antidepressants

RECENT POSTS

Differing Views On Antidepressants During Pregnancy

The question of taking antidepressants during pregnancy is extremely intimate and complicated. Research studies evaluating the risks and benefits are mixed. There are documented harms, like an elevated risk of pre-term birth. But there are also the documented harms of untreated depression. In other words, it’s a deeply personal health decision that requires judgement based on a body of data that offers no easy answers.

The latest on this fraught debate comes from Andrew Solomon who wrote a long piece published in last Sunday’s New York Times Magazine, “The Secret Sadness,” with this basic message: “Pregnant women who are depressed often fear taking the medication they rely on. But not treating their depression can be just as dangerous.”

Solomon, whose own depression is well documented in his powerful book, “The Noonday Demon: An Atlas of Depression,” (The Times piece will be added as a new chapter in the book) begins the magazine article with an anecdote about Mary Guest, “a lively, accomplished 37-year-old woman” who “fell in love, became pregnant and married after a short courtship.”

Struggling with depression for much of her life, Mary took various antidepressant and anti-anxiety drugs, Solomon writes, but decided to discontinue the meds during pregnancy. But Mary’s mood and behavior “spiraled downward” so, “near the end of her fifth month of pregnancy, she finally, reluctantly, resumed taking an antidepressant,” he writes.

Then, at six-and-a-half months pregnant, and convinced that something was wrong with her fetus, Mary “went to the 16th floor of the building where her parents lived and jumped to her death.” Solomon quotes Mary’s mother saying: “We feel, rightly or wrongly, that if Mary had stayed on her medications, or even gone back on them sooner, it’s possible she would have survived.”

It’s an intense, moving story.

But Dr. Adam Urato, an assistant professor at Tufts University School of Medicine in Boston and a maternal-fetal medicine physician at Tufts Medical Center and MetroWest Medical Center in Framingham, says he’s got an important story to tell too: that antidepressants can also cause harm. Urato writes and lectures on this topic frequently, and says he feels that Solomon’s piece didn’t offer the complete picture. (Here’s Urato’s full rebuttal to Solomon’s article on the website Mad In America, published by journalist Robert Whitaker.

Solomon quotes Urato in the Times story (in fact, some of the quotes come from a post Urato wrote for CommonHealth). But Urato says his views weren’t fully reflected. Here, edited are a few of Urato’s points:

1. Anecdotes Have Limitations

No one wants a pregnant woman to kill herself. An article in which pregnant women stop their medications and kill themselves while others continue on their meds and have happy outcomes is sure to push readers in an obvious direction. However, such anecdotes are limited.

For example, the author could have told stories of women who stayed on their medications, weren’t counseled regarding the risks, and had severely impaired babies. Continue reading

Medicated (And Unmedicated) Women Are Talking

By Alicair Peltonen
Guest Contributor

I think a crucial step in decreasing the stigma surrounding mental illness is talking about it openly. And it seems readers want to talk.

My post, “The Medicated Woman: A Pill To Feel Better, Not Squelch Feelings,” on mental health and medication, was shared on Facebook more than 15,000 times and now has over 200 comments, so I thought it was worth a follow-up.

One thing readers wanted to discuss is the safety of antidepressants during pregnancy, a complicated topic which has been covered here and here on CommonHealth. Safety studies are mixed in many cases so women should consult their doctors. Here’s what it says on the Mayo Clinic website:

A decision to use antidepressants during pregnancy is based on the balance between risks and benefits. Overall, the risk of birth defects and other problems for babies of mothers who take antidepressants during pregnancy is very low. Still, few medications have been proved safe without question during pregnancy, and some types of antidepressants have been associated with health problems in babies.

Other comments underscored that stigma still exists but may be slowly diminishing.

(Flickr Creative Commons)

(Flickr Creative Commons)

Jackie wrote: “It took me until I was in my 50’s to accept that medication wasn’t the ‘weak”‘ way. I now see how much I lost and am living through a tremendously stressful life without those urges to accelerate into other cars or cement walls.”

“It’s in our family, but I was the first to seek help, and was probably the worst off. It was a secret that my grandfather had committed suicide,” wrote lilycarol.

And here’s a comment from helentroy4: “My mother was much like me. But to her dying day she never acknowledged that her behaviors were anything but ‘perfect mothering.’ I think had she been able to take advantage of this medication (or others of its kind), she would have been able to have the calming of her heart and soul that I have been blessed to have.”

There were many who suggested that lifestyle changes, including more exercise and sleep, meditation or yoga might be safer and more beneficial than medication. Continue reading

The Medicated Woman: A Pill To Feel Better, Not Squelch Emotions

By Alicair Peltonen
Guest Contributor

I am a medicated woman. I take 50mg of Sertraline (the generic form of Zoloft) a day. I don’t take it to be more tolerable to my husband. I don’t take it because I’m embarrassed by my emotions. And I definitely don’t take it to quietly fit into a polite societal mold. I take an anti-depressant every day to quell my anxiety simply because it feels better. I feel better.

I grew up in a talk therapy household. My father began group therapy for anger management issues in 1984, when I was 10, breaking a cycle of rage and avoidance that tends to swallow people whole, particularly men. He would come home feeling calmer and then he would implore my sister and me to explore our feelings and talk about our problems. Begrudgingly at times, I learned to think analytically. And thankfully, I learned that asking for help is not only acceptable, it’s downright healthy.

I started seeing therapists here and there in my 20s and then regularly several months after my first daughter was born. Medication had never been suggested by any of my previous therapists but this time was different. I couldn’t shake the feelings of inadequacy, the certainty that my daughter didn’t like me and I was just a glorified dairy cow. Post-partum depression is a hell of a thing.

(Rachel Zimmerman/WBUR)

(Rachel Zimmerman/WBUR)

When my therapist suggested I see a psychiatrist to discuss the possibility of medication, I went home and cried for an hour. I felt ashamed, defeated, embarrassed, weak. Even though I had seen medication transform my father from a man who growled and dragged to one who laughed and hugged, it still stung to feel like I couldn’t pull myself together.

But, remembering my father’s bravery, I thought I should at least give it a try. If I didn’t like it, I could always stop taking it. The first pill was swallowed through tears. And each successive pill went down easier. For a full year, I could go days without yelling or wanting to break things and entire weeks without crying. And I felt better.

After a year, I decided to go off the medication. Things had been much better and I wanted to see if I could “go back to normal.” And things did go back to normal. But it turns out my normal wasn’t very comfortable.

There have been many discussions and articles recently asking if modern psychiatry is over-medicating women. A recent op-ed in the New York Times by psychiatrist Julie Holland suggested that many of the symptoms for which women are treated with antidepressants are natural and healthy. “We have been taught to apologize for our tears,” she writes, “to suppress our anger and to fear being called hysterical.”

Here’s the thing, though. Breaking down into uncontrollable tears because you stubbed your toe and it’s the straw that broke the stress-camel’s back doesn’t feel good. Continue reading

Opinion: Time To Lift The Black Box Warning On Antidepressants

Paxil, or paroxetine, an antidepressant that raised early alarms about possible suicidal effects in the United Kingdom. (Wikimedia Commons)

Paxil, or paroxetine, an antidepressant that raised early alarms about possible suicidal effects in the United Kingdom. (Wikimedia Commons)

By Drs. Steve Schlozman and Gene Beresin
Guest contributors

In 2004, the Food and Drug Administration made the difficult decision to apply a “black box” warning to virtually all antidepressant medications.

A few months earlier, British health officials had issued a similar warning for paroxetine, or Paxil, a frequently used antidepressant. Both the United States and the United Kingdom were worried about the possibility of antidepressant use in some people causing an increase in agitated, and even suicidal, behavior. The warnings, still in effect, apply particularly to adolescents.

But recent research suggests that perhaps the black box warning should itself have a black box warning. A new Harvard study suggests the warning has actually led to an increase in suicides because it caused a decrease in the treatment of depression through antidepressant prescriptions. Similar studies published back in 2007 showed a fairly dramatic increase in suicide attempts by adolescents, corresponding to a decrease in prescriptions for antidepressants. The Harvard study is a reiteration of these previous findings.

We believe it is time for the black box warning to be lifted. And we suspect that bias and ignorance may play a role in the fact that it has not been.

First, some background information.

A “black box warning” is a written message that by U.S. law must accompany every prescription for which the warning is indicated. Continue reading

Doctor: Possible Links Between Antidepressants, Pregnancy And Autism

By Dr. Adam Urato
Guest Contributor

On Friday, a new study was released in the British Medical Journal showing that antidepressant use during pregnancy is associated with autism in the exposed children. This is now the second study within the last two years showing this link and it adds to the accumulating evidence of potential harm associated with the use of antidepressants during pregnancy.

Adam Urato, M.D., a maternal-fetal medicine specialist says evidence is growing on the harms of taking antidepressants during pregnancy.

Adam Urato, M.D., a maternal-fetal medicine specialist says evidence is growing on the potential harms of taking antidepressants during pregnancy.

The study was a case-control study from Sweden, which was fairly large: it looked at 4,429 cases of autism spectrum disorder and compared these cases to 43,277 matched controls. The researchers found that antidepressant use during pregnancy, with either SSRIs or nonselective monoamine reuptake inhibitors (another type of antidepressant) was associated with an increased rate of autism spectrum disorders in the offspring. The odds ratio was high at 3.34, which roughly means that antidepressant use was associated with more than a tripling of risk of autism in the children.

The study concludes:

In utero exposure to both SSRIs and non-selective monoamine reuptake inhibitors (tricyclic antidepressants) was associated with an increased risk of autism spectrum disorders, particularly without intellectual disability. Whether this association is causal or reflects the risk of autism with severe depression during pregnancy requires further research. However, assuming causality, antidepressant use during pregnancy is unlikely to have contributed significantly towards the dramatic increase in observed prevalence of autism spectrum disorders as it explained less than 1% of cases.

These results do not surprise those of us who have been following the scientific studies in this area over the past two decades. Continue reading

Prescription Nation: 4 Billion A Year, Antipsychotics Lead Psych Meds


To share these mind-boggling (and I use the term advisedly, because so many of these drugs act on the mind) statistics, I’m passing along a press release just in from the American Chemical Society in full:

People in the United States took more prescription drugs than ever last year, with the number of prescriptions increasing from 3.99 billion (with a cost of $308.6 billion) in 2010 to 4.02 billion (with a cost of $319.9 billion) in 2011. Those numbers and others appear in an annual profile of top prescription medicines published in the journal ACS Chemical Neuroscience.

Journal Editor-in-Chief Craig W. Lindsley analyzed data on 2011 drugs with a focus on medications for central nervous system (CNS) disorders. So-called antipsychotic medicines — including those used to treat schizophrenia, bipolar disorder, obsessive-compulsive disorder, Tourette syndrome and some forms of depression — ranked as the fifth most-prescribed class of drugs by sales. Antidepressants, for conditions that include depression and anxiety, ranked No. 7.

XanaxTM, CelexaTM and ZoloftTM were the most-prescribed psychiatric medicines, with other depression and anxiety medications rounding out the top 10. Two antipsychotics were among the 10 drugs that Americans spent the most on, with AbilifyTM in fourth place. Lindsley explains that while antidepressants continued to be the most-prescribed class of CNS drugs in 2011, prescriptions for ADHD medicines increased by 17 percent and multiple sclerosis medications by 22.5 percent in sales from 2010. While expiring patents on major antipsychotics in the next few years will put pressure on drug makers to innovate, the industry should be heartened by the growth of the number of prescriptions and spending.

The full paper is here, including this chart of the top 10 drugs:

Top 10 drugs

Top 10 drugs in 2011 (Source: IMS Health via ACS Chemical Neuroscience)

Commentary: Considering Medication When You’re Pregnant And Depressed

Orit Avni-Barron, M.D.

By Orit Avni-Barron, MD
Guest Contributor

Pregnancy is not child’s play. Morning sickness, varicose veins and not-fitting-into-your-jeans aside, the constant awareness of everything that can go wrong during pregnancy is often overwhelming. Throw depression or anxiety into the mix, and things can quickly go south.

About one in ten women are prescribed an antidepressant during pregnancy – most often for depression or anxiety but also for other indications like eating disorders. Stigma, fear and lack of knowledge may lead women to stop treatment prematurely (often upon discovery of an unplanned pregnancy). Discontinuing medication, especially when it is done abruptly, can expose women to a host of other problems.

The current information available to women about using antidepressants during pregnancy can be quite confusing. New studies are abundant but difficult to interpret. Media coverage often focuses on horror stories about women suffering with extreme — often untreated — depression and anxiety (think Andrea Yates).

At the same time, TV commercials solicit law suits against prescribers who attempt to treat and prevent such cases. Navigating this mine field is often challenging and even health care providers struggle with making recommendations to their patients. For women, this can result in getting different messages from different providers about the risks and benefits of taking medications while pregnant.

The final decision about treatment ultimately falls on the patient’s shoulders. She is the one who needs to put that pill in her mouth and swallow it. And then she needs to do it again, and again and again. Every day.

This woman may already be compromised by anxiety or depressive symptoms. Or, she may be symptom-free thanks to an antidepressant and scared of the way she might feel off it. Like most women, she probably feels guilty about taking medication during pregnancy. She may be embarrassed about needing treatment, maybe even hide this fact from loved ones. Her partner has an opinion about what she needs to do. Her friends tell her about an esoteric fact they heard about the particular antidepressant she’s taking. She wants to do right by her baby…she can’t tolerate the despair and anxiety.

As a women’s mental health specialist I’ve often witnessed women struggle to find a definitive answer. Continue reading

Study: Antidepressants Increase Risk Of Preterm Birth

pumicehead/flickr

Back in the 1990s, when many of us were still “Listening To Prozac,” there was a flurry of news stories that explored this question: should pregnant women take antidepressants or not?

More specifically, was it better for women with mood disorders taking antidepressants to remain on their medication during pregnancy (to prevent slipping back into depression) or stick to earlier conventional wisdom that all drugs (and alcohol and caffeine and swordfish for that matter) should be forbidden during pregnancy? A number of the stories back then concluded that the risk of an unmedicated, depressed mother was more detrimental to her baby than the possible negative effects antidepressants might have on a developing fetus.

Now the pendulum seems to be swinging back. A new report by researchers at Yale adds to a growing body of evidence that suggests taking such medications during pregnancy can increase the risk of medical problems and complications.

The Yale study found that women who are depressed during pregnancy aren’t at any higher risk of giving birth prematurely compared to non-depressed women. But the researchers did find that women taking antidepressants during pregnancy were at higher risk for what is called a “late” pre-term delivery, between 34 and 37 weeks. The study was published online last week in the journal Epidemiology. It concludes:

Our study adds to a growing body of research suggesting that SRIs during pregnancy may increase a woman’s risk of early delivery. In assessing the implications of this risk for clinical practice, care must be taken to balance the health implications for the mother with those for the fetus.

Continue reading

Is There Now A National Debate Over Antidepressants?

Author Robert Whitaker

Tell me if I’m exaggerating. But I think it’s now fair to say that there’s a rising national debate — at least judging by some of the premiere media outlets — over the value of antidepressants.

Just to update you on the latest posts and ripostes: Dr. Marcia Angell, former editor of the New England Journal of Medicine, wrote a provocative two-part series in The New York Review of Books on three recent books that call into question the current drug-heavy style of psychiatry. Then Dr. Peter Kramer, of “Listening to Prozac” fame, responded in defense of antidepressants in The New York Times on Sunday, July 10.

Now the latest gleanings from Twitter: There’s a petition afoot to get the Times to run a response to Peter Kramer’s piece. The response is by Bob Whitaker, author of “Anatomy of an Epidemic,” who challenges current practices of prescribing psychiatric drugs. (CommonHealth wrote about him here.) As of this morning, the petition had nearly 400 signatures.

Here’s Bob responding on Psychology Today’s blog. He challenges Peter’s arguments in his usual data-driven way, and concludes:

As I noted in Anatomy of An Epidemic, the real problem we have in this field of medicine is that academic psychiatry hasn’t been honest in what it tells the public about psychiatric medications. If the medications are to be used wisely, and in an evidence-based manner, we need to have an honest discussion about what science is telling us about the drugs. But on Sunday, in this essay “In Defense of Antidepressants,” the American public has been treated to yet another dose of misinformation.

Peter Kramer: ‘In Defense of Antidepressants’

Dr. Peter D. Kramer

As we’ve noted here and here, The New York Review of Books just ran a two-part essay by Dr. Marcia Angell, former editor of The New England Journal of Medicine, on the ills of modern American psychiatry, with its heavy reliance on sometimes dubious drugs.

 

Now comes a response, a piece by Dr. Peter Kramer, of “Listening to Prozac” fame, that dominated the front of the SundayReview section in The New York Times. Peter opens with the recent bad press that antidepressants have been getting, including in Marcia’s writing, then asks:

Could this be true? Could drugs that are ingested by one in 10 Americans each year, drugs that have changed the way that mental illness is treated, really be a hoax, a mistake or a concept gone wrong?

This supposition is worrisome. Antidepressants work — ordinarily well, on a par with other medications doctors prescribe. Yes, certain researchers have questioned their efficacy in particular areas — sometimes, I believe, on the basis of shaky data. And yet, the notion that they aren’t effective in general is influencing treatment.

Peter walks the reader through a broad swath of recent research on antidepressants, and writes: Continue reading