sincerely, a person who has been on prozac for 9 years
this is in response to some shitty stuff i’ve seen on my dash recently. it’s super simplified, so if you’d like to know some more indepth stuff on how exactly it works, google it—OR BETTER YET actually talk to a mental health doctor psychiatrist person wow
This is going to be super controversial, I feel.
I’m actually going to voice some disagreement with parts of this. Of course, my disagreement pertains solely to the information being given about SSRI safety and efficacy. Anyone who uses antidepressants is not worthy of blame or disrespect or anything of the like. Not in the slightest. That would be disturbing on the most basic level of decency. This post solely regards the science looking at antidepressants, and nothing pertaining to the character of individuals who use antidepressants (who, in my mind, are victims…either to depression or misguided advice or all of the above or something else).
- The notion that serotonin is the cause or even a contributor to depression is incredibly unsubstantiated. The psychiatric industry can’t make up their mind. For example, given some of the recent trials done on ketamine, many are now saying that the main neurotransmitter associated with depression is glutamate. They’ve literally gone through dopamine, serotonin, norepinephrine, and now they’re on glutamate. I mean, there have been studies which deplete and then restore serotonin levels without any observable changes in mood. So they just move on to the next!
- SSRIs are no more effective than placebos for mild or moderate depression. The only time there is a reliable change in mood beyond what placebos can do is in severe depression and it’s not a particularly long-lasting effect nor is it too predictive of functional change. Out of 15 large trials on antidepressants vs. placebo, only 2-3 showed antidepressants as being more effective on primary measures of depressive symptoms (Hammad et al., 2006). For those where there was a difference, it was about a 10% difference in effectiveness (Tsapakis, Soldani, Tondo, & Baldessarini, 2008).
- Some recent researchers have re-analyzed the data from the Treatment for Adolescent Depression Study (TADS), which was major in the FDA promoting Prozac for children/adolescents, and are finding that over 80% of those who expressed any suicidal ideation/attempt belonged to the Prozac group (this being a randomized trial). Eighteen attempts were made: 17 in the Prozac group, 1 in the non-medicated/placebo group. Further, for 8 participants who started in the placebo group and were switched to the active treatment (i.e., Prozac), 6 of them attempted suicide, and 1 expressed ideation. No youth in the placebo-only group attempted suicide at any point during the study, compared to 17 attempts in the Prozac group. Further, 3 expressed suicidal ideation in the placebo group, compared to 19 in the Prozac group. I repeat: this was a randomized trial with no differences in treatment history/depression severity at baseline, yet we’re talking about remarkable differences in suicidal ideation/attempts (Vitiello et al., 2009).
- Another RCT showed 22% of kids taking SSRIs as having a suicidal event compared to 6% in the placebo group (Brent et al., 2009).
- One of the major predictors in suicide is “arousal,” regarding excessive emotional arousal pre-suicidal event. Antidepressants are associated with 3-10x as much arousal as placebo, putting adolescents who take ADs at a higher probability of emotional arousal, often being implicated in suicidal behavior (Offidani, Fava, Tomba, & Baldessarini, 2013).
- In response to points 3-5: does this mean medication reliably induced suicidal ideation/attempts? No, we can’t say that for certain at this point in time. But it sure as hell means this requires more research before prescribing it to just anyone as is common practice. It’s common practice to prescribe these to children adolescents despite numbers clearly illustrating a frightening trend. I think that warrants further investigation before trying to erase all skepticism.
- The studies which resulted in the FDA repealing their blackbox label for Prozac in the context of child/adolescent depression, leading to public belief that Prozac is harmless for children/adolescents, were funded by Eli Lilly, a pharmaceutical company.
- Further I would not downplay the “side effects” of antidepressants (and these aren’t side effects, they are drug effects). It can’t be attributed to “probably” being on the wrong medication when these effects are remarkably common.
- Antidepressants show no significant effect for mild or moderate depression. And for severe depression, it does not translate to long-term change.
- All available data to date suggests that significantly more research is required before deciding that antidepressants are not harmful. Currently, the rates at which SSRI groups attempt/consider suicide compared to placebo groups is astounding. Like, haunting. And this includes individuals who were in the placebo group for extended periods of time, then switched to an antidepressant group, and then attempted suicide soon after (though this is a lower N size).
- The studies which suggested that antidepressants are safe and effective were funded by pharmaceutical companies. Does that mean it should immediately be dismissed? No, but when it’s 1-2 stand-alone studies against 10x as many with different results, then it brings it into question.
And this all leads me to my ultimate point: it’s okay to be skeptical. It is. Those who read the data, who read the proposed mechanisms behind antidepressants (i.e., there aren’t any - we don’t know how they “work,” hence why we continue to stab in the dark by creating new meds and then hypothesizing the effects post-hoc), should be skeptical. Way more research is needed. And given what the literature states, any child/adolescent who is given antidepressants should be: 1) undergoing behavioral therapy first, and 2) undergoing behavioral therapy while on antidepressants. I know there are financial issues here, though psychotherapy is often less expensive than an on-going prescription for antidepressants. Of course, I’m not blind to other obstacles, just stating a broad point.
I just don’t feel safe gambling with the lives of children/adolescents (or, really, individuals under 24-25 as those are the ones who tend to have greater complications with antidepressant use) is worth it. I think we should be paying more attention to the research, which I’m willing to bet 0.00001% of the general public really does.
I mean, for people who read this post and feel frustrated, just ask yourself: “How much have I really read this, directly from the publications, not from books or professionals or anyone else, but actually looking at the data myself?”
Always open to other views, but only if those views are coupled with some citations.