Should Antidepressants Be Given Prophylactically to Nondepressed Individuals?

doctor prescribes antidepressants

Story at-a-glance -

  • Depression is the leading cause of ill health and disability worldwide. Between 2005 and 2015, global rates of depression increased by 18 percent
  • Eleven percent of Americans over the age of 12 are on antidepressant drugs. Among women in their 40 and 50s, 1 in 4 is on antidepressants
  • Researchers are investigating whether antidepressants might be useful for prophylactic purposes. Studies suggest nondepressed patients at high risk for depression may lower their risk by taking the drugs
  • Antidepressants are particularly hazardous for children, teens and women of childbearing age. Research shows use of antidepressants during pregnancy raises the child’s risk of psychiatric disorders
  • Research also shows use of antidepressants is associated with a 14 percent increased risk of a cardiovascular event, such as heart attack or stroke, and a 33 percent increased risk of premature death

By Dr. Mercola

Mental health appears to be dwindling across the globe, with depression now being the leading cause of ill health and disability worldwide.1,2 Over the past decade alone (2005 to 2015), rates of depression increased by 18 percent.3 In the U.S., more than 16 million people struggle with the condition, including 6 million seniors,4 and 11 percent of Americans over the age of 12 are on antidepressant drugs. Among women in their 40s and 50s, 1 in 4 is on antidepressants.5

Clearly, something is very wrong. Part of the problem, I believe, is the fact that the go-to solution simply doesn't work, and the psychiatric field is slow to branch out into more effective yet less financially rewarding strategies. Antidepressants tend to be the first-line treatment, even though studies have proven they work no better than placebo.6,7,8,9

Now, researchers are investigating whether antidepressants might be prophylactically useful. The idea that taking a potent brain-altering drug that has the clinical effectiveness of a placebo to prevent depression is suspect in the extreme. There are many other strategies with far better track records that can both prevent and help treat depression.

Could Antidepressants Be Used Preventively? 

According to The Washington Post:10

"Some studies have estimated that up to half of patients with head and neck cancers may experience depression. A group of researchers … examined what would happen if non-depressed patients were given antidepressants before receiving treatment for head and neck cancer.

Published in 2013, the results of the randomized, placebo-controlled trial11 were startling: Patients taking an antidepressant were 60 percent less likely to experience depression compared with peers who were given a placebo. In medicine, this approach is often referred to as prophylaxis, or a treatment used to prevent disease."

Other studies assessing the benefits of prophylactic antidepressants include:

  • A 2014 analysis, which concluded antidepressants reduced incidence of major depression among patients treated for hepatitis C by 40 percent12
  • A 2004 study concluded post-stroke depression, which affects up to 40 percent of stroke victims, could be reduced through prophylactic treatment with the antidepressant mirtazapine. Forty percent of nontreated patients developed depression, compared to less than 6 percent of those receiving the drug13
  • A 2008 study also found nondepressed stroke patients given escitalopram (brand name Lexapro) were significantly less likely to develop depression compared to the placebo group over 12 months of treatment.14 However, it was later revealed the lead author had undisclosed financial ties to the manufacturer of the drug, which cast doubt on the results15
  • Other small studies have also concluded that pretreatment with antidepressants may reduce the likelihood of depression in patients receiving treatment for melanoma16,17

According to the featured article, "These findings provide compelling reasons for physicians and patients to consider using these medicines to pre-empt ­mental-health issues."18

I couldn't disagree more vigorously with this distorted view of reality. Just because an antidepressant might help prevent drug- or chemo-induced depression does not mean that nondepressed individuals will benefit from taking antidepressants prophylactically. In fact, it may well have the opposite effect. There's really no telling what kind of devastating societal health effects such a trend might create.

Antidepressants During Pregnancy Increase Child's Risk of Psychiatric Disorders

Antidepressants are particularly hazardous for children, teens (who are more prone to self-harm on certain antidepressants) and women of childbearing age. Recent research19 shows use of antidepressants during pregnancy raises the child's risk of developing a psychiatric disorder.20,21 The study evaluated data collected from more than 905,000 Danish children born between 1998 and 2012. The follow-up period lasted for nearly 17 years. The results showed that:

  • Among children whose mothers did not use antidepressants during pregnancy, the 15-year risk of psychiatric problems was 8 percent
  • Those whose mothers took an antidepressant prior to but not during pregnancy had a risk of 11.5 percent
  • Among those whose mothers had started taking an antidepressant prior to pregnancy and continued taking the drug during pregnancy, the risk for psychiatric problems was 13.6 percent
  • Children whose mothers started taking an antidepressant during pregnancy had the highest risk of a psychiatric disorder — 14.5 percent

Birth Defects Linked to Antidepressant Use in Pregnancy

Estimates suggest anywhere from 822 to 14 percent23 of pregnant women take antidepressants, even though studies suggest there are risks involved. A 2015 study24 — which looked at the effects of selective serotonin reuptake inhibitors (SSRIs) used during the first trimester of pregnancy and in the month before — concluded that:

  • Paxil (paroxetine) was associated with an increased risk of five birth defects, including heart defects and anencephaly (abnormal brain and skull formation)
  • The use of Prozac (fluoxetine) was associated with 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. Still, some birth defects occurred two to three times more often in babies born to women taking the drugs, and when the increased risk is combined with the many other studies showing harm, and few showing benefit, it still poses a serious concern.

SSRIs Increase Risk of Death by One-Third

A recent meta-analysis25 also shows SSRIs and tricyclic antidepressants dramatically raise your risk of death from any cause — an effect attributed to the disruption of "multiple adaptive processes regulated by evolutionarily ancient biochemicals," one of which is serotonin. A total of 16 observational studies were included in the analysis, involving some 375,000 participants.

Overall, use of antidepressants was associated with a 14 percent increased risk of a cardiovascular event, such as heart attack or stroke, and a 33 percent increased risk of premature death. Lead author Marta Maslej told Medical News Today:26

"We made sure to only include studies that did a good enough job controlling for important variables (like depression and other illnesses), and so we have attempted to statistically rule out other factors that could contribute to mortality. We also ensured that our findings weren't related to confounding by indication.

This means that people who have more severe depression could be more likely to take antidepressants, and if that's the case, we could not be sure whether the increase in risk of death is due to using antidepressants or having more severe depression.

To address this issue, we re-ran our analysis on only the studies that assessed depression in participants before they began using antidepressants. When we re-ran this analysis, the risk of mortality remained high which suggests that confounding by indication wasn't an issue in our study."

21st Century Reason for Rising Depression Rates

In light of the rapidly rising prevalence of depression, the question "why" is one that really needs to be looked into. I believe a significant yet completely ignored culprit is excessive microwave radiation from cellphones, cellphone towers, cordless phones, Wi-Fi, computers, smart meters, baby monitors and other electronic gadgets.

Last year, Dr. Martin Pall published a review27 in the Journal of Neuroanatomy showing how microwave radiation from these technologies is clearly associated with many neuropsychiatric disorders, including depression, anxiety, autism and Alzheimer's.

In a nutshell, microwave radiation activates voltage gated calcium channels (VGCCs) in your cells, and one of the tissues with the highest density of VGCCs is your brain. Once the VGCCs are stimulated, intracellular calcium dramatically increases, as does the release of neurotransmitters, neuroendocrine hormones and highly damaging reactive oxygen species (ROS) — all of which raise your risk for depression and anxiety.

Based on this mechanism, it seems clear that chronic exposure to electromagnetic fields (EMFs) can play a significant role in psychiatric health. As a society, we need to take this seriously. On a personal level, be sure to limit your exposure to EMFs and wireless technology. Simple measures include turning your Wi-Fi off at night, not carrying your cellphone on your body and not keeping portable phones, cellphones and other electric devices in your bedroom.

Turning off all power at the circuit breaker to your bedroom at night is probably the single most important remediation strategy I can think of. The wiring inside your walls generates dangerous levels of magnetic and electrical (not microwave) radiation that impairs your melatonin production, disrupting your sleep.

This in turn will also heighten your risk of depression, anxiety and many other health problems. To learn more about how microwaves and dirty electricity affect your health, please see my interviews with Pall and Dr. Sam Milham.

Anti-Inflammatory Diet Is Essential for Psychiatric Health

Needless to say, your diet also plays a major role when it comes to your psychiatric health. According to Dr. Hyla Cass, a psychiatrist who uses integrative medicine in her practice, one of the first steps in addressing a mental health problem is to clean up your diet and address your gut health. If you don't, you'll seriously hamper your chances of getting well.

Food sensitivities can also play a role. For example, gluten can produce symptoms of depression if you're sensitive to it. In such a case, the key is to remove gluten from your diet entirely. Merely cutting down will not work. Cass has seen many patients recover from severe depression when going gluten-free. It's also important to avoid sugar and junk food, which raises your risk of depression by promoting inflammation.

In fact, chronic inflammation appears to be a leading cause of depression.28 One theory as to why certain nutrients work so well for depression is because they are potent anti-inflammatories. Nourishing your gut microbiome is an important component of lowering inflammation, as much of the inflammation starts in your gut. My previous article,29 "Are Probiotics the New Prozac?" reviews some of the supporting evidence.30,31,32

Researchers have also found strong connections between the gut microbiome and schizophrenia33,34 and bipolar disorder,35,36,37,38 demonstrating the close relationship between your gut and your brain. To nourish your gut microbiome, increase your consumption of fiber and probiotic foods, such as fermented vegetables, kimchee, natto, kefir and others. Keep in mind that, in order for it to work, the fiber must be unprocessed.39,40 Processed supplement fiber such as inulin powder does not provide gut bacteria with what they need.

Specific Nutrients Associated With Improved Mental Health

Specific nutrient deficiencies can also have a significant impact on your mental health. On CassMD.com you can find a free report called "Reclaim Your Brain," which details a number of nutritional substances you can use to address conditions like anxiety and depression. Following are three of the most important ones:

Omega-3s — The animal-based omega-3 fats DHA and EPA are crucial for good brain function and mental health.41,42 The 2001 book, "The Omega-3 Connection" by Harvard psychiatrist Dr. Andrew Stoll, was among the first works to bring attention to and support the use of omega-3 fats for depression. Omega-3s have also been shown to improve more serious mental disorders, including schizophrenia, psychosis and bipolar disorder.43

While there's no set recommended dose of omega-3 fats, some health organizations recommend a daily dose of 250 to 500 milligrams (mg) of EPA and DHA for healthy adults. If you suffer from depression, higher doses may be called for.

In one study,44 an omega-3 supplement with a dose range of 200 to 2,200 mg of EPA per day was effective against primary depression. Good sources include fatty fish that are also low in mercury, such as wild-caught Alaskan salmon, sardines and anchovies. If you don't eat these types of fish on a regular basis, it would be advisable to take a high-quality omega-3 supplement such as krill oil, which has a number of benefits over fish oil, including better absorption.45

Vitamin D — Researchers have suggested vitamin D may play a role in depression46 by regulating brain chemicals called monoamines, which include serotonin.47 As a general rule, depressed individuals have lower vitamin D levels than nondepressed people,48 and having a vitamin D level below 20 ng/mL can raise your risk of depression by 85 percent compared to having a level greater than 30 ng/mL.49

Recent research50 also claims that low vitamin D levels appear to be associated with suicide attempts. Ideally, maintain your vitamin D level between 40 and 60 ng/mL year-round. I also recommend having your vitamin D level checked yearly to assure you're within this ideal range. 

B vitamins — A number of studies have shown deficiencies of one or more B vitamins (niacin/B3, B6, biotin/B8, folate/B9 and B12) can produce psychiatric effects. For example, vitamin B12 deficiency can trigger confusion, agitation, depression, mania, psychosis and paranoid delusions.51

One recent study52,53 found vitamins B6, B8 and B12 in combination were very effective for improving schizophrenic symptoms when taken in high doses — more so than standard drug treatments alone. Low doses were ineffective. 

The power of niacin (B3) was also demonstrated by Dr. Abram Hoffer, one of Cass' mentors and a co-founder of orthomolecular medicine, which refers to the concept of nutritional deficiencies being a source of mental illness. Hoffer used high doses of niacin to successfully treat schizophrenics. Amazingly, he was able to get many of these severely ill mental patients well enough to lead normal lives.

It turns out pellagra, a disorder caused by extreme niacin deficiency, produces the same psychiatric symptoms found in schizophrenia. In fact, Hoffer discovered that many schizophrenic patients were niacin dependent, meaning they needed far more niacin on a regular basis than normal in order to remain well.

Other researchers have found niacin may also be successfully used in the treatment of other mental disorders, including obsessive-compulsive disorder, attention deficit disorder, anxiety and depression.

Holistic Mental Health Suggestions

Regardless of the nature or severity of your mental health problem, to successfully treat it, you need to take a holistic approach. Rarely will medication be the sole answer. And, considering the seriousness of some side effects, which include depression, suicide, cardiovascular events and premature death, taking an antidepressant for preventive purposes is definitely not recommended. Instead, whether you want to prevent depression or treat it, be sure to address your diet and any nutrient deficiencies you may have.

A holistic doctor will be able to help you determine your nutrient status with appropriate tests, and identify any food sensitivities you may have. Most people need higher amounts of vitamin D and omega-3, but to determine your ideal dose, be sure to get a vitamin D and omega-3 index test. Following are some additional guidelines and suggestions — presented in no particular order — to keep in mind:

Eat real food and avoid all processed foods

High sugar and starchy nonfiber carbohydrates lead to excessive insulin release, which can result in falling blood sugar levels, or hypoglycemia. In turn, hypoglycemia causes your brain to secrete glutamate in levels that can cause agitation, depression, anger, anxiety and panic attacks. Sugar also fans the flames of inflammation in your body.

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.

Research also shows that glyphosate, used in large quantities on genetically engineered crops like corn, soy and sugar beets, limits your body's ability to detoxify foreign chemical compounds. As a result, the damaging effects of those toxins are magnified, potentially resulting in a wide variety of diseases, including brain disorders that have both psychological and behavioral effects.

Lower your microwave and EMF exposure as much as possible

As mentioned, studies have linked excessive EMF exposure to an increased risk of both depression and suicide.54 Addiction to or "high engagement" with mobile devices can also trigger depression and anxiety, according to recent research.55

It would be wise to limit exposure and/or shield yourself from Wi-Fi routers by turning them off at night, not carrying your cellphone on your body, and eliminating the use of portable phones. At bare minimum, do not keep portable phones, cellphones and other electric devices in your bedroom.

Also, the most important step you can take is to flip the circuit breaker to your bedroom at night, as a majority of the EMF you're exposed to at night comes from wiring inside your walls, unless you live in Chicago or New York or a commercial building like a hotel where building codes require the wires to be enclosed in metal conduit.

If that is the case you don't need to turn the power off but must pull all electrical plugs from the wall when you go to bed.

Spend more time outdoors

Getting closer to nature has been shown to dramatically improve people's mood and significantly reduce symptoms of depression. Outdoor activities could be just about anything, from walking a nature trail to gardening, or simply taking your exercise outdoors.

Get adequate daily movement and regular exercise

Studies show there is a strong correlation between improved mood and aerobic capacity. There's also 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.

Exercising creates new GABA-producing neurons that help induce a natural state of calm. It also boosts your levels of serotonin, dopamine and norepinephrine, which help buffer the effects of stress.

Add to your self-help tool bag

Slowing your breathing using the Buteyko breathing technique increases your partial pressure of carbon dioxide, which has enormous psychological benefits and can quickly reduce anxiety.

Other helpful tools include Eye Movement Desensitization and Reprocessing and the Emotional Freedom Techniques (EFT). EFT is particularly well-studied, and research shows it can significantly increase positive emotions and decrease negative emotional states. One scientific review found statistically significant benefits in using EFT for anxiety, depression, PTSD and phobias.

EFT is particularly powerful for treating stress and anxiety because it specifically targets your amygdala and hippocampus, which are the parts of your brain that help you decide whether or not something is a threat.56 For serious or complex issues, seek out a qualified health care professional that is trained in EFT57 to help guide you through the process.

Clean up your sleep hygiene

Make sure you're getting enough high-quality sleep, as sleep is essential for optimal mood and mental health. A fitness tracker that tracks your sleep can be a useful tool. The inability to fall asleep and stay asleep can be due to elevated cortisol levels, so if you have trouble sleeping, you may want to get your saliva cortisol level tested with an Adrenal Stress Index test. 

If you're already taking hormones, you can try applying a small dab of progesterone cream on your neck or face when you awaken during the night and can't fall back to sleep. Another alternative is to take adaptogens, herbal products that help lower cortisol and adjust your body to stress. There are also other excellent herbs and amino acids that help you to fall asleep and stay asleep. Meditation can also help.

Beneficial herbs and supplements: SAMe, 5-HTP and St. John's Wort

SAMe is an amino acid derivative that occurs naturally in all cells. It plays a role in many biological reactions by transferring its methyl group to DNA, proteins, phospholipids and biogenic amines. Several scientific studies indicate that SAMe may be useful in the treatment of depression. 5-HTP is another natural alternative to traditional antidepressants.

When your body sets about manufacturing serotonin, it first makes 5-HTP. Taking 5-HTP as a supplement may raise serotonin levels. The evidence suggests 5-HTP outperforms a placebo when it comes to alleviating depression58 — more than can be said about antidepressants.

One caveat: Anxiety and social phobias can worsen with higher levels of serotonin, so it may be contraindicated if your anxiety is already high. St. John's Wort has also been shown to provide relief from mild depressive symptoms.

Make sure your cholesterol levels aren't too low for optimal mental health

Low cholesterol is linked to dramatically increased rates of suicide, as well as aggression toward others. This increased expression of violence toward self and others may be due to the fact that low membrane cholesterol decreases the number of serotonin receptors in the brain, which are approximately 30 percent cholesterol by weight.

Lower serum cholesterol concentrations therefore may contribute to decreasing brain serotonin, which not only contributes to suicidal-associated depression, but prevents the suppression of aggressive behavior and violence toward self and others.

 What to Do If Someone You Know Is Depressed

Perhaps one of the most helpful things you can do if you have a friend or family member who struggles with depression is to help guide them toward healthier eating and lifestyle habits, as making changes can be particularly difficult when you're feeling blue — or worse, suicidal.

If you are feeling desperate or have any thoughts of suicide, please call the National Suicide Prevention Lifeline, a toll-free number: 800-273-TALK (8255), or call 911, or simply go to your nearest hospital emergency department. You cannot make long-term plans for lifestyle changes when you are in the middle of a crisis.

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