Selective serotonin reuptake inhibitors (SSRIs) are among the most widely prescribed antidepressant medications in the world.
Medications such as Prozac, Zoloft, and Lexapro are used to treat depression and anxiety disorders in millions of people.
But some experts believe that we have become overly dependent on such drugs and this has led some doctors to treat the common human crisis as a medical disease.
“We have medicalized all emotional distress,” said Professor Alan Francis, professor emeritus of psychiatry at Duke University School of Medicine in the US.
“Eighty percent of antidepressants in the US are prescribed casually by primary doctors as an easy way to get patients out of the office in 15 minutes,” Francis told DW.
“There is no pill for every psychological and social problem,” he said.
What do selective serotonin reuptake inhibitors (SSRIs) do?
As their name suggests, SSRIs inhibit, or prevent, the reuptake (also known as “absorption”) of serotonin. Preventing the reuptake of serotonin increases its levels in the body. When serotonin levels are low, it can disrupt a person’s emotional well-being.
Serotonin is a neurotransmitter, a chemical messenger that carries signals between nerve cells throughout the body.
It is one of the four so-called happiness hormones, and is most associated with stabilizing mood. It regulates anxiety and sleep cycles, and creates a feeling of overall well-being.
“We know that in depression, if you use SSRIs, you increase the amount of serotonin that cells can use to communicate. And that’s the first step,” said Carmine Pariente, a professor of biological psychiatry at King’s College London, UK.
“Serotonin is a chemical that brain cells use to talk to each other. It’s especially important for emotions,” Pariente said.
Therefore, maintaining healthy levels of serotonin is considered essential to prevent or manage depression.
“The person begins to evaluate the world around them, therefore, they become less negative about it,” Pariente said.
But some experts say depression involves more factors than just a chemical imbalance — low serotonin levels in the brain.
Are antidepressants overprescribed?
Joanna Moncrieff has long argued that SSRIs are overprescribed. “Psychiatry allowed people to believe that depression was caused by serotonin deficiency and that antidepressant drugs reversed this, although this has not been proven,” said Moncrieff, professor of critical and social psychiatry at University College London, UK.
“There was never solid evidence – some findings here and there but no coherent picture was ever found,” Moncrief told DW. He said that their apparent effectiveness may be a result of the placebo effect. When the simple act of taking a medication leads the person to believe that it is helping, when in fact, it has no effect.
Most psychiatrists and organizations such as the American Psychiatric Association reject the idea that SSRIs are primarily as effective as placebo. Parient is one of them.
“There is overwhelming evidence that antidepressants are effective in reducing depressive symptoms, and particularly in reducing major symptoms of depression,” Pariente said, adding that serotonin is just one factor in depression.
when to take ssri
Pariente said SSRIs should only be prescribed for people who suffer from clinical depression, which is “a cluster of symptoms” that go beyond normal sadness.
“There should be an impact on lives that goes beyond a sad feeling of a few days or a few weeks because something happened,” Pariante said.
“Their depression may be making their life miserable or worse,” Pariante said. “For example, they can’t go back to work, or relationships within the family begin to break down due to depression.”
Do SSRIs always help? No.
SSRIs don’t always work, or don’t work right away or all the time. It depends on the patient – and it’s really important to get the best medical help you can.
In about one-third of cases, the first SSRI a person tries will not help them. Trying other types of SSRIs may help, but they are ineffective in 70-80% of cases.
“There is currently no way to predict who will respond or who will not respond to antidepressants, or SSRIs in particular, or any specific SSRI.
“They don’t work in everyone. There is a spectrum of response. It’s trial and error, but it’s still the best option we have at this time until we find something that allows us to personalize the intervention,” Pariente said.
Consensus on antidepressants: ‘Reduce SSRI use’
Moncrief said the risks and side effects of SSRIs are often underestimated.
“They are a drug that interferes with our brain chemistry and other biological systems,” Moncrief said.
Side effects can include sexual dysfunction, dependence, osteoporosis, weight gain, bleeding and pregnancy complications, Moncrief said. “We really should reduce their use as much as possible,” she said.
SSRIs can also broadly reduce emotional responses – leading to a general, emotional numbness, which some people find helpful. But “a lot of people don’t like it,” Moncrief said.
Parient agrees that the use of SSRIs should be limited: while they work, they should not be used indefinitely.
“In an ideal scenario, for the first stage of depression, you start taking antidepressant medication — maybe you start feeling better after six to eight weeks,” Pariente said.
“Then, after six months, nine months, a year at most, the antidepressant should be gradually withdrawn and then stopped. No one needs to be on antidepressants for life just because they had an episode of depression.”
Edited by: Zulfikar Abbani