04/27/2012 05:23 EDT | Updated 06/27/2012 05:12 EDT

Don't Believe This Research, Antidepressants Work

A research report on anti-depressant use out of McMaster University in Hamilton, Ontario strikes me as a denial of mental illness and a denial of the need to relieve suffering from mental illness when we can. For those with a severe clinical depression, anti-depressants are needed.

A research report on anti-depressant use out of McMaster University in Hamilton, Ontario strikes me as a denial of mental illness and a denial of the need to relieve suffering from mental illness when we can.

The study in question was conducted by Paul Andrews, an evolutionary biologist at McMaster University and lead author of an article published in the online journalFrontiers in Psychology. The study states that anti-depressants appear to be doing patients more harm than good and that "anti-depressants have negative health effects on all processes normally regulated by serotonin."

The findings include these elevated risks:

- developmental problems in infants

- problems with sexual stimulation and function and sperm development in adults

- digestive problems such as diarrhea, constipation, indigestion and bloating

- abnormal bleeding and stroke in the elderly

The authors reviewed three recent studies showing that elderly anti-depressant users are more likely to die than non-users, even after taking other important variables into account. The higher death rates indicate that the overall effect of these drugs on the body is more harmful than beneficial.

OK, but, anti-depressants are not normally given to infants and there are warnings about giving them to women who are pregnant. The prescribing guidelines, in fact, state that treatment of pregnant women during the third trimester -- when treating pregnant women with PROZAC (fluoxetine hcl) during the third trimester, the physician should carefully consider the potential risks and potential benefits of treatment. Neonates exposed to Serotonin-norepinephrine reuptake inhibitors (SNRIs) or Selective serotonin reuptake inhibitors (SSRIs) late in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. The physician may consider tapering PROZAC in the third trimester.

Prozac is the best known of the SSRI class of drugs. This warning applies with all drugs in this class. So, the research from McMaster tells us what is already known.

As for sexual stimulation, having depression itself will impinge on libido. And, many drugs impact erectile function most commonly those used for hypertension. Should those being treated for hypertension risk stroke, heart and kidney disease for the sake of an erection? They can use an erectile dysfunction drug.

As for the gastrointestinal problems, all drugs (even so called natural health products like vitamins) have side effects. Everyone needs to evaluate if the side effects are worth the benefit and that goes for all medical treatments. And, when it comes to the elderly, caution needs to be exercised when prescribing any drug and competent doctors are aware of that and do exercise caution.

While this research suggests that the Prozac class of drugs are ineffective and dangerous, a recent report in the New York Timesproclaims that the "latest research suggests that serotonin is, in fact, central to the functioning of mood, although its mechanism of action is vastly more subtle and more magnificent than we ever imagined."

The article was written by Siddhartha Mukherjee, an assistant professor of medicine in the division of medical oncology at Columbia University. Current research, he says, indicates that increased serotonin levels in the brain result in new neuronal growth, and that may help to alleviate depression in those who are severely depressed.

And then there is suicide prevention of those who are severely depressed. A number of studies have been done correlating SSRI use with suicides. The hypothesis is that if SSRI use goes up, then suicides will go down and that has been found in almost all of these studies.

In a video presentation of this research, Paul Andrews suggests that people try other treatments for their depression like talking therapy, nutrition or exercise rather than medication. That might possibly be beneficial for those with mild depression but there is no evidence that these therapies are helpful to those with severe depression. The Cochrane Collaboration is an international network of more than 28,000 dedicated people from over 100 countries who work to help people make well-informed decisions about health care, based on the best available research evidence.

They've done 1,000 reviews on various aspects of depression treatment and conclude "antidepressants have been shown to improve depression." When it comes to talking therapy, they state that family therapy is of unclear benefit. Another review found that little evidence supports the effectiveness of psychotherapy for patients with clinically diagnosed depression including major depressive disorder.

As for exercise they found that the research data is sparse and mostly done on college students with a slight decrease only in depression when compared to no other treatment. Hardly a definitive endorsement for exercise over medication. In fact, Hamilton psychiatrist and film maker David Laing Dawson told me that "in 40 years of telling depressed people that regular exercise, even walking 20 minutes daily, will help your depression, not one single clinically depressed  person has followed this advice until and unless their depression was first improved with antidepressant medication."

I'm not sure what Paul Andrews means by nutrition and Cochrane does not seem to have evaluated the efficacy of nutritional treatment for depression. Dawson said that there is no real evidence regarding nutrition but we all recommend vitamin D and omega 3 to our patients. Depression itself is a cause of poor diet, so simply telling depressed people to eat better doesn't work.

Dawson did stress that antidepressants are probably too often prescribed for sadness, boyfriend troubles, work boredom, poverty, unsatisfying marriages, and existential crises. For those with a severe clinical depression, anti-depressants are needed.