Ruminations

Agreeing? Disagreeing! Antidepressants

"It's possible for a normal person to have increased risk of stroke or upper GI [gastrointestinal] bleeding events that could be harmful or deadly [by inadvertently interfering with platelet function]."
Paul Andrews, evolutionary biologist, associate professor, McMaster University, Hamilton

"A single study like this shouldn't frighten anybody. You've heard about the replication crisis in medicine and psychology?"
"More people are taking [antidepressants] for a lifetime. So is this safe?"
"Up to now we have said we haven't seen any problems."
Dr. Joel Paris, past chair of psychiatry, McGill University, Montreal

Controversial new research suggests antidepressants dispensed by the millions in Canada increase the risk of dying early. Aaron Lynett/National Post file photo

"[Antidepressants] are a life-saver for many, reducing the risk of suicide in depressed patients."
Royal College of Psychiatrists, U.K.

And yet another voice, that of Dr. David Baldwin, chair of the psychopharmacology committee of the Royal College of Psychiatrists in Britain speaks of those suffering from depression representing a group known to be at elevated risk of of a wide network of health problems (little wonder they're depressed) "all of which carry a risk of increased mortality", more or less putting things into another perspective, looking at the wider picture.

But then, no research is quite complete if it doesn't examine a problem from all perspectives; taking into account the add-ons, the variables that can impact the veracity of conclusions rather than focusing on a narrow range of issues, ignoring the bigger picture, and arriving at a conclusion that may fit a preconception. On the other hand, there are times that findings do zero in on inescapable conclusions based on verifiable facts. And then a balance must be achieved in risk assessment.

New research is often controversial, with proponents of results they have derived from studies they deem to have reliability being countered by others in the profession protesting the incompleteness of the conclusion. In the instance of a new research result concluding that the use of antidepressants used by millions of people in North America may be the cause of an increase in the risk of early death, many of those prominent in the field of psychiatry, scorn the paper's conclusions as alarmist.

The lead author of the study is sticking to his conclusion, that those pills that psychiatrist feel are "life-savers" for people suffering from extreme depression, are also responsible for a greater number of deaths than they manage to save. Their effect on blood platelets, he points out, whose use is to stop bleeding by forming clots a case in point. The brain chemical serotonin pairs with platelets to enable them to function the way they are meant to, yet the most-prescribed antidepressants on the market have the effect of blocking the absorption of serotonin.

They do this, it is speculated, since such drugs act on the blood as blood thinners thus elevating the risk of abnormal bleeding and hemorrhagic stroke. Molecules -- called monoamines -- with broad effects beyond the brain, the researchers wrote in the journal Psychotherapy and Psychosomatics, are targeted by all of the prescribed antidepressants, and Dr. Andrews, the lead author of the study, emphasizes this.

For people who do have heart disease the drugs appear to be less threatening given that they would emulate the function say, of Aspirin, to thin the blood and keep it flowing through narrowed arteries clogged through cholesterol buildup in atherosclerosis. Over 40 million prescriptions were filled in 2014, according to market research, affirming that Canadians present among the top antidepressant users in the world, along with the United States and Britain.

The use of antidepressants is dramatically increasing, with 64.7million prescriptions given out in England last year – double the number of a decade ago (file image)

Evidence appears to be growing that the drugs have about as much beneficial effect as placebos in the treatment of mild depression, which has led to psychiatrists being blamed for prescribing antidepressants too frequently and inappropriately. Yet family doctors are among the most frequent prescribers of antidepressants and for many more conditions than depression; insomnia, hot flashes and chronic pain among them.

The researchers had initiated their study by conducting a meta analysis in reviewing 16 studies which taken together involved over 378,000 patients and this led them to the finding that antidepressant users had a 33 percent higher opportunity of earlier death than others not using the drugs. A 14 percent higher risk of triggering a 'new' cardiovascular event like stroke or heart attack, also attached to the use of antidepressants.

Serotonin acts as neurotransmitter in the brain, while most of the body serotonin is synthesized in the gut and spills into the bloodstream, is then taken up by cells, tissues and organs throughout the body. At the same time, serotonin is vital for mitochondria, whose function is similar to miniature power plants, supplying energy to every body cell.

Side-effects of selective serotonin reuptake inhibitors are known among other effects to cause abnormally slow heartbeats and fainting. Earlier this year, the pills were linked in another study to a two=fold increase in the possibility of developing dementia. As for the condition of depression itself, it is known for its association with increased death risk, inclusive of suicide.

There are no simple solutions to human health gone awry, and every time we take a drug out of prescribed condition necessity, that interaction will always result in some kind of consequences, mostly in good outcomes, but occasionally not.