Enai

Hello all,

this site tells me that not only is depression not a lack of Serotonin in the brain, but also that SSRI's can cause brain damage. The site has no actual proof other than (to me) seemingly convincing arguments, but the other sites, for instance Undoing Depression and mental health matters have exactly the same, just they say "taking SSRI's is good for you". So, what is true? You see, I'm on SSRI's in this moment and I would very much like to avoid brain damage, after all my "being", my "mind" resides there!

I would greatly appreciate any input. I can't really discuss this with my doc, after all she's a busy person and can't argue with me for an hour about the pro's and con's of medication. Essentially, my doc relies on an (admissible) argument from authority: She spends her professional life dealing with meds (and mental disorders), and thus I can reasonably expect she knows what she's giving me. But I'm still worried.

Enai

ps418

No, depression is not simply a lack of serotonin. But there is plenty of evidence that serotonin system therapies can reduce the severity of depressive symptoms for many people.

From the article:
Silly. There is no reason to think that it is a property of the SSRI that led this person to increase her dose, the way that, for instance, the tolerance-creating properties of heroin leads heroin
users to increase their dose of heroin. People sometimes take alot more aspirin or tylenol than they should, but this is not some nefarious property of aspirin or whatever that leads to abuse. SSRIs are hardly drugs of abuse in the same way narcotics or tranquilizers are.

No evidence is presented for SSRI-induced brain damage or SSRI cognitive impairment, nor could I find any evidence of such with a PubMed search. Comparisons of the SSRIs to tranquilizers are dubious, because they are very different drugs. There are reports of movement disorders associated with SSRI, things like akathisia- compulsive movement/restlessness, dystonias- slow, repetivitive movements of the limbs, and parkinsonism- stiffness, tremors, akward gait. There are also reports of tardive dyskinesia-like syndromes. TD is a movement disorder common in patients who were given large amounts of tranquilizers, such as Thorazine, over a long period of time. Leo (1996) speculates that these symptoms result from "agonism of serotonergic input to dopaminergic pathways within the CNS." At any rate, there seems to be little question that movement disorder-like symptoms can occur with SSRIs. The bigger question is whether they are reversible, unlike TD and Parkinson's. It appears that these symptoms are reversible. My advice is just to be aware of the possibility of such symptoms, and let your doctor know if they appear. I would not be too concerned about "brain damage" at this point.

Refs

Gerber and Lynd, 1998.Selective serotonin-reuptake inhibitor-induced movement disorders.Ann Pharmacother. 1998 Jun;32(6):692-8.

Leo, 1996. Movement disorders associated with the serotonin selective reuptake inhibitors. J Clin Psychiatry. 1996 Oct;57(10):449-54.

Patrick

Deacon Doubtmonger

I haven't had a chance to look closely at those sites yet, but for reasons I'll get into below, remember that no one (website, doctor or otherwise) has any right to make simplistic blanket condemnation or praise of antidepressants -- the only way to tell what's true is to see what's true for you.
This is part of her job. You're correct in realizing that antidepressants are nothing to fool with; it's absolutely essential that you be able to discuss the medication course with her beforehand, and also be able to reach her with any concerns during the med course. If she's not willing to help in this way, you have the wrong doctor.

If this seems obvious, consider some of the problems with antidepressants, especially they way they're often prescribed in the US:

(1) Very rarely is a depression exclusively situational or biochemical; it's hard to pin down an exact cause when you're dealing with hopes, fears, dreams, loves, hatreds, opinions, prejudices, wounds, passions, fancies (yes, even prayers!), and so on. An antidepressant is strictly a neurotransmitter intensifier; there's no pill made that's so fine-tuned it can take down only the negatives in that list and leave (or intensify) the positives, so AD treatment can easily be overbroad -- somewhat like killing a fly with a shotgun.

(2) Given this, the big risk with AD's is not so much organic brain damage as having neurotransmitters "all dressed up with no place to go," so to speak. If a patient has been carrying the scars of deep trauma all her life, and is terrified of functioning in the real world, that issue has to be addressed. AD's alone will give her souped-up neurotransmitters but never touch the whys and wherefores of her underlying pain, and they certainly won't bring her any inner peace by themselves; in fact, they could actually increase her anxiety and terror if she doesn't have competent, compassionate help with her trauma issue.

(3) Unfortunately, the psychopharmacological school of thought is often hardcore in its belief that nothing more than pills are needed, so you have lots of psychiatrists handing them out indiscriminately without truly examining or caring about the patient and his/her issues. Of course, insurance companies love to "pill" problems away, as it's far less time- and labor-intensive than talk therapy. I have no doubt that this factored into many of the cases in which people taking AD's committed suicide or other violent acts. They likely had a lot of intense feelings stirred up and poor (or no) psychotherapeutic support in handling them -- and/or couldn't reach their psychiatrist to talk about the physical effects they were feeling.

(4) A corollary to the above is that doctors often hand out pills without trying to assess whether there's really cause to believe a chemical depression is present -- so-called "cosmetic psychopharmacology." This is especially so because any doctor in the US can prescribe any pill without having to be a specialist in the area the pill is used for, so you get general practitioners handing out Prozac to anyone complaining of mild lethargy, or anyone who says "I'm depressed" in the generic sense of having the normal blues of everyday life.

I'm sorry if this post seems unduly frightening. AD's can indeed be very helpful if they're prescribed and monitored wisely. Make sure your psychiatrist is willing to go the distance to handle your concerns to your satisfaction; any doctor too busy or uncaring to do so is the wrong one. Also, don't fall for a doctor who holds out AD's as some all-purpose miracle cure for all your problems and the perfect pathway to eternal peace and happiness. It's more realistic to think of them as "fog-lifters": Imagine yourself as the captain of a vessel surrounded by thick fog that makes travel in any direction impossible. AD's will often lift the fog, making navigation possible again, but they won't set your course or pilot your vessel for you, and no reputable psychiatrist will imply otherwise.

For a more impartial look at the issues, I'd highly recommend two sources:

(1) There's an episode of PBS's Frontline called "Welcome to Happy Valley" which explores the use of AD's in Wenatchee, Washington, sometimes called the "Prozac Capital of the World"; prominently featured is one of those indiscriminate prescribers.

(2) There's also a book called Living With Prozac and Other Selective Serotonin Reuptake Inhibitors (SSRIs) : Personal Accounts of Life on Antidepressants (edited by Debra Elfenbein).

Here's wishing you every success whatever course you take!

Deacon Doubtmonger

Enai

Thanks ps418 and Deacon Doubtmonger. Your input helps a lot. I think I will also try to get a hold of the papers and books you mentioned (and read them, of course).

Enai

Treacle Worshipper

This is anecdotal, but will hopefully be mildly helpful.

I have been on an SSRI since December 2002 (20 months). I had to have an MRI brain scan in Feb 2003, when I had been on it for 14 months. My brain showed to be perfectly normal. (The scan was done for reasons unrelated to my depression.)

I strongly recommend trying some form of talking therapy; I personally found it very useful. But of course everyone is different.

Best Wishes,
TW

Deacon Doubtmonger

Note: The Frontline episode might be available on videocassette at your local library; I couldn't find a transcript online.

Enai

Anecdotal it may be, but it's a comforting fact nevertheless. After all, the evidence on liftdepression.org isn't any better than anecdotes and conjecture.

I will definitely do that. I've scheduled a meeting with a shrink to determine what sort of therapy is likely to help me. After that, I'll have to find a therapist. But thankfully, this is Germany. My health insurance will pay.

Enai

HeatherD

I can't comment on the SSRI's, I've never taken them, as I've never been diagnosed with depression. (I've been avoiding the mental clinic for years, probably should go though, as people here can probably attest to)

I followed the link Enai provided and IMO they are trying to sell something. One of the links led me to HumanGivens.com and a NewScientist article on "Joe Griffin". His credentials are listed as "Joseph Griffin, BSc.Hons (PSYCH). M.PHIL.(PSYCH). FHGI".

As to his credentials, I'm not sure but the only reference I found to FHGI was a Fellow membership (Fellow Human Givens Institute) with the Human Givens Institute site and a sister site MindFields College. I doubt these are accredited institutions, which would likely make his credentials questionable. The "college" sells seminars on this "program"

That site and the article entitled "New Scientist interview with Joe Griffin" seem to be saying that you can cure depression in 24 hours. Apparently it has to do with depressed people getting too much REM sleep and spending too much time thinking depressing thoughts.

I am a bit skeptical, especially after having read this paragraph:

AmbiguousUbiquity

Enai,

As someone who does have a serotonin level imbalance and who is on 25mg of Prozac a day, all I can tell you is that although there are other factors that spark my depressive states, I think the Prozac has really been able to get me through it.

Of course, I think you are taking the correct course of action in doing the research and talking with a therapist about your condition. Too many people are just jumping on the SSRI bandwagon, before finding out it can do more harm than good.

I'm personally waiting for my 1-800-TheLaw2 commercial about the disastarous effects of Prozac and Zoloft, like they found out about heart defects and Phen Fen.

Good luck with everything. Let us know how it goes!

Lauren

Coragyps

Enai: Don't be afraid of Prozac (or the other SSRI that's the right one for you). Given the alternatives of some future undefined brain damage promised by one website and remaining in the Slough of Despond where I used to be, I'll take my medicine. (Most of my brain damage dates back to the late '60's, anyway.)

There's an interesting paper in the July 18 issue of Science on how genetics and life events can conspire to contribute to depression - the quick summary:
It might be at your library, or PM me and I'll get you a copy.