Since the 1980s, psychiatric drugs known as Selective Serotonin Reuptake Inhibitors, or SSRIs, which include Zoloft, Lexapro, and Prozac, among others were trumpeted as a revolution in the treatment of depression and have become a mainstay of mental health treatment.
According to Newsweek, in 2019, 43 million or one in eight Americans were taking an SSRI. The outlet noted that those numbers have likely risen during the COVID pandemic due to rising anxiety and doctors phoning in so many new prescriptions for Zoloft. The drug was prescribed so often that the FDA warned of a drug shortage. Doctors with very little psychiatric training prescribe SSRIs to children and adults.
Evidence is increasing that doctors are overprescribing SSRIs, according to the outlet. One recent study cited by Newsweek revealed that only 15 percent of patients derive any more benefit from the drugs than they would a sugar pill. Additionally, withdrawal symptoms for long-term users may be more severe than previously believed and sometimes be worse for the patient than the original disorder.
Some patients may even continue taking SSRIs merely to avoid withdrawal symptoms which were thought to be temporary and mild. Many patients were told by doctors that they were experiencing a relapse of their depression.
Close to 26 million people, which is more than 60 percent of Americans on SSRIs, have been taking the drugs for more than two years, six million have been on them for a decade or more, according to the Centers for Disease Control and Prevention.
The consensus is that SSRIs help some people with severe depression, but those patients are the minority of people who take the drugs.
In a new study, Dr. Mark Horowitz, a research scientist at University College London, wrote "The serotonin theory of depression: a systematic umbrella review of the evidence."
The paper debunked the foundations upon which pharmaceutical companies marketed drugs like Prozac, Lexapro, and Zoloft to consumers for decades such as; the idea that depression is associated with deficits in the concentrations or activity of the brain chemical serotonin.
Dr. Joanna Moncrieff, professor of Critical and Social Psychiatry at University College London, the lead author of the serotonin paper told the outlet, "We have a mistaken view of what psychiatric drugs are doing. This idea that they work by targeting the underlying biological mechanisms that produce the symptoms of mental disorders is actually not supported by evidence for any type of mental disorder, whether that's depression or schizophrenia or whatever."
She claimed that the drugs alter "normal brain states" and "normal mental states and processes" in ways not that much different than recreational drugs like alcohol.
She added that with SSRIs, small benefits seen in placebo-controlled trials can be attributed to emotional numbing that reduces the intensity of feelings causing the depression and anxiety, at the expense of a fuller experience of the ups and downs of life and that depression which sometimes follows the reduction in SSRI use is caused by the chemical dependence on the drugs themselves.
Recent studies cited by the outlet have linked stress to depression. Dr. Michael Thase, a professor of psychiatry at UPenn's Perelman School of Medicine said that stress hormones cause the brain to be flooded with the neurotransmitter glutamate, placing it in a state of chronic overstimulation. More glutamate is released from lack of sleep which can cause an inability to function in daily life which creates more stress.
After the paper was released, the US Food and Drug Administration published an analysis of all the antidepressant clinical trial data in its files. The study concluded that the active ingredients in 10 of the most popularly prescribed antidepressant medications made a meaningful difference in only 15 percent of the patients who took them, usually in those patients suffering from the most severe depression.
According to Newsweek, One reason may be that SSRIs are effective for many people not because of the drug but rather the placebo effect, that the patient creates an expectation of healing that results in improvement. The outlet cited research that the placebo effect is successful in 30 to 40 percent of cases of depression.
Dr. Erick Turner, a former FDA clinical reviewer, who is now a professor of psychiatry and pharmacology at Oregon Health and Science University recalled discovering multiple negative trials in the first psychotropic drug application he reviewed for the agency in the late 1990s, and being so shocked that he immediately took it to his superiors.
He told Newsweek that his boss said, "It happens all the time," before revealing that in his estimation roughly 40 percent of antidepressant trials were negative or failed.
In December, the US Surgeon General issued a mental health crisis advisory warning that from 2009 to 2019, high school students who reported persistent feelings of sadness or hopelessness increased by 40 percent and included over a third of students and that the pandemic has only made things worse.
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