Wednesday, February 15, 2006

Antidepressants in the Real World

First, kudos to ns, who was right on the money about the median length of time people stay on antidepressant medications (last week's 'challenge question'). According to a definitive study just published in the American Journal of Psychiatry, about half of all patients stop taking their meds within the first month.

This is a big problem, for a number of reasons:

(1) The vast majority of depressed patients will not achieve full recovery after just one month of treatment, and incomplete recovery is a huge risk factor for the recurrence of full-blown depression. Sadly, depression will return again eventually for 70-80% of all treated depressed patients - and that risk level actually goes up for those who terminate treatment before they're fully recovered.

(2) Because it's routine practice to prescribe antidepressants for at least 4-6 months (often much longer), it's safe to assume that most patients are discontinuing meds against medical advice. In other words, they're just stopping abruptly on their own. Unfortunately, most antidepressant meds have a well-defined withdrawal syndrome - which can include dizziness, nausea, headaches, lethargy, agitation, irritability, and even "electric" shock-like sensations in the head or limbs. Quitting these meds abruptly - without a doctor's supervision - can increase the chances of having these horrible withdrawal effects.

(3) The short-term 'cure rate' of antidepressants is low enough as it is - as low as 28% in the largest study published to date. And that's for the people who actually stay on the meds as prescribed . . . which means that the true cure rate in the real world is considerably lower, given how many patients discontinue treatment early.

But why would so many people stop taking their meds against the advice of their doctor? Although cost may be a factor in a small number of cases, in my clinical experience it's the nasty side effects that are usually the culprit. Sexual side effects - including an inability to experience orgasm and decreased libido - are quite common, especially in the SSRI class of meds that includes best-sellers like Zolft, Celexa, Lexapro, Prozac, and Paxil. Less talked about, but equally common, is the phenomeonon of 'emotional numbing' - a reduced intensity of negative emotions like sadness and anxiety, but also the blunting of positive emotions like joy and excitement (the movie Garden State did a nice job of portraying this phenemenon).

So, although they are truly a godsend for some, antidepressants don't represent a lasting cure for the majority of depressed individuals. Fortunately, there are other treatment options that look more promising for long-term success in the battle against depression, among them: aerobic exercise, omega-3 supplementation, behavioral activation, and interpersonal psychotherapy. I'll plan to elaborate on these in an upcoming post.

22 comments:

Cheryl Fuller, Ph.D. said...

Great post! I am quite concerned about the way these drugs are marketed given their actual track record.

Ziggy said...

Less talked about, but equally common, is the phenomeonon of 'emotional numbing' - a reduced intensity of negative emotions like sadness and anxiety, but also the blunting of positive emotions like joy and excitement

You say thatlike it's a bad thing. After being tossed around in the waves of mood swings for decades, I find the emotional numbing of paxil to be a great relief. No PMS, no deep depression, no anxiety attacks. I haven't noticed any great loss of joy, but maybe that's because I was so fricking depressed for most of my life that I hardly ever had any. I suspect that loss of orgasm would have been a deal-breaker for me, though. Whew!

Anonymous said...

I took Celexa for over two years. I stopped it on my own (weaned myself down and off - with help of my therapist) and one day while driving along, I suddenly realized that my very strong sense of melancholy was related to a lack of drug in my system. I restarted it and stopped it a few months later successfully (after the divorce was final!). I think of the SSRI class of drugs as "making sense" physiologically, but there can be other factors working against success. Cognitive therapy helped me more than the drugs, IMHO.

As for side effects... well, for me I had the unfortunate side effect of an almost priapism state, with a diminished ability to reach orgasm (and to thus end the problem); no partner to help me; and no libido to care. Talk about irony!

Things are better now. Tim

Nom dePlume said...

The low success rate of antidepressants, even when taken properly, is disappointing. Add to that the sexual side effects of SSRIs, and it isn't surprising that people become discouraged.

It would be nice to see the psychiatric world pay more attention to medications that work via neurotransmitters other than serotonin. Too often, the doctor's response to an SSRI not working is just to try another, similar medication, with equally poor results.

Psych Pundit said...

Cheryl - Yes, the antidepressants certainly don't live up to the marketing hype.

Ziggy - You raise a good point, and it's absolutely true that emotional numbing can be a welcome development for some, especially those in great emotional pain. But for many, the blunting of positive feelings (including sexual attraction) is a very high price to pay.

Anonymous - Glad to hear that you've been able to beat depression, and no longer have to tolerate those onerous side effects.

Nom Deplume - Yes, I suppose it really shouldn't come as a surprise to learn that so many patients give up on these meds so quickly . . . but it's a story that hasn't been covered by the mainstream media (drug companies are among the biggest advertisers, after all).

DocJohn said...

Another take on those studies:

World of Psychology

altostrata said...

I was on Paxil 10mg for 3 years and quit 28 months ago. I have had diagnosed antidepressant discontinuation syndrome ever since. It isn't trivial; I was unable to work for 6 months because of it. It does a very credible imitation of brain damage with exaggerated melancholia and anxiety. I've recovered enough to work but still have emotional blunting, hypersensitivity to stress (noradrenergic hypersensitivity), and dysautonomic hypersensitivity (kindling effect) to neuroactive medications. The problems with antidepressant withdrawal are no joke and vastly underreported since it's almost universally misdiagnosed. Who knows how many people like me are out there with neurological damage from antidepressant withdrawal? There is no free lunch -- if you think these meds are the answer, dream on.

Anonymous said...

i have been taking ssri antidepressants for 15 years and i have had an extremely bad withdrawal. i would like to warn people out there that these drugs are very harmful and they do cause ireversable damage to the neuro chemistry. my advice :NEVER TAKE THEM.

Anonymous said...

You might be right, but I feel that saying that the cure rate of SSRI antidepressants is as low as 28% might be somewhat inaccurate, as the study only examined one of the SSRIs.

nwtsbtr said...

Xanax is the FDA (Food and Drugs Administration) approved medicine to treat anxiety as well as several anxiety disorders and this striking fact associated with xanax anxiety spells out that xanax is the ultimate medicine that you should procure immediately if you are suffering from anxiety pangs. http://www.xanax-effects.com

Online Pharmacy said...

Hello friend thanks for sharing this information about Antidepressants in the Real World, this is great topic to create a blog!!!

Invertir Dinero said...

Thanks for this post about Antidepressants because I used it and I don´t have a good experience with it and I need help because I am sad.

Tadalafil said...

very interesting article about Antidepressants in the Real World thanks for sharing!!

libido supplements said...

very interesting post about Antidepressants in the Real World thanks for sharing!!

lots in Samara Costa Rica said...

The antidepressants are very important for the people that needs.
Thanks for the information.

John said...

This article is very informative and useful regarding antidepressants, this condition can affect your sexual activity so you will need to take generic viagra to avoid this situations. Thanks for sharing and have a nice day.

Properties in Samara Costa Rica said...

Excellent information to many people like that read articles to learn about these issues of great interest.

eco vacations costa rica said...

Hello people want to express my satisfaction with this blog very creative and I really like the views of the focus very good indeed Thank you for the helpful information. I hope you keep up the good work on making your blog a success!

Generic Viagra said...

As we all know antidepressants are fabulous when you have problems. But in my experience I had a terrible experience a few years back with this 'cause I got vicious and was the worst thing ever.

buy viagra cheap said...

Please one more post about that.I wonder how you got so good. This is really a fascinating blog, lots of stuff that I can get into. One thing I just want to say is that your Blog is so perfect

Mobile Application said...

My friend recommended to this blog.... you have some awesome articles shear. keep it up the great work

android application | android web application

Anonymous said...

antidepressants don't represent a lasting cure for the majority of depressed individuals.

How could they if the majority quits treatment before the medications even have the remotest chance of success?

That line at the end of your article is quite misleading.