I’ve recently come across an article by Ronald Pies MD on PsychCentral. It’s titled: Are the Puritans Behind the War on Antidepressants?
Here’s the opening paragraph:
“These are not good times for Prozac and its progeny. In the popular media, the use of antidepressants has been likened to swallowing ‘expensive Tic-Tacs’, while in professional journals, the effectiveness of these medications has been challenged, if not discounted. And even a casual Google search under the terms, “Antidepressants damage” turns up thousands of websites and articles claiming that these drugs cause brain damage, induce suicide, or lead to ‘addiction.’ Yikes!”
Dr. Pies assures us that most of these claims are either “groundless or simplistic.”
“GROUNDLESS AND SIMPLISTIC” CLAIMS
Let’s examine these “groundless” claims.
1. “…these drugs cause brain damage…”
PDR Health has this to say:
“Prozac may cause the development of potentially life-threatening reactions known as serotonin syndrome (a potentially life-threatening drug reaction that causes the body to have too much serotonin, a chemical produced by the nerve cells) or neuroleptic malignant syndrome (NMS, a life threatening brain disorder) when taken alone or in combination with other drugs. Symptoms may include mental status changes, increase in heart rate and temperature, incoordination, overactive reflexes, muscle rigidity, nausea, vomiting, or diarrhea. Contact your doctor immediately if you experience any of these signs or symptoms.”
This seems unambiguous to me.
2. “…these drugs induce suicide…”
PDR Health again:
“Antidepressants can increase the risk of suicidal thinking and behavior in children, adolescents, and young adults.”
Again, not much ambiguity.
3. “…these drugs…lead to ‘addiction’.”
“Addiction” of course is a vague term, which is presumably why Dr. Pies put it inside quotation marks. But later in his article Dr. Pies says:
“…suddenly stopping a long-term antidepressant can lead to uncomfortable withdrawal symptoms, and there may be a small percentage of patients who develop delayed “resistance” to antidepressants, with a return of depressive symptoms…”
Uncomfortable withdrawal symptoms and increased tolerance (or resistance as Dr. Pies calls it) are considered by most people in the addictions field to be the hallmarks of chemical dependence! I don’t think I need to add anything here other than the fact that a good many people who take SSRI’s do report considerable difficulty quitting. Do you remember when they used to say that Valium wasn’t addictive?
WE PURITANS
Dr. Pies now poses the questions: “why is there so much hostility directed at these medications?” In my view that is a very good question, and it would be a truly great step forward if Dr. Pies were to address it seriously.
But no! He already has his answer:
“I believe that a good deal of the animus arises from our Puritan heritage, and its attitude toward suffering, sin, and expiation.”
So there it is. Our opposition to the routine excesses of psychiatric activity is not based on logic or any rational assessment of the facts, but simply on our puritanical tendencies. This attitude, Dr. Pies informs us, “…pervades our society’s views about depression—that it is, in some sense, the ‘fault’ of the depressed individual.”
“The logical extension of this line of reasoning,” according to Dr. Pies, “is that the depressed individual must somehow ‘repent of his ways’…”
“This attitude,” he tells us, “is extraordinarily unhelpful for those struggling with a potentially lethal illness.”
ON THE OTHER HAND
Joanna Moncrieff is a psychiatrist. She is the author of The Myth of the Chemical Cure (2009). In Chapter 10, she discusses the chemistry, efficacy, and adverse effects of antidepressants and concludes:
“The SSRIs produce no effects that look likely to be useful in depression. They cause unpleasant agitation in a proportion of patients and, although it is difficult to prove conclusively, an increase in suicidal and violent tendencies may be associated with this effect. Therefore, I can think of no good reason to prescribe them at all.” (p 172)
And:
“Apart from the adverse physical effects of antidepressant drugs, they have damaging psychological effects that should cause just as much concern. The idea that your emotional state has been caused by a biochemical imbalance in your brain is profoundly disempowering. Because of the disease-centred implications of the notion of an antidepressant, every time an antidepressant is prescribed it conveys this message.” (p. 172)
I’ve always considered Dr. Moncrieff to be scholarly, meticulous, and professional, and have frequently recommended her book for the facts and insights it provides in this field.
But now thanks to Dr. Pies, I can see that she’s just another misguided Puritan like the rest of us!
Oh me!