ANTIDEPRESSANTS ARE IN THE NEWS YET AGAIN

DEPRESSED ABOUT YOUR ANTIDEPRESSANT?
YOU PROBABLY SHOULD BE!

"According to researchers at the Mayo Clinic and Olmsted Medical Center, about 20% of Americans use at least five prescription medications. That same research shows that prescription drug use has been increasing steadily in the U.S. for the past decade."  Cherry-picked from Lacie Glover's June 1, 2015 article for Nerd Wallet (The Most Commonly Prescribed Drugs in America).

Screening for and diagnosing DEPRESSION has become big business --- really big business.  Not only are ANTIDEPRESSANTS among the most-prescribed classes of medication, they are regularly being prescribed for things they were never intended to be prescribed for, like Chronic Pain (HERE).  It's no secret that off-label prescriptions --- prescribing a drug for things it has not been studied or approved for --- abound.  With the insane list of problems doctors attempt to treat with Antidepressants, it's no surprise that they are arguably the leading class of prescription drug in America (there is debate about this, as different studies claim that STATINS, OPIODS, and DIABETIC MEDS are #1 as well).   What cannot be argued, however, is that off-label use has put Antidepressants into the stratosphere as far as money is concerned.  Wikipedia says.....

"Antidepressants are drugs used for the treatment of major depressive disorder, dysthymia, anxiety disorders, obsessive compulsive disorder, eating disorders, chronic pain, neuropathic pain, dysmenorrhoea, snoring, migraine, attention-deficit hyperactivity disorder (ADHD), addiction, dependence, and sleep disorders."

• Writing for How Stuff Works (Health), Jane McGrath told her readers back in 2008 that, "In 2007, the Centers for Disease Control and Prevention made an intriguing announcement. Antidepressants were the most frequently prescribed drug, overtaking the runner-up, high blood pressure medications, by five million prescriptions. The study reported that doctors racked up 118 million prescriptions for antidepressants."
• In October of 2011, Peter Wehrwein, writing for the Harvard University's Health Blog, wrote that, "the rate of antidepressant use in this country among people ages 12 and older increased by almost 400% between 1988–1994 and 2005–2008."
• Quoting a study from the Mayo Clinic, the June 20, 2013 edition of the CBS News stated that, "Nearly one in four women ages 50 to 64 were found to be on an antidepressant, with 13 percent of the overall population also on antidepressants."
• In the November 1, 2014 issue of Scientific American, Julia Calderone revealed that, "Doctors commonly use antidepressants to treat many maladies they are not approved for. In fact, studies show that between 25 and 60 percent of prescribed antidepressants are actually used to treat nonpsychological conditions."
• On August 12 of 2013, The New York Times carried a story by Roni Caryn Rabin stating, "a recent study suggests another explanation: that the condition is being overdiagnosed on a remarkable scale. The study, published in April in the journal Psychotherapy and Psychosomatics, found that nearly two-thirds of a sample of more than 5,000 patients who had been given a diagnosis of depression within the previous 12 months did not meet the criteria for major depressive episode as described by the psychiatrists’ bible, the Diagnostic and Statistical Manual of Mental Disorders (or D.S.M.)"
• Writing for the September, 2014 issue of the Psychiatric Times (Are Antidepressants Really 'Over-Prescribed' in the US?), Dr. Ronald Pies took the opposite viewpoint (does anyone remember the ABSURD NOTION that we should be putting antidepressants in the water supply?).  "So . . . have we really become a kind of Prozac Nation, to reference the title of Elizabeth Wurtzel’s 1994 memoir?    By and large, I don’t think so."  By the way, that 'absurd idea' really was an 'absurd' idea (HERE)!

When you factor the "INVISIBLE & ABANDONED" studies on Antidepressant meds into the equation, you quickly see what a house of cards it really is.  Especially interesting in light of what I have been reading about CBT (Cognitive Behavioral Therapy) for years --- namely that it doesn't work very well (most doctors have phoo phooed this approach for decades).  And now we have studies giving us "moderate evidence" that when it comes to treating MDD (Major Depressive Disorder), both CBT and Antidepressants are equally as effective (or ineffective as the case may be).

Not surprisingly, one of the biggest reasons that CBT is now being touted as an equal to Antidepressants, has to do with side effects.  I can't imagine CBT, which involves working with and talking to a counselor of some sort, having many.  On the other hand, Antidepressants are renowned for their side effects --- side effects which tend to be UNDER-REPORTED by much as much as 99%.  The American College of Physicians (ACP), which is currently involved in creating guidelines / standards of care for treating Depression, put it another way, describing said side-effects as, "underrepresented".  This month's issue of the Annals of Internal Medicine (the official journal of the ACP) devoted a great deal of space to this topic, by carrying two studies and an editorial.

• Comparative Benefits and Harms of Antidepressants, Psychological, Complementary, and Exercise Treatments for Major Depression: An Evidence Report for a Clinical Practice Guideline From the American College of Physicians

• Nonpharmacologic Versus Pharmacologic Treatment of Adult Patients With Major Depressive Disorder: A Clinical Practice Guideline From the American College of Physicians

• Seize the Day to Implement Depression Guidelines

The studies touted screening all Americans for Depression, just like I wrote about the other day (HERE).  One of the many risk factors they suggested specifically targeting with their screening?  I'm not making it up folks; "adolescence in girls".  With recommendations like this, I guess I shouldn't be surprised at the conclusions the ACP came to. 

Researchers looked at all the studies done between 1990 and 2015 that met their criteria.  Some of them pertained to St. Johns Wort, some were about using exercise (several previous studies have said good things about using this approach), others were about CBT and Antidepressants (together), while still others pertained to everything from diet, to yoga, to acupuncture, to Fish Oil, etc, etc, etc.  Although the mainstream has been bashing St. John's Wort for a very long time, these authors found that it was equally as effective as medication (52% versus 54%).  Despite this, what did their final guideline ultimately look like?

"ACP recommends that clinicians select between either cognitive behavioral therapy or second-generation antidepressants to treat patients with major depressive disorder after discussing treatment effects, adverse effect profiles, cost, accessibility, and preferences with the patient (strong recommendation, moderate-quality evidence)."

Their excuse for not recommending the Wort was laughable.  They said that it was impossible to find herbs of the proper, "purity and potency in this country."  They are correct if you only consider grabbing the cheapest thing you can find from Mal Wart or the local health food store.   What makes this one of the worst all-time justifications for prescribing drugs is that there are any number of fantastic companies that use stringent quality control to create pharmaceutical-grade products (STANDARD PROCESS' sister company Medi-Herb comes immediately to mind).

Which all begs the question of how much these studies be really be trusted?  Plainly stated; they can't.  Committees of physicians continue to PICK AND CHOOSE THE EVIDENCE not so much based on what really works, but based on what will make the most money.  Think I'm overstating my position?  Listen to what the authors say about the research.  "Study limitations included small sample sizes, high dropout rates, poor assessment of adverse events, and different antidepressant doses between studies." 

We've already seen that adverse events are seriously under-reported (not to mention the fact that studies that turn out differently than researchers want are NEVER BROUGHT TO THE PUBLIC LIGHT).  Furthermore, if those dropping out of the studies because of side effects are not calculated into the results, said conclusions are dramatically skewed to make the drugs appear far better than they really are. It's business as usual folks --- even though these studies used language like "best evidence" about a million times.

Dr Gary Maslow (Assistant Professor of Psychiatry and Behavioral Sciences, and Assistant Professor of Pediatrics at Duke University) and Dr. John Williams Jr (Professor of Medicine and Psychiatry, Director of the Durham VA Evidence Synthesis Program, and Associate Director for the Duke Clinical Research Training Program) sum things up nicely in their letter to the editor. 

"Depression is treatable with a range of options that includes antidepressant medications, evidence-based psychotherapies, and complimentary therapies.  Most persons with depression are initially diagnosed and treated in general medical settings.  The US Preventive Service Task Force (USPSTF) and the American College of Physicians (ACP) are trusted sources of clinical practice guidelines and with good reason.  The USPSTF reaffirms its 2009 recommendations to screen adolescents aged 12 to 18 for Major Depressive Disorder.  This Grade B recommendation reflects 'moderate certainty of moderate net benefit'."

Read the paragraph again and tell me if what is being promoted is a good thing?  Even though THE RIAT ACT has shown beyond the shadow of a doubt that children get the short end of the stick when it comes to side effects of Antidepressant Medications, the band plays on as all children (not just girls) from sixth grade and up are RECOMMENDED TO BE SCREENED.  And if you give your children the drugs that will invariably be prescribed, the very best you can hope for is a moderate certainty of moderate net benefit.  Gulp!

In case you've forgotten, adolescence can be tough.  Little things get blown completely out of proportion.   You got a D on an algebra test.  You don't have a clue about the opposite sex.  You didn't make the basketball team. You backed into the neighbor's car.  You've got acne.  Your parents grounded you, and (if you're a female) you're feuding with your best friend.  You're not sure what you want to do with the rest of your life.  I could go on here ad infinitum.  Daniel Powter tells the story in his 2005 hit song, Bad Day.  "Where is the moment we needed the most.  You kick up the leaves and the magic is lost......"

Cool video that can't help but make you smile.  Bottom line is that most of the bad things that happen to us aren't the end of the world.  Furthermore, CLINICAL DEPRESSION is not what you've been led to believe it is.  Depression, along with problems like CANCER, HEART DISEASE, DIABETES, ARTHRITIS, and a wide assortment OF OTHERS, fall under a category of ailments known as Chronic Inflammatory Degenerative Diseases.  In other words, because they don't address the underlying cause of depression (INFLAMMATION), Antidepressants will ultimately fail.  It sort of makes you stop and think.  Do you really want to fill that script your doctor wrote for your 7th grade daughter?  Take a look at the raw statistics --- millions are without as much as a second thought.

There's a better way to deal with Inflammation and the wide array of diseases it causes.  Attack it at its source.  How do you go about doing this?  I've actually created a post to get you started (HERE).   And I'm not even trying to sell you anything.  It's information folks.  Nothing more.  Take it or leave it.  But rest assured; bring it up to your doctor (I completely suggest you do) and you'll be made to feel like an idiot chasing a rainbow.