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SSRI Antidepressants
Are Not Medicine

Frightening side effects, cover-ups on the record, and no reason to believe they do what they are supposed to

by Paul Ingraham, Vancouver, Canada MORE
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Credentials and qualifications

I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.

For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.


Note that recent evidence shows that new generation anti-depressant medications, like escitalopram and sertraline, are probably more safe and more effective than older and better-known SSRIs.1

I believe that I have a professional and moral obligation to question the prescription and widespread use of old-generation (SSRI class) anti-depressant medications such as Prozac, Zoloft, Paxil, Celexa and Luvox. I cannot condemn it: I am a massage therapist, and not qualified to make that judgement. Condemnation must be left to the credible experts, and their interpretation of the evidence. However, I share my concerns: that the manufacture, marketing, excessive prescription, and sale of these drugs has probably been dangerous and negligent.

This position is well-supported by references to credible and recent scientific opinion and evidence.2 Credible criticism first came to public attention when David Healy, a professor of psychiatry who lost his job for speaking out about the undeniable risk that SSRIs cause a small percentage of patients to kill themselves, which had not yet been addressed in the scientific literature.3 In January 2008, New England Journal of Medicine reported that drug manufacturers failed to publish every FDA-registered study4 that didn’t make SSRI anti-depressants look good.5 Then PLos Medicine followed up in February with the largest review of SSRI studies to date — including6 all the previously unpublished FDA studies, as discussed by arstechnica.com. The effectiveness of anti-depressants has always been debatable, but this new analysis of all the evidence resulted in a particularly underwhelming picture of the efficacy of these drugs, which appear to be no more effective than sugar pills.7 This is not a new expert opinion, but simply the most recent credible evidence to support an existing opinion. See the footnotes for full details, and please bear in mind the weight of this evidence as you read on.

A personal perspective

I have a personal history with so-called “clinical” depression and bipolar disorder. In 1991, a pyschiatrist not only diagnosed me with manic-depression (probably a misdiagnosis), but told me that I would be dead by suicide “within a year” — yikes! — if I did not accept pharmaceutical treatment in the form of SSRI antidepressants. Prozac was three years old then, and had been the most prescribed drug in history as of 1990. I walked out of that psychiatrist’s office, and later cured my own depression and mood swings through personal development.

“Take this mood-altering drug or you’re dead within a year,” was probably not the voice of compassionate wisdom.

Fortunately, I recognized that “take this mood-altering drug or you’re dead within a year” was probably not the voice of compassionate wisdom. But, in fact, it was more dangerous than I knew.

Ely Lily is the manufacturer of Prozac. “The company’s internal documents, some dating to the mid-1980s, as well as government applications and patents, indicate that the pharmaceutical giant has known for years that its best-selling drug [Prozac] could cause suicidal reactions in a small but significant number of patients.”8

Taking Prozac could have induced my suicide rather than preventing it! The same is true for all the millions of people out there ingesting SSRI antidepressants. Scientific controversy about this allegation continues vigorously to this day, as any quick internet search can demonstrate (Google "SSRI suicide"). As long the truth remains elusive, there is a strong “better safe than sorry” case to be made against their use.

Unjustified faith

I have long condemned anti-depressants on the basis of general cynicism. I always knew or suspected that they have numerous alarming side effects, that they are marketed aggressively by some of the most profitable and unaccountable corporations in the world, and that their usage does not have a sound scientific rationale. These have been reason enough to suspect that they are more myth than medicine.

Yet, for all my cynicism, I foolishly had some faith that these drugs could not be all bad. I assumed that their side effects were more or less as reported in drug references, that the manufacturers’ power to obscure the facts is mitigated by government agencies, and that the physiological rationale for the drugs is at least intelligible.

As a health care professional, I have had the opportunity to learn otherwise. I have observed dozens of my own clients struggle with depression both with and without SSRI antidepressants, had numerous conversations with other complementary and conventional health care professionals on the subject, and read many articles and books.

Worse than I’d feared

Contrary to what I once assumed, the side-effects of anti-depressants are actually numerous, severe, life-threatening and not widely known or even understood. They cause a minimum 1% rate of psychotic mania, for instance — equal to millions of people who have been reduced to quivering wrecks, their behaviour drastically altered, careers, marriages and lives lost. Withdrawal symptoms from SSRIs are even more problematic.

The power of the SSRI manufacturers is quite unchecked by government institutions like the American FDA. Indeed, there are documented cases of these companies successfully:

This is no surprise given the amount of money and conflicts of interest involved. For instance, President George Bush Sr. was on the board of directors of Eli Lilly & Co. (Prozac), and the head of the FDA during the Prozac approval now works for the pharmaceutical industry as a consultant!

Finally, the scientific rationale for anti-depressants is not, it turns out, very good at all. It is as clumsy as the rationale for electroshock therapy and lobotomy was historically. The popularity of anti-depressants is a continuation of the historical tendency to use “brain-disabling treatments” in psychiatry.9

The idea that we can diagnose a “chemical imbalance” in the brain is pure fantasy.

It is important to understand that SSRIs quite literally just “mess with your head,” specifically interfering with the function of a common messenger molecule (serotonin), one of thousands of others, whose purpose and broad significance to brain function in general is only vaguely understood, and whose particular significance to depression is completely unknown.

The most sophisticated method known for even measuring serotonin levels in the brain — never mind understanding the significance of these measurements — is to grind up a piece of brain, spin it in a centrifuge, and measure the sum total of serotonin relative to other substances. And how about our ability to measure the amount of serotonin in any given synapse at any time? Exactly zero. Yet the marketing of these drugs would have us believe that they are extremely specific in their effects. It is simply not so.

Given these limitations, the idea that we can diagnose a “chemical imbalance” in the brain is pure fantasy — even if we could measure it, we don’t what normal brain chemistry is. Bear in mind also that no pyschiatrist actually attempts to measure your brain chemistry before prescribing SSRIs. They don’t do it, of course, because they have not the slightest idea how to diagnose allegedly dysfunctional neurochemistry. They infer the idea of dysfunctional neurochemistry from your subjective symptoms (i.e. depression). That idea has achieved an outrageously disproprotionate credibility, seeming like certain knowledge to the layperson, when it fact the reality is that sertonin and related neurotransmitters remain almost completely mysterious to medical science.

We do not prescribe medicines to “treat” them, we prescribe medications that interfere with them, not because we know what to do to brain chemistry, but because it is something that we can do to brain chemistry.

Indeed, the scientific rationale for these drugs is so bankrupt that to even call them “antidepressants” has more to do with marketing than science, and various studies have shown that they simply do not work as advertised.10 Antidepressants are, in fact, closely related to amphetamines like ecstasy and cocaine. Cocaine essentially does exactly the same kinds of things to the brain, only it messes with serotonin plus a few other molecules. You can think of anti-depressants as “simplified cocaine.” And also “legal cocaine.” It’s an incredibly blunt medical instrument that does not do anything except generally interfere with normal brain function.

My responsibility as a health care professional

If the allegations against them are correct — and they seem to be — the presence of these drugs in our society is as appalling as any snake oil ever was, only much worse because of the scale. Too often we think of our civilization as scientifically sophisticated in all fields. Yet neurophysiology is still primitive in many ways, lacking in testable theories with the power to explain many mental phenomena — yet touted (marketed) as advanced. Consequently, medical malpractice is still common. It’s my responsibility as a health care professional to raise these concerns, even though there are more credible voices to be heard.

Indeed, please do not take my word for it. Although under-reported in the past, lately all of this information is readily available from other and more credible sources. If you are considering antidepressant medication, please do your homework first. If you are already taking antidepressant medication and want to quit safely, it is not sufficient to simply ask your physician. You must educate yourself.


Further Reading

  1. This article is updated by the short article SSRI Anti-Depressants Looking More Like Sugar Pills Than Ever.
  2. Review of The Antidepressant Fact Book: What Your Doctor Won’t Tell You About Prozac, Zoloft, Paxil, Celexa and Luvox, a book by Peter Breggin
  3. For those seeking help with depression or other emotional distress, perhaps the best resource in the world is a counselling and personal development school on Gabriola Island, BC, Canada, called The Haven Institute for Professional Training.
  4. In this article, I refer to my own A Short Story. It’s a cautionary tale with broad significance to anyone considering drug treatment for anything.

Notes

  1. The medical journal The Lancet calls them “clinically proven,” but a new analysis of these new-generation anti-depressants published in January 2009 also concludes that there are “clinically important differences” between different drugs of this type “for both efficacy and acceptability.” The authors explains that past studies have had “inconsistent results.” This is the first meta-analysis (study of studies) to declare two fairly clear winners, two drugs that have shown better effectiveness and acceptability (lack of side effects) for major depression: escitalopram and sertraline. Return to text.
  2. The following footnotes are explained in more detail in a short article, SSRI Anti-Depressants Looking More Like Sugar Pills Than Ever. Return to text.
  3. The David Healy Affair (http://www.pharmapolitics.com/) Return to text.
  4. What is an FDA-registered study? Drug companies are required by American law to study the effectiveness of their drugs, and to submit those studies to the FDA (to register them). The FDA uses them internally, but the drug companies independently decide whether or not to submit the papers for publication in scientific journals. So a study of a drug can be registered with the FDA … but never see the light of day! Return to text.
  5. Turner et al. “Selective publication of antidepressant trials and its influence on apparent efficacy.” New England Journal of Medicine. 2008. Full Abstract:
    BACKGROUND: Evidence-based medicine is valuable to the extent that the evidence base is complete and unbiased. Selective publication of clinical trials--and the outcomes within those trials--can lead to unrealistic estimates of drug effectiveness and alter the apparent risk-benefit ratio.
    METHODS: We obtained reviews from the Food and Drug Administration (FDA) for studies of 12 antidepressant agents involving 12,564 patients. We conducted a systematic literature search to identify matching publications. For trials that were reported in the literature, we compared the published outcomes with the FDA outcomes. We also compared the effect size derived from the published reports with the effect size derived from the entire FDA data set.
    RESULTS: Among 74 FDA-registered studies, 31%, accounting for 3449 study participants, were not published. Whether and how the studies were published were associated with the study outcome. A total of 37 studies viewed by the FDA as having positive results were published; 1 study viewed as positive was not published. Studies viewed by the FDA as having negative or questionable results were, with 3 exceptions, either not published (22 studies) or published in a way that, in our opinion, conveyed a positive outcome (11 studies). According to the published literature, it appeared that 94% of the trials conducted were positive. By contrast, the FDA analysis showed that 51% were positive. Separate meta-analyses of the FDA and journal data sets showed that the increase in effect size ranged from 11 to 69% for individual drugs and was 32% overall.
    CONCLUSIONS: We cannot determine whether the bias observed resulted from a failure to submit manuscripts on the part of authors and sponsors, from decisions by journal editors and reviewers not to publish, or both. Selective reporting of clinical trial results may have adverse consequences for researchers, study participants, health care professionals, and patients.
    Return to text.
  6. Just how good are current antidepressants? Gitlin. 2008. Return to text.
  7. Kirsch et al. PLos Medicine. 2008. From the abstract: “Drug-placebo differences in antidepressant efficacy increase as a function of baseline severity, but are relatively small even for severely depressed patients. The relationship between initial severity and antidepressant efficacy is attributable to decreased responsiveness to placebo among very severely depressed patients, rather than to increased responsiveness to medication.” Commenting on this paper, Ars Technica notes (see Just how good are current antidepressants?) that, “These trials include not just those that were published in peer-reviewed journals, but also unpublished trials that were registered with the FDA.” This is extremely important. Although it should be obvious, it helps that New England Journal of Medicine pointed it out recently: “Evidence-based medicine is valuable to the extent that the evidence base is complete and unbiased.” Yet they reported (see Turner) that the FDA has published studies of anti-depressants when they had positive outcomes, while studies with apparently negative results were “either not published (22 studies) or published in a way that, in our opinion, conveyed a positive outcome (11 studies)”! Return to text.
  8. Garnett, Leah. Prozac revisited: As drug gets remade, concerns about suicides surface. Boston Globe May 7, 2000: A1, article. Return to text.
  9. This is an idea borrowed from psychiatrist Dr. Peter Breggin. Unfortunately, Breggin is not generally a credible source. However, I think the idea in itself has merit: there certainly has been a strong tendency in psychiatry to attempt to treat ham-handedly with interventions that almost certainly change mental state by essentially changing neurology in an imprecise way. This isn’t necessarily as a sinister as it sounds: in many cases, perhaps most, such interventions have been tried in a genuinely earnest attempt to treat patients so sick that there was little left for them to lose. But the application of the principle into SSRIs, widely prescribed for only mildly depressed people, is of great concern. Return to text.
  10. Hypericum Depression Trial Study Group. Effect of Hypericum perforatum (St John's wort) in major depressive disorder: a randomized controlled trial. JAMA. 2002 Apr 10;287(14):1807-14, abstract. This good quality study showed that “neither sertraline [Zoloft] nor H perforatum [St. John's Wort] was significantly different from placebo.” Judging from the number of letters published in JAMA about this study in subsequent issues, it’s fair to say the results are probably controversial. Return to text.


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