedy. “Prevalence and Outcome of Partial Remission in Depression.” J Psychiatry Neurosci (2002): 1 par. 18 April 2008 ; http://www.ncbi.nlm.nih.gov/pubmed/12174733?dopt=AbstractPlus;.
