Antidepressant Safety Pros and Cons

Like many people, I've suffered from depression, which can be a debilitating disorder, and have at times been prescribed antidepressants. There are different types of antidepressants, and the trick is to find the one that works for you that will not cause dangerous or unpleasant side effects.

Currently the most widely used class of antidepressant, selective serotonin reuptake inhibitors (SSRIs), which include Prozac, Paxil and Zoloft, were introduced in the 1980s as a new way to treat depression. The oldest antidepressants, tricyclic antidepressants (TCAs, including Elavil, Tofranil, Norpramin and others), have been prescribed since the 1950s. Other antidepressant categories are SNRIs (serotonin-norephinephrine reuptake inhibitors, including Effexor), NASSAs (noradrenergic and specific serotonergic antidepressants, including Avanza), NRIs (norepinephrine reuptake inhibitors, including Edronax), NDRIs (norepinephrine-dopamine reuptake inhibitors, including Wellbutrin), and MAOIs (monoamine oxidase inhibitors, including Manerix).

But like any so-called "miracle drugs", the side effects of antidepressants soon became evident. They included lethargy, loss of sexual libido and ability, nausea, agitation, anxiety, constipation, blurred vision, dizziness, insomnia, dry mouth and weight gain. Why? According to psychiatrist Robert J. Hedaya in a 2000 Washington Post article, like any drug, antidepressants can cause changes in the neurochemical and hormonal systems, leading to an unbalanced metabolism. For example, three studies in 2007 indicated that men and women age 50 and older who took SSRIs were at higher risk for bone loss and fractures.

Despite these significant problems, some 25 million Americans take antidepressant medications, which are also prescribed for anxiety, OCD (obsessive-compulsive disorder), chronic pain, irritable bowel syndrome, chronic fatigue and migraines. Antidepressant use is widespread despite the fact that up to 80% of patients experience severe and sometimes dangerous side effects that impact their lives significantly.

But the side effect that has grabbed the most media coverage is suicidal thinking and self-harm in children, adolescents and young adults. Beginning in 1990, when an article in the American Journal of Psychiatry discussed six patients on Prozac who became obsessed with violent, suicidal thoughts, the wisdom of giving SSRI's to young people was questioned. The British government was so alarmed by these findings that it decided in 2003 to warn doctors not to prescribe SSRIs to anyone under 18 years old. The next year, in the United States, the Food and Drug Administration held hearings on antidepressant side effects and eventually issued a warning about suicidal ideation and behavior in children and young people who were prescribed SSRIs. It's frightening to contemplate that Cho Seung-hui, the 23-year-old loner who murdered 32 people before committing suicide on the Virginia Tech campus in 2007, was taking antidepressants at the time of his crime. Whether these drugs contributed to his rampage will never be known.

Is it safer to stick to natural remedies for depression and other psychological disorders? To be fair, even the popular herbal remedy for mild depression, St. John's Wort, has side effects that include photosensitivity (increased susceptibility to sunburn), as well as anxiety, dry mouth, GI symptoms, dizziness, fatigue, headache, and sexual problems, many of the same side effects caused by pharmaceutical antidepressants. Further, it can interact adversely with other drugs such as standard antidepressants, birth control pills, anticoagulants, chemotherapeutic and HIV drugs.

Should people reject antidepressants because of their proven dangers? That's up to the individual who is considering antidepressant therapy. Depression, anxiety, obsessive-compulsive disorders, and other psychological problems can paralyze one's life, and antidepressants should be given a place in the medical arsenal. Sometimes it takes a while to find the right antidepressant for each individual, but the search is worth undertaking because the results can be dramatic. Of course, the important role of proper diet and nutritional supplements, exercise, meditation, yoga, cognitive therapy, psychotherapy, biofeedback, the support of family and friends, and other non-drug modalities nust also be considered, along with antidepressant drug therapy.