can’t afford to run negative stories about prescription drugs, as they would lose tens of millions of dollars in ad revenue (no wonder the connection is habitually downplayed or ignored entirely). The Russian roulette of patients vulnerable to these “side effects” is only beginning to be known and may have something to do with how their bodies (and actions of their unique genetic code) metabolize these chemicals and preexisting allostatic (stress) load. Dr. Healy has worked tirelessly to expose data implicating antidepressants in risk of suicide and violence, maintaining a database for reporting, writing, and lecturing about cases of medication-induced death that could make your soul wince. And what about our most vulnerable: new mothers of helpless infants? I have countless patients like Kate in my practice who report never-before thoughts of suicide within weeks of starting an antidepressant for postpartum depression.
In a population where only a few randomized trials have examined the use of antidepressants for postpartum depression, I have grave concerns for women who are treated with drugs before more benign and effective interventions such as dietary modification, thyroid treatment, and addressing their sleep habits during this period when sleep deprivation runs high are explored. We already know that “low mood” is likely to resolve on its own within three months without any treatment, and upward of 70 percent of people will be free of depression without any medication whatsoever within a year.54 Yet we reflexively turn to these drugs and their unpredictable effects that can rob us of the ability to find permanent relief through the body’s own powerful systems, even though, by their own claims, they take six to eight weeks to “take effect.”
In 2004, the U.S. Food and Drug Administration (FDA) revised the labeling requirements for antidepressant medications with a warning that: “Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders.”55 The FDA was pushed to revise the labeling following a bevy of lawsuits in which pharmaceutical companies were forced to reveal previously undisclosed drug data.
You’d think such labeling would give people—and parents—pause. But since 2004, antidepressant use has only increased among both children and adults. I am routinely helping women who want to have a baby either avoid or taper from antidepressants, despite having been “specially trained” to prescribe for this population. For many of them, the first step is simply accepting the fact that they’ve been lied to about the value of antidepressants and their alleged benefits. Meanwhile, their downsides are not only downplayed but actively concealed.
All you have to do is spend a few minutes on SurvivingAntidepressants.org, BeyondMeds.com, or SSRIstories.org to appreciate that we have created a monster. Millions of men, women, and children the world over are suffering side effects, including complicated withdrawal routinely dismissed by their prescribing clinicians. Contrary to what Big Pharma would have you believe, weaning off antidepressants is extremely difficult, so choosing to take them could be signing up for a lifetime of medication use that creates and sustains abnormal states in the brain and entire nervous system. As a clinician who once believed in these medications, I have been humbled by what they are capable of. In fact, even when I have tapered women off of Celexa at extremely low increments of .001 mg a month, it can be hard to imagine another class of substances on earth so potentially complicated to discontinue.
I first became aware of the habit-forming nature of these medications when I worked with a patient who wanted to become pregnant in the coming year to taper off of Zoloft. She experienced about six months of protracted withdrawal that began at about two months after her last dose. My training did nothing to prepare me to deal with that.
The truth is that we have very little idea about what these medications are actually doing! At the same time, though, we need to acknowledge that the complexity of neurophysiology is overwhelming. Although the appeal is to think that we’ve cracked the code on human behavior and all of its intricate physiology, we’re far from it. For example, ten years ago we didn’t even know that the brain had an immune system, and two years ago we didn’t know it had lymphatics—basic anatomy. We used to think that immune activity in the brain only happened under certain pathological circumstances. But now we’ve identified microglia—billions of cells that play a specific role in managing inflammatory responses in the brain based on perceived threats from the rest of the body.56 And it’s not just about tinkering with chemical levels in the brain or the body for that matter.
We like to cling to simple explanations, but even the categorical name of the various antidepressants, selective serotonin reuptake inhibitors, is misleading. They are far from selective. In September 2014, an alarming new study from the Max Planck Institute in Leipzig, Germany, showed that even a single dose of an antidepressant can alter the brain’s architecture within three hours, changing the brain’s functional connectivity.57 The study, published in the journal Current Biology, was shocking not only to the health journalists who reported on it, but also to the doctors who prescribe these drugs.
An important analysis by the former director of the NIMH and published in the American Journal of Psychiatry shows that antidepressants “create perturbations in neurotransmitter functions,” causing the body to adapt through a series of biological events that occur after “chronic administration,” leading to brains that after a few weeks function in a way that is “qualitatively as well as quantitatively different from the normal state.”58 In other words, the brain’s natural functionality is assaulted by the medication to the point that it can become permanent. That said, everything we will explore in this book speaks to the body’s tremendous and almost unstoppable resilience when properly supported.
Dr. Paul Andrews of the Virginia Institute for Psychiatric and Behavioral Genetics demonstrated through a careful meta-analysis of forty-six studies that a patient’s risk of relapse is directly proportionate to how disruptive the medication is to the brain.59 The more disruptive the medication, the higher the risk of relapse upon discontinuation. He and his colleagues challenge the whole notion of relapse, suggesting that when you feel terrible upon stopping an antidepressant, what you’re experiencing is withdrawal—not a return of your mental illness. And when you choose the medication route, you’re actually extending the duration of your depression. Andrews writes: “. . . unmedicated patients have much shorter episodes, and better long-term prospects, than medicated patients . . . [T]he average duration of an untreated episode of major depression is twelve to thirteen weeks.”60
In a retrospective ten-year study in the Netherlands, 76 percent of those with unmedicated depression recovered without relapse relative to 50 percent of those treated.61 Unlike the mess of contradictory studies around short-term effects, there are no comparable studies that show a better outcome in those prescribed antidepressants long term.
Harvard researchers have also concluded that at least 50 percent of drug-withdrawn patients relapsed within fourteen months.62 In the words of one team of researchers led by Dr. Rif El-Mallakh from the University of Louisville: “[L]ong-term antidepressant use may be depressogenic . . . it is possible that antidepressant agents modify the hardwiring of neuronal synapses [which] not only render antidepressants ineffective but also induce a resident, refractory depressive state.” Dr. El-Mallakh and his colleagues wrote this bold statement in a letter to the editor of the Journal of Clinical Psychiatry in 1999.63 Then, in 2011, they published a new paper including eighty-five citations proving that antidepressants make things worse in the long run.64 (So when your doctor says, “You see, look how sick you are, you shouldn’t have stopped that medication,” you should know that the data suggests that your symptoms are signs of withdrawal, not relapse.)
In Anatomy of an Epidemic, Robert Whitaker summarizes the matter succinctly:
We
