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. We are not anti-medication (antidepressants were helpful in my own recovery), but we do believe parents should have access to both sides of the discussion on antidepressants. The purspose of this article is to start conversations, not make a medical recommendation. – Ginny Jones
It is extremely risky to write an article against a commonly-prescribed treatment. Taking medication for mental illness has become a “sacred cow,” protected without question. The most common analogy is that if we had a child who had diabetes, we wouldn’t hesitate to treat with insulin. But the data surrounding antidepressants is nowhere near as solid as that for insulin. In fact, we know very little about the biological cause of depression, how the drugs work, and their long-term impact on our overall health.
We’re taking this risk for exactly that reason. More-Love.org is completely non-revenue. We have no vested interest in any treatment for eating disorders. That is a surprisingly rare thing. For example, the New England Journal of Medicine sought an expert to write an editorial on depression in 2000 and “found very few who did not have financial ties to drug companies that make antidepressants.”
In this article, we present the case against antidepressant medication. Again, this is not because we are anti-medication, but because we 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.”
No evidence of 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)
No evidence of improving depression outcomes
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)
Evidence of severe 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 scariest concept of all is that antidepressant medication may actually cause chronic depression in 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, those of us with depression will become chronically depressed.
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.
Evidence that we’re better without the drug
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)
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 evidence against giving kids antidepressants.
Ginny Jones is the editor of More-Love.org. She writes about parenting, body image, disordered eating, and eating disorders. Ginny is also a Parent Coach who helps parents handle their kids’ food and body issues.