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SSRIs

Antidepressants; Billions of Dollars for a 2.7% Improvement

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There are some treatment approaches that sound good at the onset; find a neurotransmitter that helps to elevate mood and just synthetically increase the level of the neurotransmitter with a drug.

Conduct a few biased trials with the deck stacked in favor of a benefit and start marketing the heck out of the drug.  Prosac was launched in 1988.  There was a 600% increase in the use of SSRIs during the 90’s and the cost to the US in now well into the billions of dollars per year.

But, once we take out the biased research, what are we left with?

How ’bout a 2.7% sustained improvement according to this particular article?

Do you think PCPs are looking their patients in the eyes as they hand them the script with a smile and saying “you’re going to feel almost 3% better as soon as you start taking this!!”  At least until you get bone loss, become obese or develop diabetes.  Then you’re more upset than before you started.  Compare this improvement to use of fish oils, St John’s wort, 5-HTP.  Throw in some exercise and we’re not even in the same ballpark.

I truly think that if the public knew the sordid details about how little benefit we derive from most drugs, the entire industry would fall like a house of cards.

Whey protein rich in lactalbumin increases the ratio of plasma tryptophan – (06-06-02)

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Whey protein rich in lactalbumin increases the ratio of plasma tryptophan to the sum of the other large neutral amino acids and improves cognitive performance in stress-vulnerable subjects

Okay…I know the title is a little difficult to swallow, but there are several important concepts here. First a lesson in biochemistry of neurotransmitters… Tryptophan is an amino acid that crosses the blood brain barrier to get converted to serotonin. Serotonin is a neurotransmitter that plays a major role in mood and satiety. The major class of antidepressants (selective serotonin reuptake inhibitors or SSRIs) increases serotonin’s effects on the brain. However, when tryptophan is absorbed along with a bunch of other large neutral amino acids, passage of tryptophan across the blood brain barrier drops via competition. Hence some of the side effects with those wonderful and safe high protein diets–serotonin depletion from decreased brain tryptophan. Well…this article suggests an alternative method for getting enough tryptophan into the brain in patients under high levels of stress.

AJCN — Abstracts: Markus et al. 75 (6): 1051

Read entire article here

Maternal Selective Serotonin Reuptake Inhibitor Use During Pregnancy – (02-16-04)

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Maternal Selective Serotonin Reuptake Inhibitor Use During Pregnancy and Newborn Neurobehavior

Just the idea that anyone would think these drugs would be okay to take during pregnancy amazes me. Forget the fact that no long term studies have been done to identify any effects.

In this study we find multiple neurological changes in infants born to mothers taking SSRIs. Geez!! The more I think about this the scarier it becomes. It is entirely possibly that these developing infants will develop in the womb with “overexposed” post-synaptic transmission, with the birth and subsequent withdrawal from the SSRIs leading to serious side effects. Ever talked to anyone trying to get off Paxil?? Magnify this in an infants’ brain that has known nothing but a glut of serotonin-mediated activity.

Pediatrics — Abstracts: Zeskind and Stephens 113 (2): 368 –

Read entire article here

TREATMENT WITH MULTIVITAMIN SUPPLEMENT IMPROVES MOOD AND BEHAVIOR – (10-04-04)

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Improved Mood and Behavior During Treatment with Mineral-Vitamin Supplement

What? Oh, I get it. This is one of those “daily vitamin with an extra dose of prosac and celexa.” Right? How else could a multivitamin, something so non-specific, impact a psychological condition? This is just unheard of in the entire realm of psychology, whether at the counselors in the trenches or up to the psychiatrist with the prescription pad.

Unfortunately for them, there is mounting evidence from the medical literature that suggests that many psychological problems actually do have a physiological basis. Nothing we are currently doing is addressing these physiological problems–certainly none of the SSRIs being given like candy actually FIX anything. So here we have something as basic and non-targeted as a multivitamin improving psychologic markers. Add some specific therapies like folic acid or SAM-e and this improvement will increase.

Mary Ann Liebert, Inc. – Journal of Child and Adolescent Psychopharmacology – 14(1):115 – Abstract –

Read entire article here

NUTRITION PLAYS IMPORTANT ROLE IN PREVENTION OF DEPRESSION – (10-15-03)

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Dietary Folate and Depressive Symptoms Are Associated

The authors of this study conclude that “nutrition may have a role in the prevention of depression.” While the impact of nutritional status and psychological health is well established in the medical literature, it’s clinical use is still a rarity. And consider this, if a patient presents to his/her PCP with symptoms consistent with depressive disorder that may have a folate deficiency as a major contributing factor and the patient is put on SSRIs, what about the long term consequences of missing a folic acid deficiency??

This list could include certain types of cancer, heart disease and Alzheimer’s disease. Considering the incredibly low costs of folic acid supplementation compared to all of the psychoactive drugs, might a clinician utilize folic acid as a first approach?

nutrition.org — Abstracts: Tolmunen et al. 133 (10): 3233

Read entire article here

SELECTIVE SEROTONIN AND ADVERSE PREGNANCY OUTCOMES – (05-29-06)

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Selective serotonin reuptake inhibitors and adverse pregnancy outcomes

Some of the SSRIs have been promoted as safe during pregnancy, and yet I have major concerns with the damage to the developing fetus. Anytime a fetus is exposed to high levels of something (such as cortisol from a PTSD mother, glucose from gestational diabetes or, in this case, much higher levels of serotonin) the chance for a bad outcome after birth, when those high levels are no longer present, is there.

From this study, we see the risk to the fetus is actually quite serious. I would also recommend avoiding this class of drugs during breastfeeding as well for the same reasons.

Read entire article here

SEROTONIN AFFECTS PLATELET FUNCTIONING – (10-20-05)

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Association between SSRIs and upper gastrointestinal bleeding

I must admit that this interaction never occurred to me, but it makes sense since platelets use serotonin for proper functioning. With the inhibition of the transporter that platelets use to pick up serotonin, this would affect platelet function. By themselves, the risk is not great, but add aspirin or NSAIDs into the mix, and the risk skyrockets.

Read entire article here

USE OF ANTIDEPRESSANTS AND RATES OF HIP BONE LOSS – (01-26-08)

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Use of Antidepressants and Rates of Hip Bone Loss in Older Women

There has been much controversy lately when it comes to antidepressants. It turns out that many of the clinical trials done on antidepressants were never published because they did not find a positive effect. What a way to paint your product in a better light–keep running clinical trials until you get one that comes out the way you want it to.

The bottom line is that this class of drugs is really effective in only a small percentage of patients. To make this worse, despite widespread availability of neurotransmitter testing to get a much better idea of what’s going on to cause someone to feel depressed, this form of testing is almost never used. So, now we have a clinical trial that finds the use of SSRIs almost DOUBLES the rate of bone loss, leading to a greater risk of developing osteoporosis, which is rapidly increasing in incidence.

Read entire article here