Transcription
Okay, so we had an absolute ripper of an article, "What You Need to Know About Anti-Depressants," that was in the New York Times. And this is going to be me reacting to it. It was published last month, so I think that was in April, by Christina Karen. And, uh, let's go into it.
So she talks about how common depression is. True. How it's on the rise. True. And let's pick it up here. So let's talk about how do anti-depressants work? So they say, well, in general, they initiate changes in the way brain cells and other different regions in the brain communicate with one another. And that's, and that's all they say. So I guess one of my big beefs with the way we describe what anti-depressants do is they describe it at a level that's not really that informative to the user. Yeah, sure. Yeah, these are chemicals that change our neurochemistry, but what are they actually doing? Well, you know, really, they're inducing a drug effect, just like any other drug. They're inducing a blunting effect. And what they don't tell people is that you're taking a drug to essentially blunt your emotions, and it's having a therapeutic effect, if it is for you. Now, I feel like they don't do this because they want it to seem like it's a treatment for diabetes, like there is some underlying medical process that is wrong that the drug is connecting, that the drug is correcting. And if you want to check out where this idea came from, check out this Zoloft commercial that I reviewed recently, and that will go into where this whole idea of this chemical imbalance came from. But I think it's a really bad way of describing what these drugs do, because the more intuitive way is essentially they have a drug effect. And so I don't like that.
You know, next, at the end of this paragraph, there's a part that says, "More research is needed to better understand how anti-depressants work, especially when taken over the course of several years." One thing that people are not told by their doctor who says, "Hey, these drugs are safe and effective," you know, they're approved by the FDA, is that they're safe and effective for the two to three months that the FDA studied them for. I mean, that was the duration of the clinical trials. There's never been a randomized control trial that went, you know, one year, two years, three years, you know, like, like we do with the statins, you know, some of those other drugs that lots of people are taking. We, we look at them for several years. We've never done that with the anti-depressants because there wasn't any precedent there. And so that's a great point that the person raises, like, who knows what the outcome of taking this drug is long-term? And from my vantage point as a psychiatrist that sees a lot of people on these meds is, um, I don't see a lot of people who take this med and they're just like, fine forever, and they never need to come back. Even in my personal life, that's not the case. When I talk to people I know who take these meds, what usually happens when they take the meds is they work well for a little bit, person becomes tolerant to them, they need to go on a higher dose, and, uh, so on and so forth. So there's just like a lot of uncertainty about whether someone long-term is going to keep on working for them, or whether they become tolerant, or even sometimes the drug actually turns on them. People start to feel blunted and disconnected, or even sometimes agitated. And it's essentially just like rolling the dice. What, what are you going to get long-term? I mean, you don't know. Maybe you could be lucky, or maybe the drug turns on you later on. And we don't have any clinical information that quantifies the likelihood of each of those outcomes. So I feel like that was kind of like snuck in there. But when these drugs are taken for a median duration of two years, that's way longer than they were, that they were ever studied for. So it's, I think it's a huge oversight, um, and gap in the research about these meds.
Let's go here. So, "How long do anti-depressants take to work?" "A common myth is that anti-depressants are quick fixes," says Dr. King Cha, a pediatrician in school of medicine. "They definitely are not." Um, what is a quick fix then, if it's not an anti-depressant? I mean, we're essentially talking about a drug that's going to be blunting the anxious and depressing feelings that you're having. So let's talk about this a little bit. I mean, if you're anxious and you're depressed due to legitimate reasons in your life that need to be addressed, could be things like poverty, you could be in an abusive relationship, you know, all of the hardships that people go through. If you just blunt the way you feel about those things, I mean, that is 100% a quick fix that doesn't work. I mean, if you try and medicate away a problem without getting to the root cause, the problem just festers. I mean, let's give the devil its due, then. So when should you use anti-depressants? Well, when you should use anti-depressants is probably when you've ruled out whether the depression is coming from any identifiable cause, you know, stresses in your life, medical problems, dietary problems, and such. And if you're still depressed and you've legitimately tried to do all of those things and you've been working with doctors and they haven't found any of those things, the anti-depressant helps you go for it. But the reality is that's really not what I see. You know, I, I see a lot of people walking into family medicine offices and getting prescribed essentially after like a 20-minute consult, and then, you know, the doctor doesn't really ask them too much about their problems after that. And so I hardly ever think the drugs are being used in that way. By and large, I think these drugs actually are quick fixes. That's exactly what they're doing. So I, I, yeah, would totally disagree with that.
So we come down to this section now, and it talks about, "Are side effects inevitable?" And they say, "No." You know, but there are some common ones which a lot of people have. And they talk about libido, headache, dry mouth, upsets. Essentially, what they do in this section is they list the most common but also benign side effects of the drugs. Now, when you want to inform someone about what this class of medications do, you want to do two things. You want to talk about the common things, and then you want to talk about the clinically important things that, even if they're rare, anyone would want to know if they were taking them. So let's talk about the notable things that they don't bring up. They don't bring up PSSD, you know, the chance that you could be permanently castrated from taking these medications. Um, this is a side effect that's recognized in Europe. It's on all the drug labels for the SSRIs and SNRIs over there. They don't bring up that they could cause literal brain damage, you know, protracted withdrawal injury when you're coming off these meds. And these things, they're, they're, they're permanent. I don't think you can have an article unless you bring up what I consider to be the most important side effects of this drug because it's simply not informing the public of important information that anyone would want to consider if they're going to take it.
Next part of this article that I want to discuss is the part about the black box warning. There, gosh, just really gets under my skin. The, you know, all anti-depressants have the potential to make people suicidal. And this has been something that people have been trying to explain away for a long time using the wrong studies. And that's what they talk about saying, you know, "Other studies have found that SSRIs decreased suicidal behavior," which has led to some experts wanting to recall the risk. Well, I don't want to get into too much here, but essentially, the way these drugs make people suicidal is people have paradoxical effects to them sometimes. Although the common effect is a mood constricting effect, which is therapeutic, sometimes they simply make people agitated for reasons we don't understand. It's just due to their biology. It can happen in people of all ages. It's like, um, you know, when people get together and they smoke some cannabis, you know, four out of five people are having a good time. One person might become paranoid. You know, we don't really know why that person had a different experience. And it's the same with the anti-depressants. And when that experience is one that is agitation, you know, which can happen on the anti-depressants, if that happens to someone who's already depressed and feeling suicidal, it's going to push them over the edge. Where these other studies come in where they say, "Oh, people think, you know, the boxed warning should be removed." It's from these big epidemiological studies where they have like a thousand people here and a thousand people on anti-depressants, a thousand people not on anti-depressants. And they go, you know, "What's the rate of suicide there?" Well, when you look at the studies in that way, often times you don't really detect a difference because, you know, some of the people on the drug are going to be saved by the, uh, medication, right, because of the effect. But there's also going to be some people on the drug who are going to be worse. And so if you're doing like some kind of analysis where you want to compare rates of suicide and suicidal behavior in people not on the drug versus people on the drug, you have to have a way of identifying people who were saved because of the drug and people who were worse because of the drug. And that's the thing that they completely miss. And so, you know, you might have two populations, one on drug, one not on drug, you find that there's no difference. But really, in the group that was on drug, some people were suicidal because of the drug, and some people were saved because of the drug. And it sort of cancels out. And to say that because there's no overall difference between the two groups that the risk isn't real, uh, it doesn't make any sense from my perspective. Looking into this, this whole kind of, uh, soou by using these these other studies was was really a form of pharmaceutical marketing where they wanted people to question this issue so people would be less concerned about it. But it's so wrong.
The final section, which is interesting to discuss, is, "How do I know when it's time to get off the anti-depressant?" And this is a section that says, "Studies show that patients who are doing well on anti-depressants are more likely to experience relapses of depression if they stop taking the anti-depressant." Well, yes, you know, if you were taking that anti-depressant because of legitimate problems in your life that were stressful, and you come off of it, you're going to be stressed out by those legitimate problems that still exist in your life. And the other thing is, most doctors out there, they simply taper the anti-depressants way too quickly. Still to this day, most people think you can come off them in a couple of months, which is way too fast, especially if you've been on this drug for years and your brain has like now regrown and adapted around that drug. And so a lot of people, they come off the drug, and even if the stressor has resolved, they've been tapered too quickly, and they experience severe withdrawal, which is then misdiagnosed as depression. This is a huge failing in psychiatry at the moment is the inability to safely get people off these medications.
So there you have it. There's my review of this article. Did you read it? What were your thoughts on it? I'd love to hear more in the comments below.