A research paper I wrote about antidepressants
|Antidepressants and the Cause of Depression
No single event has been a greater boon to the proliferation of antidepressant medications than the official recognition of depression as a psychiatric disorder in 1980. That was the year that the National Institute on Mental Health, a branch of the National Institute of Health, officially declared that depression was a mental disease. The idea of depression being a physiologically-based illness has been around for time immemorial, thought to be first explored by Empedocles with his Four Humors Theory. It was him who suggested that the body has four essential fluids (black bile, blood, yellow bile and phlegm) that contribute to our mood, based upon the levels of each specific fluid in the body. (Gill) Once the Middle Ages began, this theory fell out of favor in the medical community, and depression was once again regarded as a mere personality defect. This attitude has been the predominant mindset until recent times. This is apparent in a 2004 study, in which MSNBC found that fifty-four percent of Americans surveyed agreed with the statement, “Depression is a personal weakness” (Saltz). This is likely due to a general misunderstanding of what clinical depression really is in society. Many people who have not been affected by the disorder view the increasing information on depression as a marketing ploy by the drug companies to sell people their “snake oil”. Others see something fundamentally wrong with trying to treat a disease called depression with drugs. That may especially ring true with baby boomers from the sixties who used drugs in an attempt to expand their minds, and ultimately ended up with more problems, like addiction, than when they began. In the psychiatric community, however, depression is seen as an imbalance of one or several of the neurotransmitters: Serotonin, Norepinephrine, and Dopamine (Glenmullen, 189). The fact that clinical depression is a physiological and psychological disorder is what ultimately makes the use of drugs to treat depression an acceptable course of actions. Antidepressants, however, do have a great deal of controversy surrounding their use and effects, so it is necessary to have a basic understanding of their physiological and psychological functions in a depressed individual.
The human brain is the most complex organ in the body, consisting of over 10 billion neurons, or brain cells. Neurons communicate and create the perception of thoughts and feelings by sending electrical impulses to other neurons at speed of about 1/5,000th of a second. These electrical impulses are sent from one neuron’s synapse, the part of a neuron that sends and receives the impulse, to another neuron’s synapse by chemical messengers known as neurotransmitters. “Of the 30 or so neurotransmitters that have been identified, researchers have discovered associations between clinical depression and the function of three primary ones: serotonin, norepinephrine, and dopamine,” (All About Depression). Exactly what effect these neurotransmitters have on the brain is not certain at this time. The basic understanding is that dopamine acts as a “reward” to the brain when engaging in pleasurable events such as eating, drinking, and having sex (Dopamine). Norepinephrine is responsible for bringing a person to fight or flight syndrome, which is a mental state during which the mind focuses solely on survival (Norepinephrine). The most important of these neurotransmitters, in regard to understanding depression, is Serotonin. Serotonin acts in a multitude of ways, including learning, sleep, and control of mood (Serotonin). An interesting side note on serotonin is that its molecular structure is similar to lysergic acid diethylamide, which causes speculation that serotonin imbalance may have a large effect on schizophrenia sufferers, whose symptoms are often compared to people on a bad acid trip (LSD). Serotonin’s similarity to LSD indicates that it has a tremendous amount of effect on the mind’s function, a fact that has not been ignored by the makers of antidepressants.
One of the positive, and negative, things about depression finally being recognized as a physiological and psychological disorder is that it allows it to be treated with medication. This has led to massive growth in the industry, which was literally nonexistent in 1980. A recent report by Decision Resources has projected the sale of antidepressant drugs to top $3 billion in America (Waitekus et al.). Another explanation that critics of the pharmaceutical industry like to offer is that these companies are not targeting the physicians who prescribe the medication, but instead go after the potential patients with advertising like the animated Zoloft mascot. A round little man with a rain cloud over his head, is not an advertisement to a medical professional with an understanding of the biology of depression. It is an advertisement that is meant to get patients to ask their doctors for a pill that they may or may not need. By offering vague explanations of depression such as “difficulty concentrating or making decisions nearly every day” (Lexapro), the companies who manufacture and market these drugs frequently sell their product, through requested prescriptions, to people who may have an entirely different disorder like ADD. One of the most commonly overlooked explanations to people with relatively few symptoms of depression is that their problem may be something benign and unrelated, like drinking too much caffeine at night or an emotionally difficult event occurring in one’s life. Nonetheless, the Zoloft man has been partially responsible for his creator’s twenty-three percent market share for SSRI drugs, the most commonly used class of drugs for depression (Clark).
Although many would respond to the previous statement by saying that a doctor should be aware of the effects of a medication and how it would respond with a patient based on their medical history, the truth is that many of the leading researchers in the field of antidepressants have difficulty finding strong trends in the effectiveness of certain drugs over others. One of the largest risks with incorrectly prescribing an antidepressant is the possibility of triggering a latent bipolar disorder. Reports by the manufacturer of the SSRI Luvox, the drug that 17-year-old Columbine shooter Eric Harris was taking at the time of his rampage, claim it “causes four percent of children and youth to experience mania during short-term controlled clinical trials,” (Breggin). The drug companies frequently try to sidestep this issue by offering a form-letter apology that usually ends up stating that the aggressor was probably not taking the medication at the time.
One of the most harmful aspects of America’s growing reliance on antidepressants has been the frequently overlooked cases of antidepressant addiction. Addiction has not been heavily reported upon, likely because of the antidepressant industry’s expected harmfulness. This is based on the trends of cocaine, which was originally prescribed for treatment of depression, before it was found to be addictive. Cocaine is no longer seen as the miracle drug it once was, and many drug companies secretly fear that people may eventually come to see their drugs as equally harmful as cocaine. (Glenmullen, 188) The drug companies try to downplay the risk of addiction by stating in the side-effects information that discontinuation symptoms may “occasionally experience mild symptoms when they stop taking the SRI antidepressants, but imply that tapering off the medication can prevent problems,” (Crenson). People who do experience antidepressant withdrawal report feelings of “flu-like nausea, muscle aches, uncontrollable crying, dizziness and diarrhea”(Crenson). In some of the most severe cases, patients experience “brain zaps”, which is equated to temporarily paralyzing electrical sensations on the back of the head and top of spine. Many physicians are still apparently unfamiliar with this symptom, as can be seen in the frequent misdiagnosis of antidepressant withdrawal being mistaken as a recurrence of depressive symptoms. This is treated with, ironically, more antidepressants and further reliance on the drugs (Crenson).
The general lack of knowledge on antidepressants can be attributed, in part, to the fact that much of the information that physicians receive on the antidepressants they prescribe glosses over, or completely ignores important information regarding safety and side-effects. It also doesn’t help that these pamphlets are usually published by the drug companies themselves, rather than an independent organization. One such instance was in 2004, when Pfizer was forced to pay a $430 million settlement after a Justice Department investigation confirmed accusations that the company had marketed their drug Neurontin for bipolar disorder and depression, while disregarding a Harvard study that showed the drug was less effective than a placebo for treating bipolar disorder and depression. Prosecutors also discovered that Pfizer was providing kickbacks to doctors who prescribed Neurontin to a large number of patients suffering from bipolar disorder. “The kickbacks were expensive travel and entertainment, which the company reported as consulting and medical training,” (Glenmullen, 69-70). By conducting business in an unscrupulous manner through actions like this, the antidepressant industry clearly cannot be trusted to “play by their own rules”, because the stakes for another breach of trust like this can and will likely result in a large number of deaths by people unaware of what dangers may occur by using a drug that was supposed to be safe.
By making weekly therapist follow-up visits after the first 8 weeks of antidepressant use mandatory, many negative reactions to the drugs, such as triggering latent bipolar disorder, can be recognized and treated immediately. It should also be required for all physicians who prescribe antidepressants to be tested regularly, with updated information, to be able to write prescriptions for antidepressants. This would, hopefully, create a greater understanding about the always-changing field of antidepressants and how they affect each individual uniquely.
Even with all of the potential negatives that are connected to antidepressant use, they help many more people than they hurt. Many people who have used antidepressants with a trained physician’s assistance have found that their life starts to improve, and the perpetual hopelessness starts to recede. The real problems arise when a depressed patient finds an incompetent or overworked psychiatrist who may not have the ability or time to help the patient deal with the psychological issues that the patient feels the need to address as a result of the confidence gained from the drug. (Antidepressant Follow-Up). By neglecting to talk out the negative thought processes that may have developed during depression, the patient will probably have little success with the recovery.
Although the current treatment methods for clinical depression are by no means perfect, the medical community has come a long way from just telling a patient to “stick it out”. Depression’s growing recognition as a disease creates a more scientific basis for how to go about treatment. As scientific understanding progresses, treatment will likely become more efficient and less risky. Genetic-specific treatments are one major source for this optimism, as screening individuals on risks of complication with the medication will be drastically reduced, if not eliminated entirely. Until then, it is important to keep a level of perspective on antidepressants; while the manufacturers of these medications are carefully monitored by the Food and Drug Administration and countless scientific journals, they are still a corporation, with the sole intention of turning a profit.
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