It goes without saying that there is a time and a place for antidepressants and an appropriate use for them. Sadly, these medications have a dark side as well that we are seeing time and again in our own lives and in the media. The tragic suicide of beloved actor Robin Williams, which may have been influenced by his antidepressant medication Mirtazipine (Remeron) is one example of this. Remeron, which was found in Williams’ bloodstream during his autopsy, carries 10 international drug regulatory warnings for causing suicidal ideation. Remeron is not the only antidepressant drug which is known to cause suicidal ideation. Others include the commonly prescribed Selective Serotonin Reuptake Inhibitors (SSRIs) like Prozac, Paxil, Lexapro, and Zoloft. In 2007, the overwhelming evidence and increasing incidence of suicide related to these drugs prompted the FDA to add a black box warning to the package insert of all SSRIs, which is the highest level of safety alert that can be assigned to a drug that is still able to be prescribed.
Suicide obviously cannot be blamed entirely on the drugs. After all, the drugs are being given to people suffering with depression and often people with suicidal ideation already. The problem comes when this link is under-discussed by physicians and when the families of those starting medications don’t know to watch for warning signs. Care should also be taken when prescribing these medications to people who are living alone or who are without community support because they may be even more at risk with nobody to notice strange behavior. It seems that other alternatives are less utilized than perhaps they should be. Cognitive Behavioral therapy has been shown to decrease the risk of a second suicide attempt by more than 50% and perhaps should be considered more of a front-line prescription either before the use of antidepressant medications, or concurrent with their use.
Even without suicidality, antidepressants can represent an escalating scale of reaction without solution. If individuals fail to respond to simpler medications, they are then commonly and quickly escalated to heavier-hitting drugs. Sadly, the top selling drug in the US is actually one such heavy-hitter, an anti-psychotic called Abilify. Abilify, or aripiprazole, racked up almost $6.9 billion last year, more than the sales of all other antidepressants combined. Because Abilify has been used so extensively in the general population outside of mental institutions, it has avoided the dark reputation of it’s close cousin, Thorazine. The escalation from simple anti-depressant medication to the sledgehammer of an antipsychotic drug represents a sad state for our mental health care, indicated a greater desire to want to cover problems up than to even begin to resolve them. British medical critic Joanna Moncrieff argues that antipsychotics don’t actually medicate the problem at all, they simply tranquilize the people who take them beyond caring. In this Brave New World-type scenario we are literally pacifying the population instead of finding solutions.
Even with appropriate use, antidepressant medications should still be treated with respect and caution. Most medications have some side effects and also deplete certain nutrients. Previously mentioned SSRI drugs deplete vitamins B6, B12 and folic acid. This is slightly ironic given that deficiencies of these vitamins can themselves lead to depression. SSRIs can also lead to lower levels of the sleep hormone melatonin and lower levels of protein and amino acids generally. Tricyclic antidepressants, including Elavil and Zonalon deplete CoQ10 levels, which is important for heart and cardiovascular function. They also deplete vitamin B2, or riboflavin, which is crucial for nerve and eye health. The antipsychotics Thorazine, Mellaril and Abilify also deplete CoQ10 and riboflavin. The commonly used bipolar medication lithium is known to deplete inositol levels, although replacement of inositol for those taking lithium can interfere with lithium’s action.
There are many natural options for depression, but it can be daunting for a depressed person to navigate by themselves. Working with a talented natural practitioner can make a world of difference, as they can match the specific symptoms being experienced to the best supplements for that situation and become a partner in the health building process. Also asking family and friends to help can have a tremendous impact. Exercise has been studied time and again to be as useful in mild to moderate depression as SSRI medications are, without the unfortunate suicidality side effect. Motivation can be an issue for those suffering with depression so asking for help from your community can suddenly generate walking buddies, gym buddies and a whole host of effective and helpful remedies. Additionally for anyone taking antidepressant medications a good quality methylated B-vitamin complex, like Pure Encapsulations B-Complex Plus or Thorne Research Methyl-Guard Plus can be a helpful adjunct to prevent nutritional deficiency and also because B vitamin deficiency leads to depressive symptoms.
Antidepressant medications are currently so commonly used as to be passé, but perhaps reframing the way we approach the problem and understanding the risks of these medications will push us to find better alternative solutions. Certainly there is a time and a place for antidepressant medications, but exploring gentler options first might just be a little safer for people with depression.
by Amy Neuzil, ND*. Amy is available for consultation at Peoples Wellness Center North.
*Naturopathic doctors are not currently licensed in the state of Texas.