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6 Things You May Not Know About Antidepressants

If you are considering taking antidepressants, I thought I would highlight some areas that GPs will often omit from your consultation.

It is true that antidepressants have been shown to be effective for some people in controlling depression and it is a well known fact that they do not cure depression. They just control the symptoms.

People can and do recover from depression when they learn the skills, habits and thought patterns of people who don't get depressed.

It is clearly personal choice whether or not to consume antidepressants, but in the name of balance, I have set out 6 things that you may not be told by your GP concerning antidepressants, which you may like to take into consideration.

1. Antidepressants can be harmful

All medication, including antidepressant products, carry a risk of side effects – including anxiety and sleep disorders to sexual dysfunction and suicidal thoughts. I think that it's shocking how often doctors don't even discuss the potential for harm with their patients.

Although medical drugs undoubtedly do save many lives, you may not realise that there is a huge financial incentive for drug companies to develop medications that have to be consumed 'for life'. When you are better and no longer need the drug, the manufacturer makes no more money out of you.

But it should be realised that drugs can be dangerous and side effects are not as rare as some people believe.

It is hugely concerning that medicinal drug-induced deaths are now the fourth cause of death in medical settings. [1]

2. The justification for use of antidepressant is unproven

Drug companies currently spend around 3 billion Pounds a year promoting the idea that depression is a purely biological ‘illness’ that can be effectively treated only by (in many cases) long term usage of their products.

There is no evidence, despite the billions spent on marketing the idea, that clinical depression is caused through 'faulty biology' or 'bad genes' [2][3] and this is the first thing I tell my clients.

Some doctors have been encouraged to use the analogy that depression is like Type 1 diabetes – it is not and I tell my clients so. I might also add that all trials of these antidepressants are led by the drug companies themselves, and these trials are not currently independently assessed. These companies can (and do) choose not to publish studies that show only a weak or no advantage of their products over placebo pills. [4]

3. No antidepressant is more or less effective than any other

Despite nearly 40 years of development, no single antidepressant has been shown to be any more effective than any other. So, the newer SSRIs are not more effective or less effective than the older style Tricyclic (TCAs) or Monoamine oxidase inhibitors (MAOIs) of old. [5)[6] The newer ones don't work any better, although some people believe they are less toxic. However, there is evidence that switching between antidepressants to find the one that works best for the individual produces better outcomes overall. [7]

4. Dosage makes no difference to outcome

Sometimes clients tell me their doctor wants them to increase their dosage. In such cases, I generally suggest that if they feel they have to take these products, a lower dosage is always better than higher dosage.

Why? Because it's been found that higher dosage antidepressants make no difference to outcome.[8]

It's a dangerous myth that a person will get better quicker if they are on a higher dosage of antidepressant.

5. Effective psychotherapy is better at preventing relapse than drugs

Effective psychotherapy also changes the way the brain works, but in a good way and without side effects!

Research has found that when a depressed person is taught skills that can be used for life, they are in a much stronger position at preventing relapse into depression over antidepressants. [9]

6. It is common to feel low when coming off of antidepressants

A common withdrawal symptom of coming off antidepressants is feeling low. This is because the brain is trying to adjust to life without the drug. This symptom is often not recognised as withdrawal, and is instead wrongly interpreted as an indication that the person needs to go back to taking the drug, because they are still 'depressed underneath'.

It seems sensible then to wait for the withdrawal symptoms to subside before any decision is made regarding further consumption of these drugs.

I should conclude that taking antidepressants is a personal choice and hope to educate those thinking about taking them or those that have been taking them, of some things that they may not have been made aware of.

I feel that, considering the numbers of patients who are injured or at risk of being injured [10] by taking these medications, there is a duty to provide a counterbalanced view.


(1) See also: Barbara Starfield, MD, Is US Health Really the Best in the World?

(2) See: Antonuccio, David O.; Danton, William G.; DeNelsky, Garland Y. "Psychotherapy versus medication for depression: Challenging the conventional wisdom with data." Professional Psychology: Research and Practice, Vol 26(6), Dec 1995, 574-585. A meta-analysis of over 100,000 pieces of research into the causes, consequences, and best treatments for clinical depression, conducted from 1978-1993.

(3) At least 90 studies have been done to discover what happens when monoamine levels are reduced in people. A meta-analysis of this research was conducted at the University of Amsterdam. It found that there is no evidence that lowered serotonin acts as a depressant. Ruhé HG, Mason NS, Schene AH. Mood is indirectly related to serotonin, norepinephrine and dopamine levels in humans: a meta-analysis of monoamine depletion studies. Molecular Psychiatry. 2007 Apr;12(4):331-59.

(4) Irving Kirsch, PhD. The Emperors New Drugs: Exploding the Antidepressant Myth. Bodley Head (2009).

(6) See: Kirsch, I., & Moncrieff, J. (July 2007). "Clinical trials and the response rate illusion". Contemporary Clinical Trials 28 (4): 348-51.doi:10.1016/j.cct.2006.10.012.PMID17182286. And also see: Kirsch, Irving; Sapirstein, Guy. Listening to Prozac but Hearing Placebo: A Meta-Analysis of Antidepressant Medication. Prevention & Treatment, Vol 1(2), Jun 1998.

(7) See: Equal on average does not mean equal for everyone. And see also the referenced article: K Kroenke et al. Similar effectiveness of paroxetine, fluoxetine and sertraline in primary care. JAMA 2001 286: 2947-2995.

(8) Antonuccio, David O.; Danton, William G.; DeNelsky, Garland Y. "Psychotherapy versus medication for depression: Challenging the conventional wisdom with data."

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