Antidepressant Safety Concerns
During the COVID-19 pandemic, there has been a marked increase in depression with mental health resources being overwhelmed when needed the most.
There is a role for conventional treatments with medication, especially in the situation of resistant or major depression, where more natural therapies have not been effective.
Untreated depression can rob a person of their vitality, energy, motivation, interfere with relationships, work, and enjoyment of life. Depression can become chronic and evolved into a more serious physical or mental illness, contributing to a loss of health, drug or alcohol abuse, and possible death by related medical illness, overdose, or suicide.
From an Integrative Psychiatry perspective, before considering any medication, you have to look at all the dimensions that may impact a person and their illness. Safe and more natural options are crucial initial considerations. Non-medication alternatives would depend on an individual's ability: to learn and be educated about the steps in doing a therapeutic program, to be compliant with recommendations, and to have the necessary support needed for the recommended plan.
The person would also need to have the willingness and resources to participate in any therapy recommended, whether natural approaches, psychotherapy, or medication combined with other modalities or alone. Also, the medical or physical state of the individual, their potential for harm to self or others, or the risk of side effects would be some of the other needed consideration before considering any treatment or medication use. The risk vs. benefits of any given treatment would require careful consideration.
Most antidepressant prescriptions are by non-psychiatric or mental health trained healthcare providers who are often the initial access to mental health care. Antidepressants are reported as the third most frequently prescribed medications in the U.S. About one-tenth of this country's adults are estimated to take antidepressants.
Antidepressant studies have shown side effects and potential dangers.
But when other non-medication treatments have not been available, when an adequate evaluation or consultation occurs by a qualified and trained mental health practitioner, successful application and treatment with antidepressants, with or without combination with more natural approaches, can be helpful, and sometimes lifesaving.
Significant adverse health outcomes from antidepressants, by and large, are not "absolutely" supported by recent research. Antidepressants are a consideration when other non-medication treatments are unlikely to be helpful, possible, or available. For the use of a medication or any proposed treatment, there needs to be a clear clinical indication.
Caution and careful assessment remain vital in determining antidepressant safety and use.
Areas of concern are antidepressant use during pregnancy, in children or adolescents with the possible link between selective serotonin reuptake inhibitor (SSRI) use and suicide attempt or completion, and other potential adverse health outcomes.
The linking of antidepressants to severe adverse outcomes or side effects remains a concern and a cause for vigilance, caution, and need for continued research. Some of the reported severe adverse consequences have varying levels of evidence to support the potential for dangerousness. However, the typical side effects of medications do occur. Still, the final proof that there is an actual linkage to increase in autism, violence or, suicidality in younger age groups remains an ongoing area of investigation. Likewise, some studies have linked SSRI antidepressant usage during the second and third trimesters with autism spectrum disorders (ASD).
Because of concern for possible side-effects or long term consequences of antidepressants, a thorough evaluation by a qualified and experienced medical and mental health practitioner, with skills and expertise in working with mood difficulties, is often warranted, and a better route to go when available.
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Ron Parks MD
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**The above is for informational and educational purposes only, not as medical or mental health advice. It is the reader's responsibility to direct personal medical or mental health questions to their primary care provider and specialty physicians. The information and statements contained in this material are not intended to diagnose, treat, cure, or prevent any disease or to replace the recommendations or advice given to you by your primary or direct care providers.
Your reliance on any information provided by Dr. Parks is solely at your discretion. You are advised not to disregard medical advice from your primary or direct care providers or delay seeking medical advice or treatment because of the information contained in this article. Management of severe mental or physical health problems should remain under the care and guidance of your primary care physicians, specialist, or psychiatrists.
Lead-in photo for article: ©Aleksandr Davydov/123rf.com
REFERENCES & LINKS
Antidepressants Are Safe: Final Word? Medscape Medical/Psychiatric News, Megan Brooks, October 03, 2019
Antidepressant Use During Pregnancy and the Risk of Autism Spectrum Disorder in Children, JAMA Pediatrics, Takoua Boukhris, MSc1,2; Odile Sheehy, MSc2; Laurent Mottron, MD, PhD3,4,5,6; et alAnick Bérard, PhD1,2, JAMA Pediatr. 2016;170(2):117-124. doi:10.1001/jamapediatrics.2015.3356
Prevalence and Determinants of Long-Term Utilization of Antidepressant Drugs: A Retrospective Cohort Study, Neuropsychiatr Dis Treat. 2020; 16: 1157–1170, 2020 May 7. 10.2147/NDT.S241780, Carlotta Lunghi,1,2,3 Ippazio Cosimo Antonazzo,2 Sofia Burato,2 Emanuel Raschi,2 ,et.al.
Suicide Risk During Antidepressant Treatment, American Journal of Psychiatry, Gregory E. Simon, M.D., M.P.H., James Savarino, Ph.D., Belinda Operskalski, M.P.H., and Philip S. Wang, M.D., Dr.P.H., January 01, 2006
Follow-up of children of depressed mothers exposed or not exposed to antidepressant drugs during pregnancy*, The Journal of Pediatrics, Volume 142, Issue 4, April 2003, Pages 402-408, Regina C.CasperMDBarry E.FleisherMD, Julie C.Lee-Ancajas Ph.D., AllysonGilles BA, et. Al.
Parental depression, maternal antidepressant use during pregnancy, and risk of autism spectrum disorders: a population-based case-control study
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Antidepressant exposure in pregnancy and risk of autism spectrum disorders, Clin Epidemiol. 5: 449–459, 2013, November 15. Merete Juul Sørensen, Therese Koops Grønborg,Jakob Christensen, Erik Thorlund Parner, et.al.
SEE DR. PARKS' PRIOR ARTICLES ON INTEGRATIVE PSYCHIATRY, HOLISTIC THERAPIES, MOOD DISORDER, AND DEPRESSION:
The Downside of Untreated Depression
Hurricanes, Depression, and Recovery