This article is not medical advice. It’s advice for parents who have children and teens who may be prescribed antidepressants during eating disorder treatment. I am not anti-antidepressants. They were helpful in my own recovery. But I think parents should have access to both sides of the discussion on antidepressants as well as ideas for what else they can do to help. The purpose of this article is to start conversations, not make a medical recommendation and certainly not a judgment of a highly person choice. – Ginny Jones 💕
Taking medication for mental illness is important, and it’s dangerous to question the value of medications. The most common analogy is that if we had a child who had diabetes, we wouldn’t hesitate to treat it with insulin. But when it comes to most mental health conditions, medication is a bit more complicated. These are layered and complex issues that involve genetic, psychological, and social conditions.
Because of the complexity of our mental health, most of the time, medication alone is not enough to “fix” a problem.
It’s surprisingly hard to make a list of antidepressant pros and cons, mainly because it’s hard to find negative scientific studies about them. Speaking against antidepressants is fairly unusual, and many times they are prescribed by primary care doctors as an easy solution to very complex issues. In 2000 the New England Journal of Medicine sought an expert to write an editorial on depression and “found very few who did not have financial ties to drug companies that make antidepressants.”
In this article, I present the case against antidepressant medication. Again, this is not because I’m anti-medication but because I believe parents should have access to different views on the subject. This article provides a recap of Robert Whitaker’s “Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America.”
Depression = brain disorder?
Prozac hit the market in 1987, followed by Zoloft in 1991 and Paxil in 1992. All are designed and marketed as a scientifically sound method of reducing depression by increasing serotonin levels in the brain. This idea is based on the assumption that a “chemical imbalance” causes depression. However, there is no evidence of a biological “brain disorder” that causes depression.
- There is no correlation between serotonin levels and depression (McGill University, 1974)
- “Elevations or decrements in the functioning of serotonergic systems per se, are not likely to be associated with depression.” (National Institute of Mental Health, 1984)
- “There is no scientific evidence whatsoever that clinical depression is due to any kind of biological deficit state.” (Ross, “Pseudoscience in Biological Psychiatry: Blaming the Body”)
- “In every instance where such an imbalance was thought to be found, it was later proved to be false.” (Glenmullen, “Prozac Backlash”)
- “We have hunted for big simple neurochemical explanations for psychiatric disorders and have not found them.” (Kenneth Kendler, Psychological Medicine)
Depression outcomes with medication
OK, but what if we accept that even though the drugs are designed to increase serotonin and, even though low serotonin is not associated with depression, they still are effective in helping us manage depression? What if they are poorly understood but still have incredible benefits? That would be great, but research has not shown that to be true.
- For mild to moderate depression, the difference between placebos and antidepressants was “nonexistent to negligible.” (The Journal of the American Medical Association, 2010)
- Paxil “failed to demonstrate a statistically significant difference from placebo on the primary efficacy measures. (GlaxoSmithKline internal memo, 1998)
- Drug companies publish only studies that show benefit, and almost none of the studies that show antidepressants are ineffective. (New England Journal of Medicine, 2008)
- When all available studies are combined, 80% of people get better with just a placebo. (New England Journal of Medicine, 2008)
Antidepressant side effects
All right, you say. But what if I believe in the power of placebo, and antidepressants don’t have side effects, so why not? Well, that’s not true, either. Antidepressants are known to have significant side effects in almost all people who take them.
- 86% of people taking antidepressants have one or more side effects, including sexual dysfunction, fatigue, insomnia, loss of mental abilities, nausea, and weight gain. (New England Journal of Medicine, 2008)
- Fluoxetine “may negatively affect patients with depression.” (Richard Kapit, FDA, 1985)
- On Fluoxetine, patients suffered psychotic episodes, mania, and hypomania. Other side effects included insomnia, nervousness, confusion, dizziness, memory dysfunction, tremors, and impaired motor coordination. (Richard Kapit, FDA, 1985)
- Beginning in the 1990s, Eli Lilly faced lawsuits alleging it failed to warn that Prozac could cause violent behaviors and suicidal thoughts. (Drugwatch)
- Five of the 93 adolescents treated in a Paxil-run study suffered markedly elevated suicide risk versus one in the placebo group. (GlaxoSmithKline internal memo, 1998)
Evidence of brain changes
Perhaps the most concerning concept of all is that antidepressant medication may actually cause chronic depression in some people. There is evidence presented in “Anatomy of an Epidemic” that antidepressants and other psychological drugs actually cause the very problems (plus more) that they are supposed to be fixing. In other words, someone who is suffering an episode of depression who is treated with antidepressants may become chronically depressed as a result of the treatment.
For example, the National Institute of Mental Health found that people who were treated with antidepressants were nearly seven times more likely to become “incapacitated by depression.”
The trouble, according to “Anatomy of an Epidemic,” is that psychotropic “drugs create chemical imbalances in the brain, and this helps turn a first-time customer into a long-term user, and often into a buyer of multiple drugs. The patient’s brain adapts to the first drug, and that makes it difficult to go off the medication.”
Other investigators have reported that “chronic fluoxetine treatment” may lead to a 50 percent reduction in serotonin receptors in certain areas of the brain.
Better off without it?
There is a surprising quantity of research suggesting that we’re better off without antidepressant drugs. It is worth reviewing the data:
- The 18-month stay-well rate was highest for those treated with psychotherapy (30%) and lowest for those treated with an antidepressant (19%). (National Institute of Mental Health, 1990)
- 65% of people who are depressed who are not exposed to psychotropic medications (whether diagnosed or not) had the best outcomes. They enjoyed much better “general health” at the end of one year, their depressive symptoms were much milder, and a lower percentage were judged to still be “mentally ill.” The group that suffered most from “continued depression” were the patients treated with an antidepressant. The “study does not support the view that failure to recognize depression has serious adverse consequences,” the investigators wrote. (World Health Organization)
- Depressed patients who were treated for depression were nearly seven times more likely to become chronically ill than those who weren’t. (National Institute of Mental Health, 1995)
- Those diagnosed and treated with psychiatric medications fared worse – in terms of their depressive symptoms and their general health – over a one-year period than those who weren’t exposed to the drugs. (World Health Organization, 1998)
- Those who take antidepressants were, on average, symptomatic 19 weeks a year, versus 11 weeks for those who didn’t take any medication. (University of Calgary, 2005)
- “The story of research into selective serotonin reuptake inhibitor use in childhood depression is one of confusion, manipulation, and institutional failure,” The fact that psychiatrists at leading medical schools had participated in this scientific fraud constituted an “abuse of the trust patients place in their physicians.” Antidepressant drugs “were both ineffective and harmful in children.” (Lancet, 2004)
What to think about
The purpose of this article is to illuminate the fact that giving our kids antidepressant medication is not a given. Just because antidepressants are commonly prescribed, and are increasingly prescribed to children, does not mean that parents should assume they should do so without evaluating the pros and cons.
I also think it’s worth considering that antidepressants don’t need to be a lifelong prescription. Many psychiatrists will prescribe them for short-term use to help a person get through the worst of their depression before implementing other anti-depression strategies, mainly lifestyle interventions like movement, connection, and sleep.
What to ask
Your child’s health is important! If their physician recommends an antidepressant, they are qualified to evaluate your child’s individual risk factors and should be willing to talk to you in-depth about this decision.
A few questions you can ask in evaluating your child’s possible antidepressant use include:
- Which medication is being prescribed, and why?
- Is this medication being prescribed for short-term use or long-term use?
- What specific outcomes can we expect, and when?
- How will we know if the medication is working or not working?
- When will we re-evaluate the necessity of this medication?
- What other treatments do you recommend for my child’s depression treatment?
Depression is a serious condition that must be taken seriously. The question is not whether to treat depression but how to treat it: with or without medication. Your child may benefit from antidepressants to get through this stage of their recovery. That absolutely may be the best decision right now. But at the same time, consider the power of lifestyle influences on depression. Lifestyle changes that are known to reduce symptoms of depression, often at higher rates than antidepressant medication, include:
- Sleep hygiene
- Emotional hygiene
- Close family connections
- Belonging to social groups
- Meaning and purpose
Also, don’t underestimate the impact your own mental health can have on your child’s mental health. If your child is in therapy, it will help if you pursue therapy or coaching as well. This is a great way to reflect on the patterns in your family and how your behavior impacts how your kids feel. Such self-reflection can have a huge impact on how your child feels. Therapy is not a punishment for being a bad parent. It’s a way for you to continue to learn and grow so you can meet your child’s needs and remain close even as they face their own mental health issues.
Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.
She’s the founder of More-Love.org and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.