In this post I talk about antidepressant medications (SSRIs and SNRIs) and their efficiency in the treatment of depression. I wanted to write this post since I think that antidepressants are being prescribed way too easily and without much empirical support.

I want to start by stating that even though I do study psychology, I am not a licensed doctor or a psychiatrist, and I do not wish for anyone to stop taking their medication because of this text - at least not without first consulting a doctor. My only goal with this text is to spread knowledge about the scientific support for antidepressants so that people can make informed decisions about using them – and not having to blindly trust their doctor or psychiatrist.

I have chosen to write this post from a North American point of view and I will therefore only be reporting research, laws and recommendations written in the USA. I do this because USA is one of the countries that have affected western psychology and psychiatry the most, and also because USA has the highest per capita usage of antidepressant medications.

Antidepressant medications are the most common form of treatment for depression in western society today. A commonly existing belief among many psychiatrist, doctors and a great part of the population is that depression follows as a result of a chemical imbalance in the serotonergic system of the brain, and that antidepressants can help restore that imbalance and therefore cure the depression.

What is serotonin?

Serotonin is a monoamine neurotransmitter, that carries signals between nerve cells (or neurons). It is commonly thought to have effects on the regulation of hunger, sleep and mood where high levels of serotonin is associated with decreased hunger, increased levels of wakefulness and feelings of pleasure and happiness.

SSRIs and SNRIs

The two most common types of antidepressant medications are SSRIs and SNRIs:

SSRIs - Selective Serotonin Reuptake Inhibitors – Is a type of antidepressant medication that works by blocking the receptors that reuptake serotonin from the synaptic cleft between the neurons. The blocking of these receptors results in higher levels of serotonin, which in turn is thought to result in increased feelings of happiness, and decreased feelings of depression.

SNRIs - Serotonin-Norepinephrine Reuptake inhibitors – Works in the same way as SSRIs, but also blocks the reuptake of norepinephrine (more commonly known as noradrenaline) which plays a role in the regulation of wakefulness, activity and attention.

Support for antidepressant medication is based on the belief that if serotonin affects our emotions then an imbalance in the serotonergic system should result in emotional imbalance. Antidepressant medication that works by increasing the brains levels of serotonin should therefore help reestablish this emotional balance – in other words – treat the depression.

Antidepressants in society today

In 2013 more than 40 million Americans where prescribed one or several antidepressant medications according to data gathered by IMS Health in 2014. The amount of people prescribed an antidepressant medication saw an increase by 400% between years 1988 and 2008. If antidepressant medication was effective in the treatment of depression, we should with this increase see a decrease in the number of people suffering from depression, provided that there has not been an even bigger increase in the number of depressed people.

Finding proof for antidepressants

Researchers have used PET-scans (Positron Emission Tomography) to compare the brain activity of “healthy” individuals with that of depressed individuals, and these brain images have shown that the depressed individuals had less amounts of serotonin in their brains than the healthy individuals. These studies do not, however, prove that the low amounts of serotonin is the cause for the depression. Researchers have also found a link between depression and decreased brain activity over all, so the low levels of serotonin seen on the PET-scan could just as well be a result of this reduction of brain activity as a cause for it.

PET – Positron Emission Tomography – is a scanning technology that uses small amounts of radioactive material – called radiotracers – to provide molecular information about the brain and body.

Drug approval

Researchers, and especially drug companies, have carried out experimental research to prove the efficiency of antidepressant medications. These studies are mostly carried out when a new medication is made and has to be approved before it can be launched to the market and sold. In the USA it is the Food and Drug Administration (FDA) that is responsible for the approval of new medications.

For a new medication to be approved it requires that at least two controlled studies prove the medication to be notably effective or as effective as another already approved medication. At least one of the two studies must go on for a time period of six weeks. However, the amount of studies with a negative result does not necessarily affect whether the medication will be approved or not, so the drug company can remake the studies until they get the results that they want and then apply for approval.

Because most of the research on antidepressants is conducted for a time period only lasting six weeks or less, little information can be found about the long-term effects of these medications. And even though a medication is shown to be “as good” as another already FDA approved medication, it does not prove that the medication is effective.

When researching the effect of an antidepressant medication on depressed patients, the patients are often divided into two smaller groups. The people in one of the groups are given the medication and the people in the other group are given a placebo. The problem with this setup is that many studies will use a sample of people that have been using some kind of an antidepressant medication before the study starts. This means that the group that is prescribed a placebo during the study will be experiencing a withdrawal because of the sudden discontinuation of their medication, which will distort the results of the study.

Kirsh et. al. committed a meta-analysis in 2008 where he compared all of the both published and unpublished studies on the efficiency of antidepressants and they came to the conclusion that there is very little support for the use of antidepressants especially in more mild cases of depression. Fournier et. al. committed a similar study with similar results in 2010.

Studies where researchers have completely removed all serotonin from the brains of mice have not left the mice depressed, and no one has been able to prove that there would exist a “correct amount” of serotonin in the brains of healthy humans. Even some medications that lower the levels of serotonin in the brain have been proven effective in treating depression.

And still – even though there is so little evidence for antidepressants being effective for the treatment of depression – American Psychology Association (APA), which is one of the most known psychology associations in the world, wrote in 2010 that antidepressant medications are recommended as the number one method of treatment for mild and moderate depression.

You might wonder why APA, and many other leading psychiatrist would recommend a method of treatment that has not proven to be effective. But the answer to that, as to many other things in this society appears to be money. The total sales of antidepressant medication solely in the USA has increased to more than 11 million dollars per year. And sadly both many members of the APA (the same people that decide what is considered healthy and what is considered an illness) and many other psychiatrists have connections to the drug industry. That however is a very long subject for another day.

I hope that this post will help some people realize that antidepressants are not as scientifically supported as many psychiatrists, doctors and drug companies make them seem to be. Everyone should be able to make an informed decision before starting to use a psychiatric medication.

However, this text does not prove that antidepressants cannot help in some cases of depression, and I do not want anyone to stop taking their medication because of this post - at least not without first consulting a licensed doctor or psychiatrist.

This article is dedicated to @voiceshares, an amazing community for anyone who is struggling with depression, who has overcome depression or who wants to help others.

Thank you for reading!

mialinnea