General Question

mordecai773's avatar

Why do antidepressants make you more depressed?

Asked by mordecai773 (10points) January 29th, 2009

Antidepressants cause suicial thoughts. Doesn’t that mean antidepressants are doing the opposite of what they are supposed to do? Then why are we still calling them antidepressants?

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40 Answers

dynamicduo's avatar

If you are on an antidepressant and still having suicidal thoughts, you should talk to your doctor. There are many types of antidepressant medications, and the doctor can give you another one to try. Sometimes they have different effects on different people, because everyone’s brains are not the same.

oasis's avatar

No suicidal thoughts mentioned,well not from what i can see.

Why do people assume that people on treatment for depression are suicidal?

artificialard's avatar

Yes, unfortunately antidepressant medication (and the whole condition of clinical depression) is still poorly understood. They’re somewhat of a blunt instrument and can improve the condition of some and not others.

It’s important to be patient and work with your doctor to find the right combination and continue to press on if you’re not feeling comfortable with the results. Also I strongly believe talk therapy is as important if not more so in combination with drug therapy for depression.

Jamspoon's avatar

The problem with SSRIs, SNRIs, TCAs(which are older), and MAOIs (older and possessing many contraindications)—the current array of antidepressants save a couple—is that it’s not really known how they work, though they do certainly work for many people for others they don’t seem to possess as much effectiveness.

Because it’s not known exactly what happens when a person uses an SSRI for example it’s hard to understand why things like suicidal ideation increase or why, if the drugs are working, why in fact they’re working.

You can get a very general idea of what the different classes of antidepressants do just through their names but that’s certainly not enough, because the neurotransmitters that the drugs affect aren’t understood well enough to be certain of what’s happening.

If antidepressants increase suicidal thoughts a person then that person should immediately consult with their doctor. There are many many options available for dealing with depression, pharmacological and otherwise—exercise: running, yoga, weightlifting, swimming etc; eating right; healthy social interactions; hobbies; reading. It all helps, more than it might seem at first. And like artificialard mentioned, other types of therapy’s should be pursued as well, namely counseling from a psychiatrist who expresses an equal amount of interest in the patient as in their medication.

To answer your question in a more immediate way before I end this, you could say yes, the fact that suicidal ideation increases while using some antidepressant drugs means they’re not doing they’re job and it means that we have to find better solutions and in order to do that we have to keep working to understand how the brain works more completely.

Ria777's avatar

@mordecai773, they still get marketed because the pharmaceutical companies make money off of them.

if you doubt this, read this article. it mentions how the u.s. media has shied away from a recent meta-analysis of studies, showing that SSRI fails to work:

a random selection of articles attesting to the link SSRI’s and thoughts of suicide:

addictive effects of SSRI’s:

I really reserve my ire for the people who make Ritalin, though.

Ria777's avatar

@oasis, the title of the post mislead, slightly. still, in the body of the question the original poster said: “Antidepressants cause suicial [sic] thoughts. Doesn’t that mean antidepressants are doing the opposite of what they are supposed to do?” that should answer your criticism. (emphasis added.)

Response moderated
nikipedia's avatar

I think you are asking a lot of different questions here.

Your title question, “Why do antidepressants make you more depressed?” has a flawed premise. Antidepressants might make an individual more depressed, but the reason they continue to be prescribed to treat depression is that when you consider the effects of these medications on a group of people, many of these people experience some relief from their symptoms.

Scientists are working to try to predict how a given individual will respond to a certain drug. We don’t know yet what causes these individual differences, or the best way to address them.

I am having trouble finding the study you’re thinking of, but I believe that the finding was that suicidal behavior increased, not suicidal thoughts. One explanation some scientists have come up with for this is that some people get so depressed that they’re unable to act on suicidal tendencies, and the antidepressants provide only enough relief that they become able to initiate suicidal plans. I believe this phenomenon is not restricted to antidepressants. I can look for a citation for that if you’re interested.

MarkAddison's avatar

Please, please consult help if you or anyone you know is having suicidal thoughts. As an immediate step call 1–800-Suicide in the US. As a secondary step consult family or a doctor. Please.

augustlan's avatar

Individuals react differently to different drugs. I take an SSRI, and have for years. It has vastly improved my life. It is a mistake to claim that all antidepressants cause all people to have more suicidal thoughts. It is simply not true.

Ria777's avatar

@nikipedia, you don’t have to theorize and conjectures. read the link I provided. the studies talked about suicidal thoughts, not suicidal actions.

Ria777's avatar

@augustian, and you represent one person.

the studies I linked to above looked at the collective data gathered from not one person but many.

artificialard's avatar

@Ria777 Your sources seem to indicate that in some circumstances antidepressants can be ineffective or promote suicidal thoughts but not that antidepressants cause depression on a significant amount of users. That’s consistent with any number of medical treatments – used correctly they have a probability of improving the patient’s condition. Risks of other unexpected reactions are weighed against lack of treatment in a dialog between the doctor and patient.

I’m somewhat confused about your point – is it that antidepressants shouldn’t be used because they cause depression? Because they cause suicidal thoughts? Or that they’re misrepresented in marketing?

Ria777's avatar

@artificialard, I did mean to imply that “antidepressants cause depression on a significant amount of users”.

my arguments:
—SSRI’s don’t work significantly better than placebos (see links)
—SSRI’s seem to promote thoughts of suicide in some users (see links)
—SSRI’s can cause sexual problems as a side-effect of their effect on serotonin, more well known anecdotally than the other side-effects, of course

Ria777's avatar

I also have a problem with ignoring the obvious. if our environment brutalizes us, if we give ourselves malnutrition, if we work too much and don’t get enough sleep, we start to feel the effects.

when the subject has come up before I have always asked some hypothetical questions. one, imagine living under peaceful conditions. then imagine living during a war? how depressed would you feel in the first versus the second condition?

two, imagine working 30 hours a week. now imagine working 70 hours a week. which condition would depress you more?

augustlan's avatar

@Ria777 Aspirin and Tylenol have side effects, too…should no one use them either? And for those of us who are depressed for no reason, who live lives others would envy, chemical help is pretty much the only fix there is!

Jamspoon's avatar

Antidepressants work for some people and not for others. It’s a matter of brain chemistry. Not every body is the same—even pain killers don’t work for absolutely everybody.

As augustlan has said, all drugs come with side-effects. If an increase in suicidal thought is something that someone has to deal with in order to gain a number of other much more positive effects so as to feel better then that may be the price, they can work through those negative side-effects—or investigate other drugs—with their psychiatrist and doctors.

Depression is an extremely multifaceted not well-understood problem and the pharmaceutical solutions available are limited, though they do help some. Basing treatment solely on medication is a bad idea, yet it happens all of the time…

I’m not really sure what else to say because it’d be much too easy to go on at great length about this subject, though I believe the question has been answered by a few here.

There’s no point in arguing over this subject because the answer is unequivocally yes, antidepressants express paradoxical effects in many people who use them, but conversely many other people couldn’t live normal lives without them because they make them feel better.

If someone wants to ask the question as to whether or not pharmaceutical companies are out to make vast sums of money at any cost, that’s another discussion, that would surely not be complete without an examination of their marketing strategy for certain antidepressants, yet that’s not what was asked in this question.

nikipedia's avatar

Yo, your hostility is not appreciated. Do you want to have a dialogue about this or not? I’m not going to engage you if you have zero interest in having a conversation and only want an opportunity to berate people who disagree with you.

Ria777's avatar

@augstlan, bad analogy comparing SSRI’s to Aspirin and Tylenol. one, they don’t have side-effects like causing suicidal thoughts or sexual problems. two, they cost a lot less. three, the links that I showed show the lack of effectiveness of SSRI’s, apart from anything else.

you say “depressed for no reason”, I say depressed for no apparent reason. often we cannot see the circumstances that rob us of hope, they have gotten so pervasive. I don’t think that genetic inheritance plays no part whatsoever. with any genetic expression, the environment plays off of that and with the genes.

Ria777's avatar

@Jamspoon, from the abstract to the paper “Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration”:

Meta-analyses of antidepressant medications have reported only modest benefits over placebo treatment, and when unpublished trial data are included, the benefit falls below accepted criteria for clinical significance. Yet, the efficacy of the antidepressants may also depend on the severity of initial depression scores. The purpose of this analysis is to establish the relation of baseline severity and antidepressant efficacy using a relevant dataset of published and unpublished clinical trials.”

emphasis added. part of the point of this study, by the way, had to do with looking at papers that the medical establishment has decided not to publish because the makers of the SSRI’s had funded the study.

nikipedia's avatar

I love it when non-scientists get their panties in a bunch about some kind of putative conspiracy designed to keep the masses down. You know, if scientists had that kind of authority and organization, we would probably have knocked down Alzheimer’s, cancer, and the common cold by now.

Ria777's avatar

@nikipedia, oh but they didn’t need to find cures. the Greys from Zeta Reticuli gave us the remedies to that a long time ago. (note to the irony-deaf: I don’t believe this. I just made a funny.)

really, though, the study I cited got published in a peer-reviewed journal. the people who wrote it had degrees. do you want to tell them they have gotten it wrong? and what basis would you do this?

Jamspoon's avatar

@Ria777 In “published peer-reviewed” articles the authours cite their references throughout and duly use quotes from other work where they see fit, though it’s all with a point in mind, a message that they’re trying to get across. So far you’ve been quite defensive in respect to your point of view that you’ve not entirely expressed all you’ve done is cite a number of online sources. I’m not discounting the value of information on the internet but paper sources would help to bolster your argument.

Better yet instead of reacting to others’ counter-points or opposing opinions with thinly thought out retorts and web links, why not explain your perspective, how you understand the question? You should excuse the rest of us for feeling defensive of our own.

Up to this point you’ve focussed almost entirely on SSRI’s. There are many other groups of antidepressants on the market today. How do they fit into your argument?

You’ve mentioned the loss of libido as one of your primary reasons in detracting any worth these drugs might maintain—it can be argued that it is a side-effect that comes along with many other drugs, not just antidepressants. Though it doesn’t make it alright, it’s not a point that can really be used as leverage against them.

I just think this has unfortunately gotten far from the intention of the original question.

Ria777's avatar

@Jamspoon, I hadn’t commented on other meds because I don’t have any opinion of them as worse/better than SSRI’s.

upthread, I already summarized my POV on SSRI’s. I have not simply quoted and provided links, though I really do think that they put across my arguments far better than I ever could do it. where I have failed to connect the dots, though? have I not put up a coherent argument?

as far as loss of libido, I referred back to a particular essay by Helen Fisher which I half-remembered.

Jamspoon's avatar

I didn’t mean to seem hostile, and you’re right, I should have thought out my last response bit more before making it.

I feel that this subject requires more measured responses rather an ones that might possibly encourage argument or disagreement; as you’ve made it apparent there’s a lot of data available on the subject, a lot of it conflicting.

It just seems that this shouldn’t have been a debate, more an objective presentation of information.

@Ria777 However it seemed to you, for whatever reasons, to me, at least, it felt like an unsolicited argument.

artificialard's avatar

@nikipedia Agreedness.

I remember having a conversation with my friends that are finishing med school about people that like self-diagnose over the internet. Medicine is sufficiently complex that I find it hard to believe that any of us can take whatever public studies are available from the internet and make deductions from them that we can pass off as facts.

And it’s not merely understanding any given individual study (which is doubtful for those without a medical degree) but being able to contextualise the information within a larger body of knowledge and opinion that the medical community consists of. Not to mention that there is a dearth of peer-reviewed studies in your pointed sources.

Remember that ridiculous vaccine-causes-autism scare? That was a result of a group of people that weren’t medical professionals putting undue weight on a single (what turned out to be flawed) study and many children weren’t vaccinated for preventable diseases because of that. Situations like this are why the scientific community relies on the academic process of peer review for studies that are then selected by journals that when substantiated by other peers becomes a consensus view.

The medical community sees antidepressants as a specific treatment option for specific types of depression and medical professionals use their judgment on case-to-case basis as they do with all treatment options to offer the patient a choice of pursuing antidepressants. While it’s arguable that some doctors over-prescribe there is also a healthy counterargument against the over-prescription of antidepressants (which I’ve personally witnessed).

We all can and should express our opinions, debate, and speculate about things both random and serious like this topic. But for flawed supposition to be positioned as fact is irresponsible given the fact that there’s already stigma against depression and a such distorred view of antidepressants that people that might benefit from them don’t seek or refuse treatment.

In conclusion: don’t be Tom Cruise

Ria777's avatar

@artificialard, the paper I linked to above doing a meta-analysis of the effectiveness of SSRI’s, did, in fact, get published in a peer-reviewed journal. (and, of course I do understand what peer review means.)

apart from that, more than one study has made the connection between SSRI’s and suicidal thoughts. (and, of course, on the lack of effectiveness of SSRI’s.)

if you mean to insinuate that I believe in Scientology doctrine, no I don’t. I oppose it, as you would see if you searched for Fluther discussions on Scientology and saw what I read there. nor do I oppose taking psych meds wholesale, though, it shouldn’t surprise anyone to know that I view them with a lot of suspicion.

lastly, I want to note that I have not made any ad hominem attacks on this thread and I ask you all to do me the same favor.

Ria777's avatar

@Jamspeed, I don’t care about starting arguments or not starting them. I want to put across the truth, whether or not that starts arguments.

asmonet's avatar

Then you asked a question with an agenda, and that’s not really what Fluther is about.

Ria777's avatar

I did not start this thread. I only responded to the original poster and elaborated on his/her questions. when you guys challenged my opinions, I responded to them. I have the right to reply, you know.

Ria777's avatar

and sure I have an agenda. but I wouldn’t express my opinions if the thread hadn’t called for it, if you know what I mean.

asmonet's avatar

That was my fault, I did get you confused with the OP. Sorry about that. Either way it still isn’t something Fluther usually tolerates long, debating is fine agenda pushing isn’t. But then again, I’m just expressing my opinion.

Jamspoon's avatar

artificialard really hit the nail on the head and was the point I wanted to get across without stating it so bluntly because it strikes me as a common sense approach. The internet is not the most ideal source of information. As well, I doubt many in the conversation are doctors and have the necessary breadth of knowledge that would make it possible to truly state any “truths” about the subject.

@Ria777 Nobody here is denying that SSRI’s don’t work for everybody and cause negative side-effects but every time somebody tried to express their positive experience with them you replied with a bevy of links contesting the things they were saying, without acknowledging the point of view.

People will consider what you have to say a lot more if you first do the same for them.

Ria777's avatar

@Jamspoon, on the one hand you say, “you should seriously consider the anecdotal testimonies of people helped by SSRI’s” on the other, “listen to artificialard! multiple peer-reviewed analyses trumps scattered one or two individual analysis!” (and presumably other anecdotal evidence.) well, I agree with the second statement, not the first one. look at the statistics, not at the anecdotes.

and again, it doesn’t have to do with “SSRI’s [working] for everybody”, it has to do with peer-reviewed papers looking at SSRI’s and testifying to their ineffectiveness.

lastly, a bit of information I neglected to post before. in 2003, the European Medicines Agency banned SSRI’s for teenagers and children under 18. Great Britain did the same, except for allowing Prozac. somewhat different from concerned parents signing petitions against vaccinations.

artificialard's avatar

@Ria777 My reference to Tom Cruise was an attempt to inject some levity to the discussion while the substance of my answer was based on objective dissemination of the topic at hand. There was obviously no implication that you were an actual Scientologist.

With my reference to the vaccine-autism scare it was a general comparison that I was trying to make about how isolated pieces of information can be misinterpreted by the public and negative influence public health opinion and policy, not a comparison based on the specific details of such a scenario.

Your mention of the 2003 EMEA ban was overturned in 2006. If you’ve brought up this 2003 ban by the EMEA as a supporting argument than you should believe that the EMEA is an authoritative matter on the subject. And the EMEA has ruled that antidepressants are be a possible treatment option for depression in children and adults.

You’re using straw man arguments that misinterpret responses here and I don’t know if it’s deliberate or not but I can’t forward the discussion with the complete tangents that are coming off here, especially because this is a topic that I personally feel very strongly about.

So good day sir.
I said GOOD DAY!

Jamspoon's avatar

Oh dear, he broke out the bold. ;D

Ria777's avatar

@artificialard, I haven’t used straw man arguments deliberately, as far as I know. I did not know that the EMA ban got overturned.that still doesn’t make SSRI’s more effective, only less dangerous (according to the EMEA).

as for the Tom Cruise reference, I won’t pretend to understand your intentions. I will say a) that (serious) accusations of belonging to the Church of Scientology or of sympathizing with it almost inevitably come up when I voice antipsychiatry views, so that I make extra careful to show that I don’t share them and b) whenever you say anything online, no matter how goofy, someone will take it literally.

you will notice that up-thread when I made a self-mocking statement that I identified it as such.

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