By Dr. Mercola
Antidepressants are the most commonly prescribed class of medication other than antibiotics, taken by more than 1 in 10 Americans (and 1 in 4 among women aged 50 to 64).1
Many assume that such pills are the best available treatment for symptoms of depression, but in fact the difference between antidepressants and placebo pills is very small — and both are ineffective for most depressed patients.2
In a meta-analysis published in PLOS Medicine, only the most severely depressed showed any response to antidepressants at all and that response was quite minimal.3 This lack of effectiveness must be taken into consideration along with the drugs' side effects — of which there are many.
Antidepressants May Increase Your Risk of Bipolar Disorder
If you're considering the use of antidepressants, it's probably because you want to feel better. However, antidepressants called serotonin reuptake inhibitors (SSRIs) may leave you with a new set of mental challenges, specifically symptoms of mania or bipolar disorder.
SSRIs include drugs such as Paxil, Zoloft, Celexa and Lexapro. Researchers from King’s College London’s Institute of Psychiatry, Psychology and Neuroscience reviewed more than 21,000 medical records for the recently published study.4
Those prescribed antidepressants had a slightly increased risk of developing mania and bipolar disorder. The risk increased by more than 30 percent for those prescribed SSRIs or another antidepressant called Effexor.
The study was observational, which means it can’t prove that antidepressants caused the increased risk; however, the results suggest risk factors for mania should be considered when treating people with depression.
Antidepressants During Pregnancy Linked to Autism
It's estimated that 14 percent of U.S. pregnant women use antidepressants,5 often after being assured they are safe. But a growing collection of research suggests serious caution is warranted.
Most recently, a JAMA Pediatrics study concluded that use of antidepressants, specifically SSRIs, during the second and/or third trimester increases the risk of autism spectrum disorder (ASD) in children, even after considering maternal depression.6
After reviewing data from pregnancies in Quebec from 1998 through 2009, antidepressant use during the second or third trimester was associated with an 87 percent increased risk of autism.
The use of SSRIs was associated with double the risk of autism in the child, while the use of two or more antidepressants increased the risk more than four-fold.
SSRIs work by preventing the reuptake (movement back into the nerve endings) of the neurotransmitter serotonin. This makes more serotonin available for use in your brain, which is thought to improve your mood.
However, serotonin is involved in fetal brain development, particularly during the second and third trimesters, so manipulating it with SSRIs could be posing a problem. The drugs are also known to cross the placental barrier and reach the fetus.
The use of antidepressants among pregnant women more than doubled between 1999 and 2003, while the prevalence of autism also increased, from 0.04 percent in 1966 to about 1 percent in 2015.7
Susan Hyman, a former chairperson of the American Academy of Pediatrics committee on autism, told the NZ Herald:8
"We need to think even more carefully about the prenatal environment. And not just about birth defects you can see at the time of delivery but about longer-term consequences."
The JAMA Pediatrics study found no association between antidepressant use in the first trimester and autism. However, past studies have.
One study found boys with autism are three times more likely to have been exposed to SSRI antidepressants in utero than non-autistic boys, and those whose mothers used SSRIs during the first trimester were found to be at greatest risk.9
The Vitamin D Connection to Preventing Autism
The autism/antidepressant link may have to do with serotonin metabolism, which is also impacted by vitamin D. The link between vitamin D deficiency in pregnant women and the proportionate jump in autism has been highlighted by Vitamin D Council founder Dr. John Cannell and others.
Vitamin D receptors appear in a wide variety of brain tissue early in the fetal development, and activated vitamin D receptors increase nerve growth in your brain.
In addition, according to a study by the Children's Hospital Oakland Research Institute, vitamin D may affect autistic behavior by activating a gene responsible for the production of tryptophan hydroxylase 2 (TPH2), an enzyme that converts tryptophan to serotonin in your brain.10
The research also shows that two other brain hormones associated with social behavior, oxytocin and vasopressin, are activated by vitamin D. As reported by Newswise:11
"This suggests that adequate levels of vitamin D may be required to produce serotonin in the brain where it shapes the structure and wiring of the brain, acts as a neurotransmitter, and affects social behavior.
They also found evidence that the gene that makes the enzyme tryptophan hydroxylase 1 (TPH1) is inhibited by vitamin D hormone, which subsequently halts the production of serotonin in the gut and other tissues, where when found in excess it promotes inflammation.
This mechanism explains many of the known, but previously not understood, facts about autism including:
1) The 'serotonin anomaly' low levels of serotonin in the brain and high levels in the blood of autistic children
2) The preponderance of male over female autistic children: estrogen, a similar steroid hormone, can also boost the brain levels of serotonin in girls
3) The presence of autoimmune antibodies to the fetal brain in the mothers of autistic children: vitamin D regulates the production of regulatory T-cells via repression of TPH1."
The researchers propose treating ASD with a combination of vitamin D, tryptophan and omega-3 fats in order to naturally elevate the concentration of brain serotonin without side effects. This isn't the first time vitamin D has been implicated as a contributing factor to rising autism rates.
According to previous research, there is indeed a link between rampant vitamin D deficiency in pregnant women and the proportionate jump in autism.12
It is my personal belief that this may be one of the largest contributing factors to autism and that it is a deficiency of sun exposure to the pregnant mom, and subsequently to the fetus, that puts the child at a massively increased risk for abnormal brain development.
I believe one of the most important changes that could radically reduce autism is to make sure ALL pregnant women have their vitamin D levels normalized to 50 to 70 ng/ml.
Antidepressant Use During Pregnancy Linked to ADHD and Birth Defects
It's not only a potentially increased risk of autism that should prompt women who may become pregnant, and those who already are, to carefully consider the use of antidepressants.
Research shows taking SSRIs when you're pregnant may increase the risks of low birth weight, preterm birth, fetal death, infant death, neonatal seizures, and the need for mechanical ventilation.13
It was also found that children born to women who took antidepressants during pregnancy were more likely to develop attention-deficit hyperactivity disorder (ADHD).14 That study also found a link between taking antidepressants during pregnancy and the risk of autism in the offspring, although it became less significant when material history of severe depression was taken into account.15
Another study, published in BMJ, specifically looked at the effects of SSRIs used during the first trimester of pregnancy and in the month before.
The researchers analyzed data from nearly 30,000 women and revealed the use of the antidepressant Paxil (paroxetine) was associated with an increased risk of five birth defects, including heart defects and anencephaly, which is abnormal brain and skull formation.16
The use of Prozac (fluoxetine) was associated with two birth defects, including heart wall defects and abnormal skull shape (craniosynostosis). The increase in absolute risk was low; for instance, 10 out of 10,000 women may give birth to a baby with a heart defect but this increased to 24 out of 10,000 among those using Paxil.17
Still, some birth defects occurred two to three times more often in babies born from women taking the drugs, and when the increased risk is combined with the many other studies showing harm, and few showing benefit, it poses a serious concern. In addition:
- Prolonged use of SSRIs during pregnancy was associated with lower language competence at the age of 318
- Women using antidepressants during the second and third trimesters are more likely to give birth prematurely19
- Babies exposed to SSRIs in utero have an increased risk of clubfoot, low birth weight, and persistent pulmonary hypertension20
- Babies exposed prenatally to SSRIs had lower Apgar scores at birth, which is a measure of newborn well-being21
- SSRIs may disrupt fetal deep sleep, which is crucial for normal growth and development; they've also been linked to an increased risk of miscarriage,22 and many babies exposed in utero even display withdrawal symptoms to SSRIs at birth
SSRI Stories: Antidepressant Nightmares
The potential side effects of antidepressants stretch far and wide. For instance, research suggests taking an SSRI may double your risk of bone fractures.23 This is because serotonin is also involved in the physiology of bone.
If you alter serotonin levels with a drug, it can result in low bone density, boosting fracture risk. A large study of post-menopausal women also found that those taking tricyclic antidepressants or SSRIs were 45 percent more likely to suffer a fatal stroke.24
The research also found that overall death rates were 32 percent higher in women on the drugs, while other research linked antidepressant use to thicker arteries, which could contribute to the risk of heart disease and stroke.25 Among the most concerning side effects, however, especially to society as a whole, are suicidal thoughts and violent behavior.
At SSRIStories.org, you can browse through a collection of more than 6,000 stories in which prescription drugs, primarily SSRIs, were potentially linked to serious side effects, including violent behavior. Categories include murder-suicide, postpartum reactions, road rage, school and other mass shootings, workplace violence, and more. According to the site:26
"The stories on this site include many where young people have been casually given prescriptions for antidepressants, for situational conditions such as loss of a loved one, bullying by classmates, or anxiety about school or relationships. Too often, the treatment intended to cushion the impact of unhappy life experiences results in suicide, homicide, alcoholism, or drug addiction.
It is axiomatic that had the families known of the risks, they would [have] tried to have prevented their loved one from taking the drug. But families do not know, because they are not told. If they ever realize that the antidepressant was the problem, it happens only after serious damage has been done, which in too many cases is death."
Talk Therapy Treats Major Depression as Well as Antidepressants
If you're diagnosed with depression, be aware that there are many treatment options available, including cognitive behavioral therapy (CBT). In a systematic review of 11 studies, no statistically significant difference in effectiveness was found between second-generation antidepressants and CBT.27
Lead author Halle Amick, a research associate with the Research Triangle Institute-University of North Carolina in Chapel Hill, told Medicine Net:
" … [There was] 'no statistical or clinical difference between the two treatments … We're not saying that one treatment is better than the other. All we can say is that both seem to be equally effective … On the other hand, medications might have a higher risk for adverse side effects. Our data didn't explore these issues, though they need to be considered when choosing between the two.'"
That being said, whichever form of treatment you're leaning toward, if you are experiencing severe depression please seek help from a professional. For milder depression, and in addition to professional treatment for severe depression, the place to start is to return balance — to your body and your life.
If you're currently taking antidepressants and wish to stop, be aware that you should wean off them gradually and under the care of a knowledgeable health care provider. As reported by SSRI Stories:28
"Withdrawal, especially abrupt withdrawal, from any antidepressant medications can cause severe psychiatric and/or physical problems. Every individual is slightly different, but it is important to withdraw slowly from these drugs, sometimes over a period of a year or more, and ideally under the supervision of a qualified and experienced specialist.
In many jurisdictions, doctors who have the knowledge and the will to assist their patients to withdraw are hard to find. Withdrawal is often more severe than the original symptoms or problems for which the antidepressant prescription was given. Withdrawal can cause a wide range of symptoms, from headaches, brain 'zaps,' insomnia, lethargy, or fatigue, to feeling anger, irritation, or even extreme, uncontrollable rage, and countless others."
Non-Drug Options for Treating Depression
Research confirms that there are safe and effective ways to address depression that do not involve unsafe drugs. This includes addressing your gut health, as mentioned above, and more:
- Dramatically decrease your consumption of sugar (particularly fructose), grains, and processed foods. (In addition to being high in sugar and grains, processed foods also contain a variety of additives that can affect your brain function and mental state, especially MSG and artificial sweeteners such as aspartame.)
There's a great book on this subject, “The Sugar Blues,” written by American writer and news desk assistant editor William Dufty more than 30 years ago, that delves into the topic of sugar and mental health in great detail.
- Increase consumption of probiotic foods, such as fermented vegetables and kefir, to promote healthy gut flora. Mounting evidence tells us that having a healthy gut is profoundly important for both physical and mental health, and the latter can be severely impacted by an imbalance of intestinal bacteria. Avoiding sugar will also help toward this end.
This is especially important during pregnancy, because if mother's flora is abnormal, her baby's flora will also be abnormal. Whatever organisms live in her vagina end up coating her baby's body and lining his or her intestinal tract.
- Get adequate vitamin B12. Vitamin B12 deficiency can contribute to depression and affects one in four people.
- Optimize your vitamin D levels, ideally through regular sun exposure. Vitamin D is very important for your mood. In one study, people with the lowest levels of vitamin D were found to be 11 times more prone to depression than those who had normal levels.29
The best way to get vitamin D is through sun exposure or use of a high-quality tanning bed. A vitamin D3 supplement can be used if these aren't possible, but you'll need to monitor your levels regularly.
- Get plenty of animal-based omega-3 fats. Many people don't realize that their brain is 60 percent fat, but not just any fat. It is DHA, an animal-based omega-3 fat, which, along with EPA, is crucial for good brain function and mental health.30
Unfortunately, most people don't get enough from diet alone. Make sure you take a high-quality animal-based omega-3 fat, such as krill oil, or consume sardines or anchovies regularly.
Dr. Stoll, a Harvard psychiatrist, was one of the early leaders in compiling the evidence supporting the use of animal based omega-3 fats for the treatment of depression. He wrote an excellent book that details his experience in this area called "The Omega-3 Connection."
- Evaluate your salt intake. Sodium deficiency actually creates symptoms that are very much like those of depression. Make sure you do not use processed salt (regular table salt), however. You'll want to use an all-natural, unprocessed salt like Himalayan salt, which contains more than 80 different micronutrients.
- Get adequate daily exercise, including high-intensity exercise, which is one of the most effective strategies for preventing and overcoming depression. Studies on exercise as a treatment for depression have shown there is a strong correlation between improved mood and aerobic capacity.
So there's a growing acceptance that the mind-body connection is very real, and that maintaining good physical health can significantly lower your risk of developing depression in the first place.
- Get adequate amounts of sleep. You can have the best diet and exercise program possible, but if you aren't sleeping well you can easily become depressed. Sleep and depression are so intimately linked that a sleep disorder is actually part of the definition of the symptom complex that gives the label depression.