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What’s Really in Antidepressants?
What They Don’t Tell You: the Small Print
Words by Ebun Lufadeju
Credit: Unsplash Many people go through bouts or periods of depression at some point in their life. I have been a community pharmacist for almost four years now and I do not think a day has gone by that I have not dispensed a prescription for some kind of antidepressant. Working in a pharmacy, I have seen textbooks come to life and see that depression can affect anyone - although it mainly occurs in early adulthood.
Depression can affect people in different ways, symptoms range from; feeling low, feeling unhappy, body aches, constantly feeling tired. Sufferers of severe depression can experience suicidal thoughts. People often ask what causes depression – well, it varies for each individual. Some common causes of depression could be anything from family bereavement to money issues to giving birth.
According to Public Health England, in 2017 – 2018, a study showed that 7.3 million people (17% of the adult population) were on antidepressants. In 2015 – 2018, antidepressants cost the NHS just over £670 million and prescriptions for antidepressants are continuously increasing. This leads me to ask these questions, are doctors too eager to prescribe antidepressants? Are people using therapy as a form of treatment? Why is the NHS spending so much money on antidepressants? What’s in these tablets?
Credit: ShutterstockSo, how do we treat depression?
Credit: Unsplash Treatment for depression includes lifestyle changes and therapy. In mild depression, a doctor will ask patients to wait and see if they get better. In cases that do not respond to therapy, a doctor may prescribe medication, commonly called antidepressants. So, if treatment includes lifestyle changes and therapy, why are so many people on antidepressants? Do they work?
There are currently over 20 antidepressants that are licensed in the UK. The most commonly prescribed antidepressants are a group of drugs called: Selective Serotonin Reuptake Inhibitors (SSRIs), such as Sertraline, Citalopram, Escitalopram and Fluoxetine. In 1967, a study showed that low levels of serotonin (a chemical messenger, also called a neurotransmitter), were found in cases of depressive suicides. Following this study, the pharmaceutical company - Eli Lilly began to develop drugs, such as Fluoxetine – the first SSRI. These drugs would selectively inhibit the reuptake of serotonin at serotonin transporters and help to treat depression via a mechanism that makes serotonin more available to your brain. Low levels of the chemical have been associated with depression. So, this medication works by making sure levels of serotonin in the brain do not go too low, which in theory – lifts one's mood and thus treats depression.
Common side-effects of SSRIs include nausea, difficulty sleeping, nervousness, sexual dysfunction and tremors. Patients are often told that they can feel worse before they feel any better. Antidepressants are also associated with withdrawal. Several placebo-controlled trials showed that withdrawal symptoms, such as insomnia, depression, suicidal ideation and physical symptoms, follow when patients stop taking medication. This means that many patients will end up on these medications for a long time, potentially to avoid these withdrawal symptoms.
Whilst SSRIs are generally well tolerated with regular use, citalopram and escitalopram have dangerous side effects in overdose. These drugs can cause seizures and a potentially serious heart issue, called QT prolongation. Therefore, these drugs should not be used in patients with a history of seizures or QT prolongation.
According to some papers, the use of antidepressants is no better than a placebo. Before any trial gets into the hands of a patient, it must have gone through clinical trials. It is often hard with depression to tell because, at the time of the trial, the subject may not have actually had depression or could have felt better weeks later – we don’t know. Another theory is that people may exaggerate their symptoms to receive treatment.
However, since these antidepressants work by increasing the level of serotonin in the brain, how else can we increase serotonin levels? Outside of SSRIs, the following factors have been shown to also boost serotonin levels and thus may prevent depression:
Credit: Unsplash Exposure to bright light: Sunshine or light therapy are commonly recommended for treating seasonal depression.
Exercise: Regular exercise has been shown to increase the level of serotonin in the brain
Diet: Certain foods can increase serotonin levels include eggs, cheese, turkey, nuts, salmon and pineapple.
Meditation: Meditating can help relieve stress and boost serotonin levels
Getting plenty of sleep
Speaking to positive people
Reducing stress; especially by recognising triggers
Some people are interested in natural options to treat depression. St John’s Wort, is a herbal treatment that has been used for several years. Always consult your doctor before starting or stopping any medication.
What are my thoughts?
I know for a fact that no case of depression is the same and everyone has their individual experiences. However, I do think that if lifestyle changes and therapy are the first-line treatment for depression, then these options should be explored and exhausted before considering medication. Antidepressants play a part in treating depression, however, there is no single medication that has shown to be the most effective and so it depends entirely on the patient and their circumstances.
The side-effects and withdrawal symptoms of these medications could potentially make the condition worse. I am a firm believer of dealing with the cause of an issue, rather than just the symptoms. Simply because if you take away the medication – without dealing with the root cause, it has only acted as a local anaesthetic, numbing the pain.
Ebun Lufadeju (MPharm), Community Pharmacist
