Antidepressants are the focus of many studies that can seem conflicting and be difficult to finally decipher. Due to their frequent prescription and potentially deadly side effects, the drugs are repeatedly re-examined and re-tested with the hope of conclusive answers to open questions.
The fact is that what is known about the brain is ambiguous, inconclusive, and constantly changing. Consequently, theories of how drugs work in the brain are also constantly transforming.
One synopsis of 2013 health indicators concluded that antidepressants are prescribed more frequently in most countries now than they were in 2000. The report was published by the Organization for Economic Cooperation and Development and included statistics from most of the 34 member countries. The United States did not have reported statistics for antidepressant prescription in this study.
Data from the Center for Disease Control and Prevention from 2011 shows that antidepressants prescriptions increased by nearly 400 percent between the early 90’s and 2005-2008 in the United States. Antidepressants are the third most commonly prescribed medication in the US, used by roughly one in ten people over the age of 12.
Yet another recent study showed that clinicians are hesitant to prescribe anti-depressants to teens. How to finally decipher the seeming inconsistencies in reported antidepressant trends?
In 2004 the FDA issued a public warning about increased risk of suicidal thoughts among children and adolescents on SSRI antidepressants. SSRI stands for selective serotonin re-uptake inhibitor, and explains how the drug acts in the brain. The neurotransmitter serotonin is blocked from re-absorption, causing it to stay in the synapse longer and contribute to extended feelings of calmness and contentment.
In the wake of the FDA warning, SSRI’s were demonized, and SNRI’s, serotonin- norepinephrine re-uptake inhibitors, were advocated in their place. Now, a study published in the journal Pediatrics shows that SNRI’s are no more effective at preventing suicide than SSRI’s.
It may be not be the drug, but genetics that produce the suicidal ideation. Sundance Diagnostics just came out with a potential test that measures biological factors to see whether a person is predisposed to the negative side-effects of antidepressants. Seventy nine genetic traits were identified as leading to a higher risk of suicidal thoughts when combined with SSRI’s.
In the study on clinicians prescribing antidepressants to teens, the researchers found that health providers who were well informed about depression were more likely to prescribe antidepressants. When providers had the option of consulting with a mental health professional, they were also more likely to prescribe the medication.
After the FDA’s initial warning in 2004, an addendum was issued in 2006 saying that the benefits of antidepressants outweighs the risks of taking them for people with severe depression. In the study, providers were asked to assess two hypothetical teens, one of whom had symptoms of moderate depression and one of whom had symptoms of severe depression.
Most providers in the study said that they would refer the teens to a psychiatrist for medication management. About a third said they would prescribe antidepressants for the teen with severe depressive symptoms, and a quarter said they would do the same for the teen with moderate depressive symptoms.
Overall, the study suggests that many practitioners are uncomfortable making decisions about treatments for adolescent depression without consulting an expert in mental health. At the same time, other studies suggest that antidepressants are overprescribed to the general population.
According to the CDC, less than one third of those on antidepressants have seen a mental health professional in the last year. Psychotherapy is far more costly than prescribing medication, and there is a shortage of child psychiatrists. Whether there is a shortage of psychiatrists for adults, or a stigma against attending talk therapy, or over-prescription of antidepressants without referrals to mental health professionals remains to be finally deciphered.
By Julia Waterhous