Psychological side-effects of anti-depressants worse than thought

[Ecoclimber]

Date:February 25, 2014
Source:University of Liverpool

Summary:
Thoughts of suicide, sexual difficulties and emotional numbness as a result of anti-depressants may be more widespread than previously thought, a researcher has found. In a survey of 1,829 people who had been prescribed anti-depressants, the researchers found large numbers of people -- over half in some cases -- reporting on psychological problems due to their medication, which has led to growing concerns about the scale of the problem of over-prescription of these drugs.

A University of Liverpool researcher has shown that thoughts of suicide, sexual difficulties and emotional numbness as a result of anti-depressants may be more widespread than previously thought.

In a survey of 1,829 people who had been prescribed anti-depressants, the researchers found large numbers of people -- over half in some cases -- reporting on psychological problems due to their medication, which has led to growing concerns about the scale of the problem of over-prescription of these drugs.

Psychologist and lead researcher, Professor John Read from the University's Institute of Psychology, Health and Society, said: "The medicalization of sadness and distress has reached bizarre levels. One in ten people in some countries are now prescribed antidepressants each year.

"While the biological side-effects of antidepressants, such as weight gain and nausea, are well documented, the psychological and interpersonal effects have been largely ignored or denied. They appear to be alarmingly common."

Each person completed an online questionnaire which asked about twenty adverse effects. The study was carried out in New Zealand and all of the participants had been on anti-depressants in the last five years. The survey factored in people's levels of depression and asked them to report on how they had felt while taking the medication.

Over half of people aged 18 to 25 in the study reported suicidal feelings and in the total sample there were large percentages of people suffering from 'sexual difficulties' (62%) and 'feeling emotionally numb' (60%). Percentages for other effects included: 'feeling not like myself' (52%), 'reduction in positive feelings' (42%), 'caring less about others' (39%) and 'withdrawal effects' (55%). However, 82% reported that the drugs had helped alleviate their depression.

Professor Read concluded: "While the biological side-effects of antidepressants, such as weight gain and nausea, are well documented, psychological and interpersonal issues have been largely ignored or denied. They appear to be alarmingly common."

"Effects such as feeling emotionally numb and caring less about other people are of major concern. Our study also found that people are not being told about this when prescribed the drugs.

"Our finding that over a third of respondents reported suicidality 'as a result of taking the antidepressants' suggests that earlier studies may have underestimated the problem."

Adverse emotional and interpersonal effects reported by 1829 New Zealanders while taking antidepressants
John Read Claire Cartwright Kerry Gibson
Received 15 October 2013; received in revised form 21 January 2014; accepted 27 January 2014. published online 18 February 2014.

Abstract
Background
In the context of rapidly increasing antidepressant use internationally, and recent reviews raising concerns about efficacy and adverse effects, this study aimed to survey the largest sample of AD recipients to date.

Methods
An online questionnaire about experiences with, and beliefs about, antidepressants was completed by 1829 adults who had been prescribed antidepressants in the last five years (53% were first prescribed them between 2000 and 2009, and 52% reported taking them for more than three years).

Results
Eight of the 20 adverse effects studied were reported by over half the participants; most frequently Sexual Difficulties (62%) and Feeling Emotionally Numb (60%). Percentages for other effects included: Feeling Not Like Myself – 52%, Reduction In Positive Feelings – 42%, Caring Less About Others – 39%, Suicidality – 39% and Withdrawal Effects – 55%. Total Adverse Effect scores were related to younger age, lower education and income, and type of antidepressant, but not to level of depression prior to taking antidepressants.

Conclusions
The adverse effects of antidepressants may be more frequent than previously reported, and include emotional and interpersonal effects.

Keywords: Antidepressants, Depression, Adverse effects

 

[A.B.]

Over half of people aged 18 to 25 in the study reported suicidal feelings and in the total sample there were large percentages of people suffering from 'sexual difficulties' (62%) and 'feeling emotionally numb' (60%). Percentages for other effects included: 'feeling not like myself' (52%), 'reduction in positive feelings' (42%), 'caring less about others' (39%) and 'withdrawal effects' (55%). However, 82% reported that the drugs had helped alleviate their depression.

Very odd. They say it has helped their depression, but report depressive symptoms.

 

[Valentijn]

Very odd. They say it has helped their depression, but report depressive symptoms.

 

[Helen]

In this critical lecture about Big Pharma , also the side-effects of SSRI medications are discussed.

 

[peggy-sue]

I certainly experience all these side-effects from the 10 mgs of citalopram I take.

I feel a great deal of both the positive and negative emotional effects do come from "caring less".
Suicidal ideation is easier, as would carrying it out be, because you care less about whether you live or die.

But the lack of love-life is the worst bit. That affects relationships in a very detrimental way.

But it does fix serious depression - the total anhedonia which makes every second you live utterly unbearable.
It's far easier to deal with a few depressive symptoms you don't care about too much, than it is to deal with full blown clinical depression.

 

[anciendaze]

peggy-sue, what you are calling anhedonia sounds like severe dysphoria, which really can precipitate suicide. Anhedonia is the absence of appropriate positive emotions, while dysphoria is very much a kind of non-localized pain.

One particular comment about the numbers being reported here. In the literature for testing of antidepressants which have actual been approved and widely used, the percentage of patients who respond is seldom much over 30%. There are few studies of really long-term response, but doctors routinely notice that a drug has stopped working, and switch to a different one. Patients on long-term maintenance may have a list of 30 medications which have either flatly failed or lost effectiveness over time.

Comparing these numbers with percentages of adverse responses above should have a sobering effect on doctors who routinely prescribe antidepressants without close monitoring of patients.

 

[peggy-sue]

Anhedonia is being unable to feel anything. Nothing at all. No ups no downs.
Food has no taste; there is no joy, no sadness, just unending, agonising, infinite tedium.
If I had been told I'd won the lottery, I wouldn't have bothered to check it or collect it.
If my cat or somebody very close to me died, I was merely jealous.
The first waking thought was; "oh shit, what the heck did I do that for." (wake)

I can remember being flopped at the bottom of the stairs, having got up and dressed and downstairs, but I simply couldn't work out where to go next. I was very uncomfortable, but couldn't be bothered moving to get comfy.

Michael tried to cheer me up by saying; "We're going on holiday in threee months time!".
That made things worse. I didn't want to have to live through the afternoon, far less another 3 months.

My current suicidal "ideation" is of a more practical nature. More about investigating methods and deciding which would be easiest and planning to get them organised for if/when I might need it.

My lack of caring worries me. Before the pills, I was really good about putting an injured mouse out of its misery if Muzzy brought one in. I overcame my revulsion, would get it from her and could kill it quickly. I'm afraid that since I've been on the pills, I chase them both outside. I put my revulsion before the animal's suffering. I do still capture uninjured ones in a humane trap with peanut butter and put them back putside.
This worries me, because it's not me to be like that.

I have had severe clinical depression several times, before and after ME. I'm quite aware of how it builds and what all the stages feel like.

Perhaps I don't know all the names of the labels folk who haven't had it have come up with.

But I have checked dysphoria - that is the opposite of euphoria, it's depression, down feelings.

Anhedonia is NO feelings, and that is far worse that at least being able to feel sad or unhappy.

 

[anciendaze]

I've been there, and I have to say that some of this does worry me. "Pragmatic" suicidal ideation is a very troubling indication. So is depersonalization, which seems to connect with behavior being "not me to be like that". Hang in there.

 

[peggy-sue]

I have a whole load of tablets saved up that will do the job, in combination with each other.
(gps shouldn't go around prescribing useless loads of antidepressants willy-nilly, when they are not required).

But it won't be pleasant. I had always thought I would try to get hold of some ******** pills (I know which ones, but won't say so out loud) in conjuction with a bottle of vodka - but Michael objects to the notion of me having alcohol - even if it is to do away with myself! (I'm a non-practising alcoholic).

Investigations since have convinced me that *** might be the nicest way to go. I saw Michael Portillo trying out one (while investigating "humane" methods for executions) and he had to be rescued from it, he was enjoying it so much.

I take it my practical side of this is what you mean by "pragmatic"?
I find it comforting to know I have the means, should I ever need it.

I am not currently planning to use any means to do away with myself, I have loads of things to look forward to.

 

[caledonia]

I'm not surprised. If you think ME/CFS is a rabbit hole, psych drugs are a whole other one.

After I went through horrible Zoloft withdrawal that wiped out almost a year of my life and almost killed me, I did a lot of research on these drugs. Doctors prescribe them like candy for psych and non-psych problems alike. Many people on here are on them for pain and sleep and might not even realize they're taking a psych drug.

You can have side effects just starting them, side effects while on them, side effects when they "poop out", and side effects during withdrawal. This is the drug industry's dirty little secret.

Nobody should be on these drugs. Fortunately, there is an alternative, which is methylation treatment. Psych problems are caused by poor methylation, so treating that should fix it. The trick is tapering off the psych drugs, which, for some, can be difficult and take a very long time. But people are doing it successfully - see the Paxil Progress forum for more info.

Also see this article which explains how methylation can be used to treat psych problems. http://metabolichealing.com/mental-illness-or-methylation-mutation/

Note, the people at Paxil Progress don't understand or believe in methylation, just in tapering off the drugs onto nothing and then doing talk therapy to deal with mental problems. So they can only be helpful for a taper.

 

[Hip]

Why was there no control group in this study? They are reporting high percentages of various negative effects in depressed patients taking antidepressant drugs, but the question is, how many equally depressed people who were not prescribed antidepressants also developed these negative effects?

I am not arguing that antidepressants do not cause adverse effects. I myself experienced these adverse effects first hand when I took an SSRI and immediately experienced an intense suicidal ideation. After this ordeal was over (when the drug left my system by the next day), it made me appreciate exactly how SSRIs can precipitate suicide in people, which they are well known to do (there is a black box warning now on all SSRI drugs indicating that they can cause suicidal thoughts as a side effect in some cases).

Very odd. They say it has helped their depression, but report depressive symptoms.

A medication can help depression, but not eliminate it; so therefore you still report depressive symptoms, even though you have obtained some improvement in your depression.

 

[Ecoclimber]

Oh joy, from the APA standpoint, a Win/Win. Just think of all those extra categories of dysfunction that can be added now to the patient's chart under DSM-V and of course the extra therapy sessions! Of course we all know the reason why depression continures; you are increasing your 'false illness belief' by not following proper procedure.

The Gulf War Veterans will be thrilled with this disclosure given the fact that they are given anti-depressants as a recommended primary treatment for their 'false illness belief' CMI.

Unfortunately, most GPs' do not have the in-depth pharmcalogical background and understanding in regards to the interaction of anti-depressants and a patient's metabolism. Pyshchiatrists with Pharmaceutical background PhD would be best. With an organic disease such as ME/CFS, Fibro, GWI etc., it should be used as an adjunct if needed, not as a primary tool for treatment.

 

[Hip]

@peggy-sue

I was in a very similar state for several years, with severe anhedonia, and on top of that, severe anxiety. My ME/CFS seemed quite easy to deal with in comparison.

Anhedonia is strongly linked to suicidal ideation. I once experienced clinical depression for a couple of years (a long while ago), but during that period of depression, I never remotely thought about suicide. It never once entered my head. But that is because my clinical depression at that time did not involve anhedonia.

But when I developed anhedonia alongside my ME/CFS and generalized anxiety disorder, there was not one hour in the day that I did not think of suicide. It was constantly on my mind; I constantly had the desire not to be alive. I also have a file of all the suicide methods that I had researched, as I also found it comforting to know I have the means.

The drug that helped get me out of this dire anhedonic state was very low dose amisulpride. I view amisulpride as a bit of a wonder drug. At full doses, amisulpride is actually an atypical anti-psychotic, used for schizophrenia; but at very low doses, amisulpride functions differently in the brain, and acts as an antidepressant.

Amisulpride is particularly good for anhedonia, and I think much of the credit for getting me out of the hellish state of anhedonia I had for years goes to amisulpride.

The daily dose of amisulpride I take is only 12.5 mg (a tiny fraction of the 400 mg to 1200 mg dose used for anti-psychotic purposes). This very low dose amisulpride not only improves my anhedonia, but has a number of other benefits. I found amisulpride reduced my anxiety, fatigue, noise sensitivity, ADHD and irritability symptoms, and improved my sociability (I had more desire to socialize). The only side effect I noticed was some loss of libido. This loss of libido is due to the fact that amisulpride lowers prolactin a little (the supplement pantethine may prevent this).

Amisulpride also seems to provide a mood boost that feels very natural. Before I discovered amisulpride, I used to use the tricyclic antidepressant imipramine (similar to amitriptyline). This helped, but the mood boost imipramine gave felt somewhat unnatural and synthetic. I also felt with imipramine that it caused parts of my mind to become mood boosted, but other parts of my mind remained depressed. So imipramine gave me an unbalanced and uneven mood boost that did not feel natural.

Whereas amisulpride gives me a clean, balanced, and natural boost in mood. Amisulpride does not feel like a drug, it just feels like you old self is returning a bit.

I should reiterate that although amisulpride is an anti-psychotic drug at high doses, it does not act as an anti-psychotic at lower doses. At lower doses, amisulpride has a completely different mechanism of action, and acts as an antidepressant. So if you take amisulpride at very low doses, you are not really taking an anti-psychotic drug.

I am certainly not fully cured of anhedonia, but I do now experience much more of the normal little daily pleasures and rewards that mentally healthy people take for granted.

You might want to try amisulpride.

This Drug Interaction Checker found no interaction between amisulpride and citalopram (but obviously check with your doctor first).

I also started a thread on amisulpride for ME/CFS here.


The other factor that I think may have played a role in improving my anhedonia symptoms is the set of anti-inflammatory supplements I used as a radically alternative treatment for my anxiety disorder. These supplements (which are listed in my thread here), dramatically reduced my anxiety levels within hours, by an anti-brain inflammation mechanism, I believe.

Now, since brain inflammation has been linked to a number of mental conditions, including depression, it makes sense that reducing brain inflammation by anti-inflammatory supplements may also help with reducing anhedonia (as anhedonia is often found in depression).

 

[taniaaust1]

I have a whole load of tablets saved up that will do the job, in combination with each other.
(gps shouldn't go around prescribing useless loads of antidepressants willy-nilly, when they are not required).

But it won't be pleasant. I had always thought I would try to get hold of some ******** pills (I know which ones, but won't say so out loud) in conjuction with a bottle of vodka - but Michael objects to the notion of me having alcohol - even if it is to do away with myself! (I'm a non-practising alcoholic).

Investigations since have convinced me that *** might be the nicest way to go. I saw Michael Portillo trying out one (while investigating "humane" methods for executions) and he had to be rescued from it, he was enjoying it so much.

im not sure if this is a good thing to say or not but dont want to not say anything at all to your post. Even "nicest way to go" ways can fail and the after effects can lead a person to even more suffering.

When I was in the ICU due to my own suicide attempt, there was a person who had choosen to overdose on meds to commit suicide in a "nice" manner and someone had found her before it was too late. The anti-depressent drugs she had taken had left her on life support (she was fully conscious thou on it and hooked up to all this equipment so she couldnt get out of bed.. she in fact had ruined her body soo much by what she'd done that she couldnt physically get herself out of bed either even without being hooked up to a big equipment stuff. She really really regreted what she'd done and it was too late..she was severely damaged.

After a week of being trapped in bed unable to get out.. they put her in a wheelchair (strapped in) for a short time to allow her husband and young children to push her out of the ward and down the hospital cooridoor for 5mins or so..even for that she had to be hooked up to things (and had to be on oxygen with a tank with her etc). Her heart had been damaged by her suicide attempt. Her body was never going to recover. She spent a lot of time crying over what she'd done to her body.

 

[Martial]

I had a lot of issues after being on cilitopram for over 4 years previously, I had pretty bad sexual difficulties and high emotional blunting, thankfully no suicidal impulses or ideation though.. The issue is sometimes the effects can be extremely insidious for example depression itself can cause suicidal action, sexual dyfunction, anahondia etc..

Sadly most doctors are told a kind of glorified story about the effects of these drugs without being informed of the more adverse side effects that happen..

Dr. David Burn's wrote a wonderful article called Placebo nation that discusses a lot of this, and the sleek sexy mis informed adverts of big Pharm companies

 

[rosie26]

In the first year of ME I was given Prozac and then Aropax.
Prozac was like being given a lead coat to wear - on top of my severe ME symptoms ( it was sadistically bad ).
Aropax had me laughing at nothing, and it was too strange, all the while suffering severe and distressing physical symptoms of ME at the same time.

I suffer a lot from depression off/on as a result from suffering a long drawn out physical illness. I scrape through. I wish I could manage it better. I think what makes it more difficult is the neurological head inflammation we get in ME - I find it hard to think things through properly, I really struggle with my emotions as I have a lot of neurological sensitivities, hypercusis, misophonia, allodynia, visual and others that I can't think of right this minute and that heightens my reactions to things. It's like I feel things 10 times worse or more.
I really hope we get some good findings from the researchers this year. It would just be great.

 

[barbc56]

One factor to keep in mind is that when someone starts taking an AD, energy usually improves before mood so for some people this may be a time where the risk of suicide is greater as you are able to follow through on any suicidal thoughts.

Unfortunately, it's hard to predict who will do well on what type of AD, so part of recovery may necessitate the frustrating process of trying different medications or changing dosages. Predicting who will do well on an AD has become an exciting area of research but may take time as prospective studies are needed.

This is why monitoring progress of patients is so important.

And as @Ecoclimber says, it's better to see a psychiatrist than a GP.

Barb

 

[adreno]

This is a thrash study. There is no way to discern whether the ADs caused these issues, or whether it was caused by depression or other factors. Just sensationalism. Move on.

One potential problem with ADs are that they are usually overdosed (to make sure they work). A lower dose is often enough to lift the depression without causing severe side effects, a quarter to half the recommend dose will often do.

Another way to counteract side effects is to combine the SSRI with a drug that increases DA/NE. The emotional blunting and libido loss is often caused by the suppression of dopamine and norepinephrine by serotonin. Ironically, many with ME/CFS have high sympathetic activity and might actually benefit from this suppression in other ways; you can't win them all. Contemporary drugs are not region specific, but works across the whole brain. This causes both wanted and unwanted effects. The interactions between neurotransmitters are very complex.

There are also differences between SSRIs, they do not all work the same. Some have anti-cholinergic properties which can certainly cause sexual side effects. Others affect sigma receptors or others. I like fluoxetine because it is also a 5-HT2C receptor antagonist, which cause release of dopamine. I get no sexual side effects from this, but sertraline made me feel like I injected anesthesia directly into my penis. Overall my emotional reactivity and stress response is much improved on the SSRI. It also ensures that my sympathetic system doesn't get out of control.

 

[A.B.]

Or perhaps antidepressants barely work at all, and are just another hyped up pseudotreatment for "psychological" problems.

As described in a Medscape article, a 2010 review of four meta-analyses of efficacy trials submitted to the US Food and Drug Administration (FDA) suggests that antidepressants are only “marginally efficacious” compared with placebo and “document profound publication bias that inflates their apparent efficacy.”6

In addition, when the researchers also analyzed the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, “the largest antidepressant effectiveness trial ever conducted,” they found that “the effectiveness of antidepressant therapies was probably even lower than the modest one reported…with an apparent progressively increasing dropout rate across each study phase.

“We found that out of the 4041 patients initially started on the SSRI [selective serotonin reuptake inhibitor] citalopram in the STAR*D study, and after 4 trials, only 108 patients had a remission and did not either have a relapse and/or dropped out by the end of 12 months of continuing care,” lead study author Ed Pigott, PhD, a psychologist with NeuroAdvantage LLC in Clarksville, Maryland, told Medscape Medical News.

“In other words, if you're trying to look at sustained benefit, you're only looking at 2.7%, which is a pretty jaw-dropping number,” added Dr. Pigott.

Overall, “the reviewed findings argue for a reappraisal of the current recommended standard of care of depression,” write the study authors.

http://mpkb.org/home/othertreatments/antidepressants

Link to the actual study
http://www.karger.com/Article/FullText/318293

 

[adreno]

Or perhaps antidepressants barely work at all, and are just another hyped up pseudotreatment for "psychological" problems.

Well, we do know that SSRIs increase serotonin in the brain. Whether this will help your depression or not, is an individual question. We also know that stress and depression causes damage to neurons in the hippocampus, and the SSRIs partially reverses this damage. But a big problem is that there is no concensus of what causes depression, and that makes it hard to treat. Likely there are several pathways that lead to depression, and SSRIs isn't going to help all of them.