Depression: Are the Drugs as Dangerous as the Disease?

A just published article has comprehensively reviewed the side effects of the newer generation of antidepressants. This newer generation of drugs is widely believed to be safer than the drugs it succeeded, but that belief is misguided. . . .

Antidepressants are among the most widely prescribed drugs in America. The newer generation of antidepressants include selective serotonin reuptake inhibitors (SSRI), serotonin noradrenaline reuptake inhibitors (SNRI), bupropion, mirtazapine, trazodone, agomelatine, vilazodone, levomilnacipran and vortioxetine.

Despite the popularity of prescribing these drugs for depression—7% of visits to the doctor end in a prescription for an antidepressant—a significant number of people with depression do not get adequately better on their medication. And one reason for that failure is because so many of them have to discontinue their drugs due to side effects. Amazingly, up to 43% of people with depression discontinue their medication because of side effects.

Some of the most common side effects include gastrointestinal side effects, liver toxicity, weight gain, diabetes, sexual dysfunction, osteoporosis, eye diseases and suicide.

Gastrointestinal
Approximately half of all people who take newer generation antidepressants experience gastrointestinal side effects. Nausea, diarrhoea, indigestion, GI bleeding and abdominal pain are amongst the most common side effects of antidepressants. So common is GI bleeding on short term use of 7-28 days of antidepressants that the authors of the review recommend that, based on this statistic, the same well-known cautions for NSAID’s should be given for antidepressants.

Liver Toxicity
For people taking SSRIs and SNRIs, the incidence of drug-induced liver toxicity is 0.5-1%. Higher doses are more likely to cause toxicity. That means that antidepressants cause liver toxicity in 1 out of every 100 or 200 people who use them. When you consider how many people use them, that’s alarming.

Weight Gain
Compelling evidence indicates that the use of most antidepressants may increase weight in a significant proportion of patients who use them and that they increase the risk of obesity.

Diabetes
There is some evidence that antidepressants increase the risk of diabetes. Studies have had mixed results, but a 2013 systematic review and meta-analysis of 8 studies found a 50% increase in the risk of diabetes (Diabetes Metab Res Rev 2013;29(4):273-84).

Sexual Dysfunction
All SSRIs and SNRIs have been shown to have significant sexual side effects. Sexual dysfunction affects as many as 50-70% of people taking SSRIs.

Osteoporosis
The use of SSRIs is associated with reduced bone mineral density and a higher risk of fracture. A recent meta-analysis of 13 studies found a 72% increased risk of fracture with SSRIs (Osteoporos Int 2012;23(1):365-75). In some studies, there is a ful 98% increased risk of fracture on Prozac, Zoloft, Paxil and Celexa.

Eye Diseases
SSRIs increase the risk of angle-closure glaucoma by as much as nearly 6 times. The newer generation antidepressants also increase the risk of cataracts by about a third.

Suicide
A 2016 meta-analysis (BMJ 2016 27;352:i65) of 70 studies found a significant 139% increased risk of suicide for children and adolescents: that’s more than double the risk of suicide. The same study found a 179% increase in aggression for children and adolescents and more than double the risk of agitation. Adults also experience twice the rate of agitation.

Psychother Psychosom 2016;85:270-288

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