Antidepressants: The Pills We Can't Kick

Antidepressants have become the go-to drugs of many doctors treating women—not just for depression but also for insomnia, weight loss and migraines. Yet the prescriptions may be creating more problems than they are solving. Learn how to decide what’s right for you

by Ginny Graves
pills yield sight
Photograph: Illustrated by Oliver Munday

When Prozac Nation was published in 1994, the catchy title was a serious exaggeration. Now it couldn’t be more apt. Doctors today dole out antidepressants as if they were Halloween candy, using them to treat everything from blue moods to hot flashes to low back pain. And women are their best customers. Nearly one quarterof women ages 40 to 59 are on Prozac or another anti-depressant, a far greater percentage than in any other age group, according to a recent report from the Centers for Disease Control and Prevention.

Behind that astounding figure lies a disturbing fact: For several conditions, the case for antidepressants is iffy at best; they aren’t even effective across the board in treating depression, the illness they were designed to alleviate, and may not relieve the other problems—such as migraines—for which they are prescribed. Nor are these drugs risk free. “Antidepressants can be helpful under the right circumstances, such as when people are very seriously depressed or suffer from anxiety disorders. But you definitely don’t want to take one if you don’t have to,” says Ramin Mojtabai, MD, PhD, associate professor in the department of mental health at Johns Hopkins Bloomberg School of Public Health.

Yet a significant number of women are using antidepressants when other treatments might be more effective and safer. Here, what you need to know so you and your doctor can determine if these drugs are best for you.

The Antidepressant Revolution

In 2011, American pharmacists filled 264 million prescriptions for antidepressants, up more than 25 million since 2007, according to IMS Health, a health care technology and information company. How did these drugs get so popular?

The first antidepressants—tricyclics and monoamine oxidase inhibitors (MAOIs)—were discovered by happenstance in the 1950s, when doctors were looking for drugs to treat schizophrenia and tuberculosis, notes Alan Frazer, PhD, chairman of the pharmacology department at the University of Texas Health Science Center in San Antonio. “Doctors noticed they lifted patients’ moods,” he says. But no one ever wrote a book called MAOI Nationor Tricyclic Nation, and here’s the reason: Both now and when they were first introduced, MAOIs could cause serious, sometimes fatal reactions in users who eat foods like pepperoni and aged cheeses that contain the amino acid tyramine. And tricyclics are what pharmacologists call dirty drugs. “They bind to several receptors in the body and as a result cause unpleasant side effects, like dry mouth, blurry vision, drowsiness and weight gain,” Frazer says. Even modest overdoses of tricyclics can be lethal, so the only MDs comfortable prescribing them were psychiatrists, who closely monitored patients.

The picture changed in 1988, when Prozac hit the market. It’s an SSRI (selective serotonin reuptake inhibitor), which means it prevents the neurotransmitter serotonin from being reabsorbed by brain cells, leaving more of it in the synapse between neurons. Prozac is a cleaner drug. “It has side effects, and the longer it’s been on the market, the more those have become apparent. But there’s almost no risk of overdosing,” says Frazer. Over time, Prozac and its siblings became known as safe antidepressants, and that perception opened the door for doctors to prescribe them widely, not just for depression but also for a variety of other conditions. That makes many doctors nervous, for the following reasons.

Concern No. 1

Antidepressants are prescribed for many conditions besides depression and anxiety

When Andrea Burnett had trouble sleeping after breaking her back in a boating accident, her doctor prescribed Elavil, a tricyclic antidepressant that has a sedating effect but isn’t approved by the FDA to treat insomnia. The drug knocked her out but caused terrible nightmares and hallucinations, so after two weeks she stopped using it. She finally got the relief she was looking for when she started taking Tylenol PM to help her sleep.

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