By Ms. Sue Newton, MN, RN

There has been a lot of controversy in recent years about the efficacy of SSRIs (selective serotonin reuptake inhibitors)- medication used to treat mild and moderate depression. Two large meta-analyses from the United States have shown that SSRIs are no more effective than a placebo (the dummy pills that medications are tested against in clinical trials) and many are now questioning if SSRIs are being overprescribed or mis-prescribed.

Depression and anxiety continue to be Canada’s fastest rising diagnoses. Over 15 million prescriptions for SSRI antidepressants were written in Canada in the early 2000s and the numbers keep rising. Twice as many women as men are diagnosed with depression/anxiety and married women have higher rates of diagnosis of depression than single women and it occurs most frequently between the ages of 24-44. SSRIs initially became available for prescription in the late 1980s, with fluoxetine (Prozac) being the first popular one, and the initial claims by pharmaceutical companies were that these medications were 80-90% effective. By 2004, brand-name antidepressant companies made more than $14 billion annually. These sales mean big business and consumer advertising (such as television commercials) has helped fuel it. Studies indicate that this kind of advertising has contributed to the significant growth in SSRI prescriptions. When people see commercials for antidepressants, such as Zoloft, and think that it can help them, they go to their doctors and request it. Doctors are more likely to prescribe an antidepressant when a patient specifically asks for it.

In terms of balancing benefits with the risk of adverse drug effects, efficacy is of paramount importance, especially because SSRIs are presently being used for long-term maintenance treatment of depression and anxiety. The energizing effects of SSRIs may likely cause subjective improvement, which can be important to many people. However, the same energizing effect of SSRIs can put suicidal patients in a dangerous position because their energy rises before their mood does, thus creating a high-risk window of suicidality for some people. SSRIs do suppress the experience of overwhelming feelings, which may be beneficial in acute situations but can reinforce avoidance of dealing with feelings long-term that complicates problems that need to be dealt with for a healthier life. Further, the change in chemical balance in the brain with the use of SSRIs results in withdrawal symptoms that can be very challenging when an individual tries to come off them.

Treating depression is an art as well as a science as depression manifests itself in different ways in different people so it’s crucial to get a thorough assessment and appropriate follow up. Ideally, a mental health professional or primary care physician asks questions about mood, symptoms, family history of mood disorders, and current life circumstances before arriving at a diagnosis and prescribing medication. Depression and anxiety are common symptoms related to drugs and alcohol-related problems. These symptoms can also stem from underlying medical causes, such as thyroid or heart diseases, or the side effect of a medication used for another condition. A careful assessment can help rule out these possibilities. It can also help determine whether you are experiencing a temporary low period due to a specific stressor, like the death of a loved one or a job loss, if it is connected to addiction-related problems or if this is a true depressive episode that could respond to medication. A concern for many is that SSRIs are prescribed too liberally when a thorough assessment has not taken place.

Despite research findings, most experts agree that antidepressants remain an important treatment option for depression and anxiety, especially when an individual is functionally disabled and they are used in combination with psychotherapy. It is essential that people with mild symptoms get help in dealing with problems with psychotherapy and/or proper nutrition and exercise first; and consider medication only if these non-medicinal options offer insufficient relief rather than opt for a prescription as the first treatment option. If you are hesitant to take antidepressants or your condition is not severe enough to warrant therapy, you do have options. Regular exercise has been found to dramatically relieve depression. In addition, maintaining a balanced, nutritious diet, avoiding the use of alcohol, smoking cessation and reducing the intake of stimulants, such as caffeine, are very helpful as well.