Jane was seriously worried. Terrified, in fact.
“I don’t want to die!” (She handed me an article printed from the internet.) “But this ‘Sudden Cardiac Death’ from taking antidepressants sounds terrible. And look, it’s three times the rate among people who take the antidepressant that I’m taking, Lexapro, escitalopram, mine, right? than people who don’t take it. I want off!”
“Whoa! Wait!”, I answered. “With 15% of Americans taking one of the SSRIs (Prozac, Lexapro, Celexa, Zoloft) or SNRIs (Effexor et.al) this is quite a lot of people. But you don’t see Clybourn Avenue in front of WholeHealth Chicago clogged with bodies. Let’s talk first.”
The heart risks of the antidepressants have been known for years, probably an effect on the way electrical current passes through the heart muscle itself, triggering a fatal arrhythmia, fortunately quite rare. The heart effect is both ‘dose-related,’ meaning, ‘the more you take, the higher the risk.’ But it’s also related to how long you’ve been taking it.
Let’s start with what we treated in the first place.
Symptoms of depression (called Major Depressive Disorder or MDD). These mean two weeks or longer of:
- Sadness and low mood,
- Lack of interest or pleasure,
- Difficulty concentrating,
- Sleeping too much or not enough,
- Feelings of guilt or worthlessness,
- Thoughts of ending one’s life.
This differs from symptoms of Generalized Anxiety Disorder (GAD) also treated with SSR. Including:
- Excessive Worry: Excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities.
- Difficulty Controlling Worry
- Associated Symptoms: The anxiety is associated with three or more of the following (with at least some symptoms present for more days than not in the past 6 months):
- Restlessness or feeling keyed up/on edge.
- Being easily fatigued.
- Difficulty concentrating or mind going blank.
- Irritability.
- Muscle tension.
- Sleep disturbance (difficulty falling/staying asleep, or restless sleep).
- Functional Impairment: The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
“Jane?” I asked, “You remember your anxiety? Pretty horrible, wasn’t it?” Nod.
Any psychiatrist will tell you there’s nothing quite as horrible as deep depression or severe generalized anxiety and when you can turn the symptoms around with an SSRI or an SNRI, it’s miraculous, and nobody, patient or doctor, wants to go back to the dark place.
Now, concerning the SCD (Sudden Cardiac Death) study— they’re comparing patients on SSRIs with the general population not taking any psych meds. And yes, the SCD rate is 2.2 times higher. But they’re not comparing patients on SSRIs with untreated patients suffering depression or severe anxiety. This is very important because untreated patients with mental illness are well known to have a higher rate of SCD than the general population. This is caused by the wide spectrum of causes of heart disease in the first place (lifestyle issues, health neglect, stress and blood pressure, poor sleep, etc., etc.).
What I suggested to Jane was this: if she really wants off her medication (although she’s hesitating now), work with her practitioner or find a psychiatrist and plan to go slowly (weeks, usually). More than likely her brain will completely return to its premedication functioning, minus the anxiety, although she may be more comfortable with a small dose indefinitely.
Keep in mind there are quite a few ways to deal with depression and anxiety besides pharmaceuticals. I hate to sound cynical about this, your health insurer LOVES it when you’re on an antidepressant: you’re calm, passive, reasonably happy, and your generic Lexapro costs him only about $20 A YEAR. Moreover, he doesn’t have to salary a clerk to sit by a computer and deny your psychotherapy claim.
Pay out of pocket for Cognitive Behavioral Therapy and consider it a gym membership for your mind.
Work on the nutritional treatment of mental illness, try Yoga, acupuncture, T’ai chi, or learn the guitar and sing loud.
Be well,
David Edelberg, MD