I recently read that 16% of Americans (approximately 54 million of us) are taking antidepressants. This got Secretary Kennedy’s knickers all in a twist. He announced that the U.S. faces a “dependency crisis” because we’re overmedicated and should begin “deprescribing” of antidepressants by supervised tapering. Depressed and anxious patients need to be offered alternatives like psychotherapy, exercise, and social support. (Does anyone’s health insurance cover psychotherapy? Health club membership?)
It’s chilling when you realize the extent of this man’s ignorance.
- He seems to believe that 54 million depressed Americans are all alike, depression-wise, but data proves him wrong.
- Most of us are satisfied using antidepressants. The criteria for satisfaction: rapid relief of symptoms (2-3 weeks); few, if any side effects. Our dissatisfaction list: no relief, feeling ‘numb,’ fatigue, brain fog, weight gain.
- In order to reach maximum benefit, the SSRIs (Prozac, sertraline, Lexapro), and SNRI (duloxetine) should be taken for at least 12-14 months to prevent relapse of symptoms. However, for a third, symptoms eventually return, and meds need to be restarted. Some patients with chronic depression simply need a maintenance antidepressant, much like someone with high blood pressure or diabetes needs their maintenance med.
- Once correctly discontinued, most patients do not experience a relapse of their depression. Unfortunately, the majority of prescribers are better trained in ‘prescribing’ than in ‘deprescribing.’
- Discontinuing antidepressants suddenly triggers the antidepressant withdrawal syndrome which you really do not want to experience. Headache, dizziness, nausea, electric shock sensations in your brain, return of depression, insomnia, and anxiety. All can be avoided by a slow taper of your medication.
- Unfortunately, some prescribers (usually family physicians) unfamiliar with ‘deprescribing’ tend to leave their medicated patient on an SSRI for years, long after it has outlived its usefulness. If her patient has a relapse while medicated and doesn’t respond to a dose increase, she’ll be referred to a psychiatrist who usually adds more medications. Although this may be the situation Secretary Kennedy wants to “prevent,” he needs to confer with some experienced clinical psychiatrists before encouraging the general public to replace their Lexapro with an exercise class for their Major Depressive Disorder.
- Some patients (and fortunately their number is not large) are so sensitive to the withdrawal process that it can actually take over one year to get the medication out of their system. Mark Horowitz, M.D. in his book, “Deprescribing Guidelines” describes some patients who still feel withdrawal symptoms long after any trace of a med has left their bodies.
What Does This Mean for You?
If you are experiencing a period of depression, start (or continue) “talk therapy.” Here is a link to an article I wrote about Cognitive Behavioral Therapy, although the therapists mentioned are no longer with WholeHealth Chicago. You can discuss with your therapist if an antidepressant is a reasonable idea.
If your depression is just mild, and you want to try a natural antidepressant, you can start either SAMe (S-adenosylmethionine 400 mg) by Pure Encapsulation, twice a day, empty stomach OR St. John’s Wort 300 mg (NOW or Karuna) two in AM, one in evening. Like prescription antidepressants, these need to be taken every day and will take 3-4 weeks for maximum effect. Both have been tested in clinical trials and found effective for mild depression.
When talking about an antidepressant with a psychiatrist, ask about effectiveness, side effects, duration of treatment, and discontinuing it. Have a list of questions for her.
Be well,
David Edelberg, MD
*Always consult with your physician when starting or stopping a new medication or supplement.