all fits together, and why the widespread use of these drugs would contribute to a rise in the number of disabled mentally ill in the United States. Over the short term, those who take an antidepressant will likely see their symptoms lessen. They will see this as proof that the drugs work, as will their doctors. However, this short-term amelioration of symptoms is not markedly greater than what is seen in patients treated with a placebo, and this initial use also puts them onto a problematic long-term course. If they stop taking the medications, they are at high risk of relapsing. But if they stay on the drugs, they will also likely suffer recurrent episodes of depression, and this chronicity increases the risk that they will become disabled. The SSRIs, to a certain extent, act like a trap in the same way that neuroleptics [tranquilizers] do.65
More than twenty years have passed since clinicians and researchers started collecting evidence against antidepressants. Although these drugs may offer relief in the short term thanks to the placebo effect, they lead to chronic, persistent depression that resists treatment when taken for an extended period of time. In some people, stopping the drug can cause a slow and gradual lightening of the mood, but this doesn’t always occur, and depression can become more or less permanent. Remember the alcohol effect.
Not surprisingly, the powers that be in my field have not looked into this matter or launched a serious investigation. And yet the studies keep emerging. In early 2015, yet another headline hit that Big Pharma turned a blind eye to. It read “Stopping SSRI Antidepressants Can Cause Long, Intense Withdrawal Problems” and referred to the first systematic review of withdrawal problems that patients experience when trying to get off SSRI antidepressant medications.66 A team of American and Italian researchers found that withdrawing from SSRIs was in many ways comparable to trying to quit addictive benzodiazepine sedatives and barbiturates.67 They also discovered that withdrawal symptoms aren’t fleeting; they can last months or even years. Moreover, entirely new, persistent psychiatric disorders can surface from discontinuing SSRIs.
The authors analyzed fifteen randomized controlled studies, four open trials, four retrospective investigations, and thirty-eight case reports of SSRI withdrawal. Paroxetine (Paxil) was found to be the worst, but all the SSRI antidepressants were documented as causing a wide range of withdrawal symptoms from dizziness, electrical shock sensations, and diarrhea to anxiety, panic, agitation, insomnia, and severe depression. They write: “Symptoms typically occur within a few days from drug discontinuation and last a few weeks, also with gradual tapering. However, many variations are possible, including late onset and/or longer persistence of disturbances. Symptoms may be easily misidentified as signs of impending relapse.”
In their conclusions, they state what should be the obvious: “Clinicians need to add SSRIs to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with benzodiazepines, barbiturates, and other psychotropic drugs.” An accompanying editorial to their paper notes that “This type of withdrawal consists of: (1) the return of the original illness at a greater intensity and/or with additional features of the illness, and/or (2) symptoms related to emerging new disorders. They persist at least six weeks after drug withdrawal and are sufficiently severe and disabling to have patients return to their previous drug treatment. When the previous drug treatment is not restarted, post-withdrawal disorders may last for several months to years.”
The editorial also states that “With SSRI withdrawal, persistent postwithdrawal disorders may appear as new psychiatric disorders, in particular disorders that can be treated successfully with SSRIs and SNRIs. Significant postwithdrawal illnesses found with SSRI use include anxiety disorders, tardive insomnia, major depression, and bipolar illness.”
This bit of news is extremely unsettling to current practices in psychiatry. According to the current American Psychological Association treatment guidelines for major depressive disorder, “During the maintenance phase, an antidepressant medication that produced symptom remission during the acute phase and maintained remission during the continuation phase should be continued at a full therapeutic dose.” Such a guideline merely promotes more drug sales, and more crippling side effects.
DON’T GO DOWN THE RABBIT HOLE
We need to break out of the spell that the pharmaceutical industry has put us under. Psychiatry’s swan song has been sung; listen for its plaintive wail. We must reject the serotonin meme and start looking at depression (and anxiety, and bipolar disorder, and schizophrenia, and OCD) for what they are: disparate expressions of a body struggling to adapt to a stressor. There are times in our evolution as a cultural species that we need to unlearn what we know and change what we think is true. We have to move out of the comfort of certainty and into the freeing light of uncertainty. It is from this space of acknowledged unknowing that we can truly grow.68
From my vantage point, this growth will encompass a sense of wonder—both a curiosity about what symptoms of mental illness may be telling us about our physiology and spirit and a sense of humbled awe at all that we do not yet have the tools to appreciate. For this reason, honoring our coevolution with the natural world and sending the body a signal of safety through movement, diet, meditation, and environmental detoxification represents our most primal and most powerful tool for healing. We also need to identify vulnerabilities and chemical exposures and support basic cellular function, detoxification, and immune response. This is, ultimately, personalized medicine.
To me, the worst part of the misguided mess we’ve made of mental health care is that we are missing out on the potential for true resilience and self-healing. Safe, effective alternatives to help us through these passages in life do indeed exist. Perhaps most concerning to a holistic physician is data that suggests that long-term antidepressant treatment actually compromises the benefits of exercise!69 The effects of exercise have been shown to be comparable to Zoloft but can be diminished when combined with Zoloft; patients relapse at higher rates than they do with exercise alone. I’ll be going into much greater detail about exercise in Chapter 7, and I’ll share why I think this is the case. Exercise is an antidote to depression best used without antidepressants.
Mental health will always be grounded in whole body health. When you discover the real imbalances underlying all your symptoms—physical and mental—and take steps to address them, you can restore your health without resorting to problematic drug treatments and endless psychotherapy.
The next question to answer is: What kind of “imbalances” come under the veil of depression? We’ll find out in the next chapter.
What Gut Microbes and Silent Inflammation Have to Do with Mental Health
Depression is often an inflammation-driven condition, not a neurochemical deficiency disease.
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The most powerful path to our brain—and peace of mind—is through our gut.
Pick up any health or diet book published recently and you’ll likely read about the ills of chronic inflammation and the blessings of the human microbiome. The two have been the science buzzwords of late, and for good reason. These concepts reflect the zeitgeist of the modern patient because we have reached a point in our collective evolution where our health is being outpaced by lifestyles that are not aligned with how we are biologically designed to live. We are idle when our bodies want to move, we eat foods that are unrecognizable to our systems, and we expose ourselves to environmental factors that assault our cells. This incompatibility is creating serious internal conflict and driving rampant levels of chronic inflammation like
