Wednesday, December 23, 2009

Depression is Big Business

What is Depression ?

The term "depression" is descriptive and vague. I believe the whole concept of depression is flawed and needs to be revised. The term “depression” does not point to one discrete disorder but to a variety of unpleasant experiences common to all humans. When the term “depression” is used without qualification, it is usually misleading. Since antidepressant drugs have become a big business, the promotion of "depression" as a widespread illness, treatable with drugs has become a scandalous marketing enterprise with little or no merit. Although the term “depression” was an invention of psychiatry the use of the term is pervasive in medicine, the media and in folk psychology. Writers, TV journalist and MDs  have been talking about “clinical depression” as if “clinical” increased the credibility of this dubious term. The best use of the term “depression’ is to point to someone who is unusually and chronically sad, critical and angry; a person who withdraws from work, play and close relationships with other humans.

There are eight circumstances that cause sadness, anger and sustained dysphoria:

1. The inhalation, ingestion and injection of bad chemicals

2. Chronic illness

3. Oppression and abuse

4. Wrong food

5. Too little exercise

6. Noise, clutter and poor living conditions

7. Information noise and confusion

8. Loss of persons, property and prestige

All humans are involved in competition and negotiation with other humans. If you are losing a competitive struggle, you feel, sad and angry, sometimes with a terrible sense of loss; you want to withdraw, hide, cry and sometimes you want to die. If you habitually lose competitions or have an effective oppressor close by, you often feel dysphoric. We can call this social inhibition, oppression or suppression rather than depression.

Physicians have routinely prescribed drugs to patients who were sad, discouraged and thought of suicide. None of the drugs prescribed have reduced the overall suicide rates and new evidence suggests that some antidepressants increase the risk of suicide. For patients who died of an overdose, the prescriptions took on the ominous aspect of tools of self-destruction. The prescribing physician becomes an accomplice in the patient’s death.


Antidepressants were a hard sell until recently. Although many drugs in this class modified the behavior of patients, their slow action and many side effects were negative features. The introduction of a “new class” of antidepressants that increase serotonin activity, led by Prozac changed the market for psychotropic drugs. The effects of Prozac on “personality” were widely publicized and drug companies advertise indirectly and, more recently directly to the consumer, relegating physicians to the role of middleman. The patient now demands the prescription and the doctor complies. The consumer hopes that Prozac and related drugs can increase energy, confidence and assertiveness. “Shy” people were added to list of potential customers.

Although writers such as psychiatrist Peter Kramer (Listening to Prozac) suggested that the patient's interest in personality changing drugs was a new market force, nothing new really happened; it is the same old interest in psychotropic drugs but the names, the players and the prices changed. Cocaine outsells Prozac, but the profitability of prescription antidepressant drugs is outstanding.

Goodman, Chair of the US Food and Drug Administration (FDA) Psychopharmacologic Drugs Advisory Committee made a public statement in 2006 that claims in drug monographs and advertising that selective serotonin reuptake inhibitor (SSRI) antidepressants work by normalizing serotonin levels are not based on scientific evidence and should be prohibited. Moynihan and Cassels described the drug industry's marketing tactics. With obscene profits from drug sales; a drug company can afford to control the naming and perception of diseases by physicians, government, and consumers. They create drug demand by advertising to consumers and doctors at the same time. For example, Cohn & Wolfe Healthcare, SmithKline's PR firm created “social phobia disorder” treatable with Paxil, which became the world's best-selling antidepressant, earning US$3 billion annually.

Brain Drugs -- Benefit or Harm?

A review of data, just published, from the US Women's Health Initiative study (involving 136,293 postmenopausal women) revealed that , 5496 women taking drugs from the two major antidepressant groups, tricyclic antidepressants (TCI) and selective serotonin-reuptake inhibitors (SSRI), had increased all-cause mortality; SSRIs users had a 45% increased relative risk of incidence stroke and a 32% increased risk of death with a higher incidence of hemorrhagic strokes. The incidence of stroke per 1000 person-years with no antidepressant use was 2.99; the incidence for SSRI users was 4.16 for. Death rates for per 1000 person-years were 12.77 for SSRI users and 14.14 for TCI users, compared with 7.79 for non–antidepressant users. Studies of this nature cannot differentiate the negative effects of dugs from the underlying disease processes. In medical talk, depression has assumed a false reality, becoming a malevolent agent that acts upon its victim. While sad, tired and angry people are real, depression is not real and is not a cause of something else such as a stroke. My conclusion is that antidepressant drugs are potentially harmful and can add to the existing pathologies that they pretend to treat

Antidepressants are chemicals that are added to a dysfunctional chemical mix that caused dysfunction and dysphoria in the first place. Few patients make any effort to alter their disease-causing lifestyle and few physicians make any effort to investigate and improve the patient’s chemistry overall. Psychotropic drugs are added to the dysfunctional chemical mix and its effects merge with coffee, alcohol, the chemistry of food additives, and contaminants, sugars, food allergy and airborne neurotoxins that act on the brain.

New problems added by the prescription chemical may suddenly emerge such as unexpected bursts of anger and aggression or increased tendency to have violent suicidal thoughts. One young woman reported to me that after taking Prozac for two weeks, she had threatened her live-in boyfriend with hammer, chased him into the bathroom and attacked the closed door, smashing holes in the door until she more or less recovered composure. Her boyfriend fled the apartment and never returned. The boyfriend was domineering and verbally abusive, as boyfriends sometimes are, but the pre-Prozac young woman was usually compliant and never had a violent temper. Her Prozac rage is an example of chemically triggered behavior. Prozac may provoke agitated preoccupation with suicide or violence directed against others. The drug facilitates the rage response, as do most of the drugs that suppress appetite. Up to 73% of patients taking antidepressant report sexual dysfunction, such as diminished sexual desire, delayed sexual arousal, and muted or absent orgasm.

Fisher suggested that these drugs blunt emotions and interfere with forming and maintaining meaningful relationships. When men and women take serotonin-enhancing drugs and fail to achieve orgasm, an important feature of pair bonding fails. You would not be surprised to learn that a woman taking Prozac decided to divorce her husband, stating that she no longer loved him. After she stopped taking the drug, she loved him again and stayed married.

Prozac can facilitate the rage response and may lead to acts of aggression and violence that otherwise would not occur. Prozac also inhibits appetite for food and sexual appetites; sometime useful effects, but not always. In Canada, three similar antidepressants were among the top-selling drugs; these are Prozac, Paxil, and Zoloft. Lauren Slater called Prozac the "Big Mac of Medicine" because of its popularity and the faddish consumer appeal based on the futile hope that a drug could resolve human suffering. She described the dramatic and brief benefits of taking Prozac: "those first few mornings were fairy tales, tall tales, replete with all the bent beauty of a New World." Her story is not simple, however and the long-term effects of taking the drug are mixture of benefits and negative effects. The initial recovery from depression is not sustained and a three or four phase sequence can often be discerned, beginning with an initial improvement that occurs in the first 2 to 4 weeks. The statement “the first time was the best time" applies to most, if not to all psychotropic drugs.

In Slater's experience, Prozac removed her sexual drive, blunted her creativity and reduced her appetite. The underlying problems are many and begin with the lack of specificity of the drug. Prozac blocks Serotonin re-uptake and in stage 1 of its activity, probably increases serotonin receptor activity in all areas of the brain. Serotonin synapses are not all conveniently arranged just to alleviate depression and a whole complex of unrelated functions are affected. The brain is not passive and changes to offset or accommodate the drug activity; the effects then shift to an adapted state, different from the initial drug-dependent state. The person taking the drug has also shifted in terms of behavior and learning and may be learning new skills and, at the same time, coping with new problems such increased anger, loss of libido and blunted feelings.

Martin Enserink reviewed the development of antidepressant drugs and stated: ‘Antidepressants have evolved through several generations since the 1950s, each a “huge improvement” over its predecessor--or so advocates have claimed. But a government-sponsored study published last month confirmed what other analyses had shown before: The fashionable antidepressants of the 1990s are no more effective than those of previous generations. The study, a meta-analysis commissioned by the Agency for Health Care Policy and Research (a part of the Department of Health and Human Services, USA) and carried out by the Evidence Based Practice Center in San Antonio, Texas, looked at 315 studies carried out since 1980. It focused primarily on the hottest pills that have hit the market since 1987, the "selective serotonin reuptake inhibitors" (SSRIs), a group that includes such brands as Prozac, Paxil, and Zoloft. The study found that on average, about 50% of patients in SSRI treatment groups improved, compared to 32% in placebo groups. But in the more than 200 trials that compared new drugs with older ones, the two classes proved equally efficacious. Because the newer drugs appear to have less severe side effects, however, patients may be able to stay on them longer. The failure to find evidence of progress is disappointing, scientists admit. And one of the biggest disappointments is that researchers still don't understand what causes--or relieves--depression. Most antidepressant drugs are based on the assumption that depression results from a shortage of serotonin or norepinephrine in the brain. Both are neurotransmitters, chemical messengers that cross the synapse, the cleft between two nerve cells. The first generation of antidepressants, discovered during the early 1950s, the MAO inhibitors, block monoamine oxidase, an enzyme that breaks down serotonin and norepinephrine. This allows the neurotransmitters to linger in the synapse, increasing their effect. Another type of drug discovered in the late 1950s, the tricyclics, prevents the nerve cells that excrete the neurotransmitters from mopping up these compounds shortly after they are released. Blocking "reuptake" also prolongs their effect. Because studies pointed to serotonin shortage as the main culprit in depression, industry developed the selective reuptake inhibitors, which now dominate the market.”

Data from United Kingdom's General Practice Research Database of 6.4 million patients were used to discover a relationship between antidepressant use and diabetes 2: 165,958 patients were identified who received at least 1 new prescription for an antidepressant between January 1, 1990 and June 30, 2005. The researchers conclded that taking moderate to high daily doses of antidepressants for more than 2 years is associated with an 84% increased risk for diabetes.The increased risk was particularly notable for the selective serotonin reuptake inhibitor (SSRI) paroxetine and the tricyclic antidepressant amitriptyline. Another study, the Diabetes Prevention Program (DPP) trial found that antidepressant use over an average of 3.2 years was associated with an increased risk for diabetes of 2.60 in the placebo group and 3.39 in the lifestyle-intervention group, but there was no increased risk in the metformin group. Paroxetine caused a 4-fold increased risk for diabetes above 20 mg/day. Related drugs, fluoxetine, citalopram, or sertraline did not increase the risk.

From the book: The Human Brain in Health and Disease by Stephen Gislason MD