How Safe Are Antidepressants?

With increasing consciousness about psychological well-being, the frequency of prescription of anti-depressant drugs has also risen in equal proportions. With increasing use of anti-depressant medication, there is a need that people be aware of its potential adverse impacts, so as to be able to seek experts advice at the earliest.  
How Safe Are Antidepressants?
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Increasing complexity of modern life, progress in psychiatric medicine and easier access to pharmacological remedies have made us better equipped to deal with many medical problems, but also resulted in increasing prescription and consumption of many psychiatric medicines including antidepressants. Perhaps it is time that we also improve our general awareness about their profile, safety and side effects.


The Rising Incidence of Antidepressant Consumption

Studies suggest that between 1992 and 2002, the use of anti-depressants in United Kingdom and France more than doubled. In United States, anti-depressants are the most prescribed group of medicines, with almost 11% of women and 5% of

men having taken it at some point of time. However certain studies also suggest that almost 25% of the patients of depression are cases of over-diagnosis, and many feel that all the 67% patients of depression who are prescribed anti-depressants may not actually require them.

These statistics take us to the issue of what harm might be caused to those who are unnecessarily being administered anti-depressants. The real issue is as to whether anti-depressants are safe enough to allow over-diagnosis and over-prescription or whether the guidelines for their use need to made more restrictive.

Anti-depressants act by increasing the activity of certain chemicals called 'neuro-transmitters' in brain. The two main neuro-transmitters whose activity is augmented are serotonin and noradrenaline. Anti-depressants used today belong mainly to four broad categories. Since each one of them has a different mechanism of action, it is best to discuss each of them separately.

Selective Serotonin Reuptake Inhibitors (SSRI)

First group is that of Selective Serotonin Reuptake Inhibitors (SSRI) like Fluoxetine (Prozac), Paroxetine (Paxil) and Citalopram (Celexa). They reduce the uptake of serotonin around the neuron cells, thereby increasing the amount of serotonin there and reducing depression that results from low serotonin levels. These are the later anti-depressants and have far less adverse side effects than tri-cyclics and MAO inhibitors. They are the most prescribed group among the anti depressants.

SSRIs can lead to many adverse side effects including drowsiness, dry mouth, nervousness, anxiety, insomnia, decreased appetite, and decreased ability to function sexually. The most severe side effect is usually associated with an overdose which can also threaten life by way of SEROTONIN SYNDROME. It is likely to be more severe and dangerous if more than one antidepressant are taken in overdose at the same time.

In milder case of Serotonin syndrome, only symptoms may consist of increased heart rate, shivering, sweating, and tremors or twitching. More severe cases lead to high blood pressure and high body temperature (with temperature up to 106 F). Mental state gradually becomes abnormal and in severe cases, shock, muscular rigidity and delirium can happen which can pose a risk to life by causing kidney failure and internal blood clotting (desseminated intravascular coagulation).

SSRIs are dangerous in children and adolescents, as they increase suicidal tendencies, and hence should not be given in them. They have to be usually used for long periods of

over one year. Such prolonged use leads to dependence and withdrawal symptoms though it is not like addiction, because there is no craving for taking the medicines. Sudden withdrawal of SSRIs can lead to serious withdrawal symptoms consisting of stomach upsets, flu like symptoms, anxiety, dizziness, vivid dreams at night and electric shock like sensations in the body. When severe they constitute what is known as 'SSRI DISCONTINUATION SYNDROME'.

Like other antidepressants , SSRIs also cause weight gain. They also interact with a large number of medicines and hence should be avoided when multiple medicines are given.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRI)

The second group consists of Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as Venlafaxine (Effexor) and Duloxetine (Cymbalta). The side effects of this group of medicines are very similar to those of SSRIs.

Tri Cyclic Anti Depressants

Third major group is that of Tricyclic antidepressants, which are the oldest and include amitriptyline and desipramine. They lead to adverse side effects that are worse than the SSRIs. They include dry mouth, blurred vision, drowsiness, dizziness, tremors, sexual problems, skin rash, and weight gain or loss. In older people, they can cause confusion, difficulty in passing urine, fainting and loss of consciousness because of low blood pressure, and falls. These side effects can become very dangerous in case of heart diseases.

An overdose of these or their interaction with other antidepressants can lead to Serotonin syndrome. Their sudden stoppage can also cause withdrawal symptoms similar to SSRIs though they may be somewhat less severe.

MAO Inhibitors

Fourth and now mostly outdated group consists of Monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil). They cause the most common interaction with foods containing tyramine like mature cheese, cured meats or yeast extracts, and their overdose leads to most dangerous kind of serotonin syndrome specially if combined with any other anti-depressants. Because of their more frequent side effects and interactions they are not used very commonly these days except in very selective cases.

Thus all anti-depressants have many side effects and most of them cause significant problems related with dependence and interaction with other medicines. These are enough reasons to ensure that they are used only in cases where they are necessary. This is another reason as to why more efforts should be undertaken to manage cases of depression with alternative treatments like psychotherapy, where side effects are less. It may be right to say that their use in milder cases can be avoided or at least postponed to attempt a trial with psychotherapy.

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