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13 Myths and 13 Truths About Today's Antidepressants
You can thank tuberculosis for the 29 antidepressants we now have on the market.
No, that’s not an urban myth, that’s actually true.
Sixty years ago, a drug called iproniazid was being used to treat tuberculosis. But when the doctors discovered their previously discouraged TB patients dancing in the hospital hallways one evening, researchers began studying its possible impact on depression.
It turned out to be effective in treating depression in many people. Unfortunately, doctors learned the hard way that iproniazid came with a notable danger: if while taking the drug the person drank wine, ate cheese, or consumed any other food that had the amino acid tyramine in it, the person could experience a drastic spike in blood pressure that in some cases resulted in sudden death.
And so the search was on for a drug that could treat depression without running the risk of killing the patient.
Since then, controversy about the use and effectiveness of these drugs has grown about as immense as their popularity, and the conversation around antidepressants has created two distinct camps: one declaring that antidepressants are life-saving and the other insisting they are somewhere between worthless and down right dangerous.
With emotions running high, it’s not surprising that a slew of myths from both sides have crept into social media, making the discussion even more confusing.
In the interest of science and truth, below are 13 of the more popular myths with fact-based commentary that comes from the scientific community and my thirty-plus years as a psychiatric nurse.
MYTH #1: Antidepressants are the best and fastest way to treat depression.
TRUTH: The chances that antidepressants are the “best” treatment for depression are only about 30% statistically.
Research has shown that of those who are clinically depressed, about 30% of them respond best to a consistent exercise routine. Another 30% respond best to cognitive-behavioral therapy. Only 30% respond best to antidepressant therapy.
But for that 30%, antidepressants can be a godsend.
As to their speed, well, antidepressants are anything but fast. Most antidepressants will take at least 1-2 weeks before their effects can be felt by the patient. Sometimes, it’s as much as a month. And for the full effects to be known, doctors ask you to wait 6 weeks.
Once they’ve kicked in, the dose may still need to be adjusted. Since the best rule of thumb for prescribing antidepressants is “Start low, go slow,” your doctor will likely start you on the smallest dose available and then, if necessary, titrate the dose up after she’s seen how you’re responding… which will take more time.
Not exactly a “quick fix.”
MYTH #2: Antidepressants are basically serotonin supplements.
TRUTH: Antidepressants are not supplements. They are highly complex drugs that require careful monitoring by an experienced doctor.
Scientists have not yet found a way of capturing or manufacturing the brain hormones called neurotransmitters (like serotonin, norepinephrine, dopamine) themselves, the way we’ve been able to manufacture insulin (for diabetes) or thyroxine (for hypothyroidism).
They have, however, found a way of making parts of the brain more sensitive to the neurotransmitters that are necessary for strong mental health, effectively increasing the levels that way.
But again, the increase in sensitivity takes time, which is why it takes 2-6 weeks before you really know how the medication is working for any given individual.
MYTH #3: Antidepressants will change your personality
TRUTH: The short answer to this is, No. They will not make you gregarious if you have always been shy or analytical if you have always been intuitive. Your core self will remain entirely intact.
But there’s a much bigger conversation going on about this that’s worth touching on.
Peter Breggin, the brilliant psychiatrist who wrote Talking Back to Prozac and Toxic Psychiatry pondered this philosophical point: when someone is born with a pessimistic view of themselves and the world–a sort of human Eeyore–is that their core personality? Or were they born with a chemical imbalance that is actually hiding their core personality?
The answers to these questions are worth exploring. But I’m a bit more of a pragmatist. So my questions are more like this: Is the person in emotional pain because of a psychological inability to reach their dreams and aspirations? And if so, does that person want to change? If the individual is suffering and wants to increase their ability to do something, I’m in favor of trying to help, as safely and with as much integrity as possible.
MYTH #4: They are addictive
TRUTH: The chemicals that make up antidepressants have no addictive qualities. According to the American Society of Addiction Medicine, one of the key components to addiction is the inability to control one’s behavior. Antidepressants have no such effect on the brain.
In fact, many of my patients on antidepressants report feeling that they have more control over their behavior and lives, not less. They no longer feel imprisoned by the crushing fatigue and brain fog. They feel able to socialize again and be more productive.
It is true, however, that your body may get used to the drug being there (which would be considered more of a physical dependence, not addiction), and that a decrease in dosage may cause you some side effects of withdrawal. So it’s vital that when the time comes for you to stop taking an antidepressant that your doctor taper the dosage down slowly, sometimes over a period of weeks. Stopping abruptly could cause some unpleasant, but temporary, symptoms, such as nausea, diarrhea, headache, lethargy, and other flu-like symptoms.
MYTH #5: Once you start taking them, you have to take them the rest of your life
TRUTH: People who have suffered numerous bouts of depression, and who have also found relief from antidepressants, are usually urged to stay on medication indefinitely. So yes, some people choose to take antidepressants for decades.
But the vast majority of people are on them for only a few months after they’ve achieved remission.
Why is the length of time so important? Because studies have shown that continuing on antidepressants for several months after most of the symptoms are gone decreases the chance of a relapse later on. Stopping the medication too soon could cause a return of the depressive symptoms. And each occurrence of depression makes effective treatment just that much more difficult to achieve.
The more depressive episodes you’ve experienced, the longer you should stay on antidepressants. How long that is, is up to you and your physician. So try not to cut corners by going off the medication too soon.
MYTH #6: They ruin your sex life
TRUTH: Many of these medications effect sexual function in some people, especially at the beginning of therapy. Sometimes it’s nothing more than they cause the sensations in the genitalia to be less intense at the beginning of therapy. But in some cases, antidepressants can cause erectile dysfunction and make it difficult to experience orgasm, even after being on them for a while.
Fortunately, the percentage of people who experience this side effect is fairly low. And if you are not currently active sexually, these side effects may be of little concern to you.
If you are sexually active, and you do have side effects that decrease your ability to participate or enjoy sexual contact, it’s important to be direct with your doctor about this. Solving the problem may be as simple as switching medications.
MYTH #7: They make you gain weight
TRUTH: Some antidepressants cause a change in appetite in some people. For instance, while nortriptyline (Elavil) and fluoxetine (Prozac) might increase it, bupropion (also known as Wellbutrin) often decreases it. Since one of the side of effects of moderate to severe cases of major depression is weight loss, this might not be a bad thing. But as a rule, antidepressants don’t themselves pack on the weight.
However, if you are already overweight or have a medical condition that would worsen with weight gain (such as diabetes, orthopedic problems or cardiac disease), my recommendation is always the same: before you try an antidepressant, get into some kind of exercise program. Get a personal trainer, swim at the Y, ride your bike, or take an exercise class, and see if you’re among the 30% whose depression can be alleviated through exercise.
Regular moderate exercise increases oxygenation to the brain, releases feel-good hormones, improves self-esteem, and helps us connect more with the outside world, all of which contribute to a better mood. By all means, try this for a month and see if it doesn’t brighten your mood considerably!
MYTH #8: They make you feel numb
TRUTH: Usually the opposite is true. Sinking into clinical depression can be so painful, emotions may shut down all together, leaving the person feeling emotionally numb. When the depression begins to lift (through whatever treatment), people often comment that they feel alive again, that they are experiencing color again, instead of everything looking and feeling grey.
It is true that in some people, antidepressants even out some of the highs and lows, and that evening-out can feel strange, perhaps even dull or numb, to someone used to the emotional roller coaster.
MYTH #9: Antidepressants work on all kinds of depression.
TRUTH: Not even close. For instance, depression that is caused by bipolar disorder (previously known as Manic-Depression) must be treated with an entirely different class of medication (such as mood stabilizers or antipsychotics) than those that are used to treat major depression. Antidepressants can actually trigger psychotic episodes in those with bipolar disorder.
Depression due to a loss of some kind, such as divorce, death of a family member, loss of job, etc. is usually best treated with support groups or individual talk therapy, such as Human Needs Counseling or Cognitive Behavioral Therapy. If after supportive counseling the person still feels stuck in their emotional quicksand, a short course of antidepressant therapy can help get them unstuck and moving forward in their healing.
MYTH #10: Antidepressants are like antibiotics–they cure what’s wrong
TRUTH: Depression is nothing like an infection, and antidepressants bear no resemblance to antibiotics. This particular myth probably stems from our society’s penchant for taking something vs. doing something to resolve pretty much any discomfort. Backaches are addressed with muscle relaxants instead of strengthening exercise and stretching. Headaches are addressed with vasoconstrictors and anti-inflammatories instead of meditation and a non-allergenic diet. We’ll throw medications at anything troubling, if we think they have a chance of making it quietly go away.
Depression is much more complex than most people realize. There is a long list of stressors that can cause depression, and in most cases, it’s not one but several that are involved. Maybe it starts out as feeling unattractive after a break up, but picks up steam when the person also has lost self-esteem because the relationship had been abusive. And maybe, because of the abuse, the person now has terrible anxiety about trusting people and no longer believes in their own lovablility. And all of that together causes so much pain, the person tries everything they can think of to relieve the pain… including behaviors that are actually far more destructive than they ever are helpful.
In my 30+ years of working with depressed and traumatized people, this complex storyline is the norm, not the exception. Medication alone might be a good place to start, but it’s not going be enough to get this person safely to the other side of this crisis. The person also needs education and coaching to have a good chance at fully recovering.
MYTH #11: Once you feel better, you can go off the medication
TRUTH: Most doctors recommend staying on antidepressants for at least 6 months, to allow the brain to adapt to the higher level of sensitivity. And as stated earlier, discontinuing antidepressants too soon can set you up for a recurrence of the symptoms.
Once you and your doctor have settled on the right antidepressant for you, and your symptoms have resolved, the general consensus is that patients should stay on an antidepressant for at least a year. That way, your brain has the chance of adapting and sort of “locking in” the changes, decreasing the chances of remission. If this is your first depressive episode, stopping treatment sooner than 6 months may increase your risk of your symptoms returning. If it’s your second or third, most doctors recommend at least a full year.
MYTH #12: The side effects are worse than the depression
TRUTH: As someone who has herself suffered bouts of severe depression, I’d have to say that nothing is worse than depression.
But more to the point, it is true that antidepressants may cause uncomfortable side effects in some people.
For instance, in some cases antidepressants can briefly cause or intensify thoughts of suicide. Antidepressants across the board often cause dreams to become quite vivid, sometimes even a bit “wild.” I always found it more entertaining than disturbing, but it’s different for everyone.
Tricyclics (TCAs) side effects tend to be along the lines of dry mouth, dry nose, dry skin, blurred vision, urinary hesitancy, weight gain, drowsiness, and/or constipation. Selective Serotonin Reuptake Inhibitors (SSRIs) sometimes cause agitation, anxiety, irritability, jitteriness, confusion, headache, reduced sexual desire or ability to perform, insomnia, change in weight, diarrhea and/or nausea.
But it is also true that many people have few, or no, side effects while on them. There’s no way to know ahead of time whether you might experience side effects or not, and if so, what exactly those might be.
MYTH #13: They’re all about the same. So if one doesn’t work, none of them will.
TRUTH: There are 29 separate antidepressant formulas on the market that fall into one of 7 different drug classes:
- Monoamine oxidase inhibitor
- Norepinephrine and dopamine reuptake inhibitor
- Serotonin and norepinephrine reuptake inhibitor
- Selective serotonin reuptake inhibitor
- Tricyclic antidepressant
- Tetracyclic antidepressant
Each drug class works differently in the brain, and even drugs within the same drug class have chemical differences. For instance, citalopram (Celexa) and escitalopram (Lexapro) are both SSRIs and chemically very similar. And yet, people react very differently to each of them. Many patients have told me that they’ve tried both and found that one of them gives them great relief while the other hardly affected them at all.
There’s no way to predict how each individual’s brain will match up with any given antidepressant.
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