Prescription Alternatives
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SSRIs create a false sense of emotional detachment, allowing those who use them to disengage from their problems rather than solve them.
What Are the Potential Side Effects? According to a report in New Scientist, researchers at the Weill Cornell Medical Center found that men who take SSRI antidepressants have more sperm with damaged DNA, which is not viable for fertilizing an egg. This could be significant to couples who are trying to get pregnant.
Multiple new studies suggest that SSRIs can substantially increase the risk for bleeding ulcers and other gastrointestinal upset, especially when combined with NSAIDs such as aspirin and ibuprofen.
In clinical trials, 15 percent of those on Prozac, 20 percent of those on Paxil, 10 to 15 percent of those on Zoloft, 22 percent of those on Luvox, and 16 percent of those on Celexa stopped using the drugs because of adverse effects.
Nervousness, insomnia (especially with Zoloft), drowsiness (especially with Paxil), fatigue, weakness, tremor, increased sweating, dizziness, anxiety, irritability, headache (especially with Paxil), dry mouth (with Zoloft and Paxil), loss of appetite, nausea (seen most with Luvox, but experienced by more than 20 percent of subjects for all the SSRIs), diarrhea, stomach discomfort (Prozac and Zoloft), altered appetite and weight, and constipation (Paxil). Because SSRIs reduce testosterone levels, there is substantial risk of sexual dysfunction and loss of libido in both men and women who take them.
Rash, fever, joint pain, abnormal changes in blood cell counts, swelling, excessive excretion of protein in the urine indicating liver or kidney damage, and elevated enzymes in the bloodstream (also indicating tissue damage) have occurred in some people who use Prozac. If you experience any of these symptoms, you probably are sensitive to it and should stop taking it. People who continue to use it after developing these symptoms may end up having a life-threatening anaphylactic reaction.
For the prescribing physician, figuring out which antidepressant to prescribe involves far more guesswork and trial-and-error than you might imagine. Only half of the time does the first antidepressant prescribed work well without negative side effects that make the person want to go off of the drug. Switching to new drugs and adding drugs to try to balance out side effects is standard practice. In recent years, genetic testing has been studied as a way to circumvent this process of trial and error; with a blood test, the action of specific detoxification enzymes in the body can be “typed” in a way that helps predict which antidepressants will cause the most side effects. This type of testing measures how fast your body processes antidepressants, which also helps the doctor rule out the antidepressants least likely to be effective at improving your mood and to prescribe a dose level that is least likely to bring on side effects. Unfortunately, the test can’t be used to measure the effects of all antidepressants—only of a few SSRIs (fluoxetine, paroxetine, venlafaxine) and a few of the tricyclics (imipramine, desipramine, nortriptyline, clomipramine).
SSRIs can interact with other drugs to cause potentially fatal “serotonin syndrome.” Synapses become so flooded with serotonin that hallucinations, agitation, confusion, fluctuating blood pressure, seizures, fever, stiffness, and irregular heartbeat result. SSRIs can also bring about abnormal (excessive) bleeding when used along with aspirin, warfarin, or NSAIDs.
Significant withdrawal syndromes are often experienced when discontinuing the SSRIs, especially with the short-acting SSRIs such as Paxil, Zoloft, and Luvox. The effects of withdrawal can include dizziness, nausea, headache, fatigue, poor concentration, electric shocklike sensations, visual hallucinations, mental fogginess, and moodiness. If you’re withdrawing from SSRIs, do it gradually, over a period of one to two weeks, and if you need to, use the natural alternatives given at the end of this chapter under the supervision of a health care professional who is familiar with their use.
CAUTION!
• Clinical trials of most of these drugs have lasted only for 5 to 16 weeks. Studies of Prozac have lasted for up to a year. In other words, the long-term effects of these drugs have not been systematically studied.
• Because of the risk of serotonin storm, which can be fatal, none of the SSRIs should be taken with any MAOI, additional SSRI, SNRI, or tricyclic antidepressant. The weight-loss drug sibutramine (Meridia) works on serotonin-reuptake channels and should also not be added to SSRIs. Don’t take SSRIs with MAOIs or within 14 days of stopping MAOIs. The antibiotic drug linezolid, which can have effects on monoamine oxidase similar to those of MAOIs, should also be avoided with SSRIs. For the same reasons, avoid using other serotonin-raising substances in combination with these drugs, including amphetamines, buspirone, amantadine, bromocriptine, St. John’s wort, the amino acid tryptophan, and 5-HTP.
• Please avoid these drugs if you have impaired liver function.
• If you tend to be manic, SSRIs may make you more so. In an article published in 2006, psychiatrist Peter Breggin, M.D., wrote about a phenomenon he called medication spellbinding. Those who develop this rare but dangerous side effect while on SSRIs enter a manic state where committing crimes or harming others does not seem wrong. In one case related by Dr. Breggin, a man with no criminal record robbed banks while under the influence of SSRIs and didn’t even seem perturbed when sent to prison—until the drugs wore off. In other more tragic cases, people on these medications harm themselves or others without realizing that what they are doing is wrong. Psychiatrists sometimes point the finger at a pre-existing psychosis that is somehow “activated” or “unmasked” by the SSRIs—an explanation that seems to go against the medical school dictum, “When you hear hoofbeats, think horses, not zebras.” In other words, when you give someone a drug and the person drops into psychosis, doesn’t the source of the problem seem plenty obvious? Dr. Breggin, the world’s best-known expert on the harmful effects of SSRIs and other psychiatric drugs, thinks so.
• Use caution when taking this drug if you have a history of seizures.
• If you are using diuretics to lower blood pressure, Prozac and Paxil can make it more likely that you will have electrolyte imbalances. These imbalances can cause heart rhythm disturbances.
• If you are diabetic, you should know that Prozac can make low blood sugar more likely, and high blood sugar can hit when the drug is stopped. Dosages of insulin and sulfonylurea drugs may require adjustment when taken with this drug.
• If depression has made you feel suicidal, be aware that SSRIs could increase the likelihood that you’ll follow through on thoughts of suicide or violent behavior.
• SSRIs can cause drowsiness or dizziness. Use caution while driving, performing tasks requiring alertness, or operating machinery.
Be Aware. Fluvoxamine inhibits enzymes that metabolize warfarin, theophylline, propanolol, and alprazolam. This could cause an increase in levels of these drugs.
What Are the Interactions with Food? You can take SSRIs with or without food. Avoid alcohol while taking SSRIs.
other Antidepressants
Bupropion (Wellbutrin, Zyban)
What Does It Do in the Body? This drug is a tetracyclic antidepressant. It weakly inhibits the reuptake of serotonin and dopamine, neurotransmitters that play important roles in determining your mood. This drug doesn’t fit into any of the categories most antidepressants do, and no one knows just exactly how it works.
What Is It Used For? Treatment of depression, nicotine withdrawal.
What Are the Potential Side Effects? Ten percent of the people who took this drug in clinical trials stopped because of problems with side effects. The most common were rashes; psychological disturbances such as agitation and mental status changes; neurological disturbances such as seizures, headache, and sleep disturbances; and gastrointestinal disturbances such as nausea and vomiting.
Other side effects may include constipation, weight loss (may be up to 5 pounds), increased appetite, stomach discomfort, menstrual problems, dry mouth, excessive sweating, tremor, insomnia, auditory disturbances, blurred vision, taste disturbances, dizziness, cardi
ac arrhythmias, high blood pressure, palpitations, fainting, agitation, confusion, hostility, decreased libido, anxiety, euphoria, fever, and chills.
CAUTION!
Think Twice About Taking This Drug If . . .
• You have a seizure disorder; it increases your risk of seizures.
• You have or have had bulimia or anorexia.
• You are switching from MAOIs to Wellbutrin. At least 14 days should elapse between your last dose of MAOIs to the first of Wellbutrin. Don’t take this drug with MAOIs.
• You have recently had a heart attack or any other kind of unstable heart disease. Bupropion should be used with care.
• You are taking other antidepressants or antipsychotic drugs. If you have had head trauma or have any history of seizures, you are much more likely to experience seizures as a side effect of this drug. High doses or sudden changes in dosage of this drug can cause seizures.
• You have manic-depressive (bipolar) disorder. This drug may trigger manic episodes. Use with caution.
Your ability to drive or to perform other tasks requiring judgment or motor skills may be impaired. Wait a few days before operating a car or machinery to be sure the dose you’re taking isn’t too sedating.
Bupropion has been shown in animal studies to be toxic to the liver in large doses. If you already have liver or kidney impairment, you should avoid this drug altogether or start at a low dose.
If you start to feel extremely restless, agitated, or anxious, or can’t sleep when you start taking Wellbutrin, you may need to discontinue it. You may be sensitive to it and prone to delusions, hallucinations, psychosis, confusion, or paranoia with continued use.
Take Wellbutrin in equally divided doses, three to four times a day, in order to minimize risk of seizure.
Be Aware. MAOIs such as phenelzine increase levels of bupropion in the body, possibly resulting in deadly toxicity.
Don’t take this drug with alcohol, as this combination can cause seizures.
Mirtazapine (Remeron)
What Does It Do in the Body? Mirtazapine, a tetracyclic antidepressant like bupropion, increases the activity of mood-elevating neurotransmitters in the brain. Unlike many other antidepressants, mirtazapine has strong sedative effects.
What Is It Used For? Treatment of depression.
What Are the Potential Side Effects? About 16 percent of subjects who participated in trials of this drug dropped out because of side effects. Side effects reported included increased appetite with weight gain (nearly 8 percent increased their body weight by 7 percent or more during the studies), low blood pressure, heart pains, heart attack, slow or otherwise irregular heartbeats, dizziness, migraine, apathy, depression, listlessness, vertigo, twitching, amnesia, restlessness, numbness, acne, dermatitis, dry skin, loss of appetite, urinary tract infection, abnormal thirst, aches and pains, cough, sinusitis, eye or ear pain, malaise, and abdominal pain.
There is no reason to use a drug this dangerous when so many safer alternatives are available.
CAUTION!
• If you experience sore throat, fever, or other signs of infection soon after you begin using mirtazapine, you may be developing a rare blood disorder called agranulocytosis that can be caused by this drug. Call your doctor.
• If you have glaucoma or problems with urinary retention, this drug should be avoided. It can increase intraocular pressure and worsen urinary retention.
• If you have heart disease or a history of irregular heartbeats, avoid this drug. It can aggravate both of these problems.
• If you tend to get dizzy when standing up from a prone position, be aware that mir-tazapine can increase this effect, increasing your risk of falls.
Venlafaxine (Effexor)
What Does It Do in the Body? Alters neuro-transmitter activity in the brain. It is an SNRI, which means it is a weak inhibitor of the reuptake of the neurotransmitters serotonin and norepinephrine. Inhibiting reuptake of these neurotransmitters leaves more of them active in the synapses. Effexor also affects reuptake of dopamine.
What Is It Used For? Treatment of depression.
What Are the Potential Side Effects? In clinical studies of Effexor, 19 percent of patients stopped taking it because of side effects. Nausea, sleepiness, insomnia, dizziness, abnormal ejaculation, headache, nervousness, dry mouth, anxiety, weakness, and excessive sweating were the adverse effects most often experienced with this drug.
While venlafaxine may help alleviate depression, it can increase feelings of anxiety or cause insomnia. If you are often anxious, this may not be the right drug for you. Loss of appetite and body weight, mania, seizures, and elevated heart rate are other side effects to look out for.
CAUTION!
• Don’t combine this drug with MAOIs. High body temperature, sudden rapid muscular twitches, extreme agitation, delirium, and even coma and death have resulted from this deadly mix of drugs. Allow a minimum of 14 days between stopping MAOIs and starting venlafaxine, and a minimum of 7 days between stopping venlafaxine and starting MAOIs.
• If you have hypertension, you should know that venlafaxine may cause a sustained increase in blood pressure. The higher the dose, the greater the increase.
• If you have kidney or liver impairment, use this drug with caution.
• Use of this drug for longer than four to six weeks has not been evaluated with clinical trials. Work with your physician to be sure that the drug is continuing to have benefit for you.
• If you have another illness that affects your blood pressure or metabolism, use caution when taking Effexor.
Duloxetine (Cymbalta)
What Does It Do in the Body? Alters neuro-transmitter activity in the brain. Like venlafaxine, duloxetine is an SNRI, which means it inhibits the reuptake of the neurotransmitters serotonin and norepinephrine. Inhibiting reuptake of these neurotransmitters leaves more of them active in the synapses.
What Is It Used For? Treating depression, generalized anxiety disorder (GAD), and pain caused by diabetic nerve damage.
What Are the Potential Side Effects? Nausea, dry mouth, diarrhea, dizziness, insomnia, fatigue, sleepiness, constipation, reduced appetite, increased sweating, and sexual dysfunction. These drugs can also cause difficulty with urinating or emptying the bladder completely during urination.
CAUTION!
Think Twice About Taking This Drug If . . .
• You have liver or kidney disease.
• You have narrow-angle glaucoma.
• You are diabetic. Duloxetine can affect glycemic control; you may need to adjust your insulin or other medications.
• You have an alcohol problem. In a few cases, duloxetine users have turned up with liver failure because they drank heavily while on this SNRI. Alcohol is best avoided with any SSRI or SNRI.
• You have any tendency to become manic. This is one medication that has been known to “activate” a so-called latent mania, precipitating a slide into bipolar disorder. This is not a good medication for bipolar disorder treatment.
Be Aware. As with any drug that affects serotonin, combining duloxetine with other drugs in its class or related classes can lead to serotonin syndrome. This includes SSRIs, tricyclics, MAOIs, and even 5-hydroxytriptan drugs for migraine, which work through a mechanism affecting serotonin levels.
Natural Alternatives for Insomnia, Anxiety, Depression, and Stress
We have become accustomed to running to the medicine cabinet for a drug when we’re suffering from insomnia, anxiety, or depression, but 90 percent of the time the cause of these problems is something that can be remedied without taking medication.
Sugar, alcohol, and coffee are our legal American drugs, and it’s a good bet that these drugs plus food allergies contribute to the vast majority of insomnia, anxiety, and minor depression. Both sugar and alcohol (which is high in sugar) can cause depression. Sometimes fatigue caused by sugar or alcohol is mistaken for depression. If you have a sugar habit (and if you have one, you know it), it’s likely t
hat fatigue is always dogging your tracks. Sugar stimulates your adrenal glands, and taken in excess it will wear them out. When your adrenals are tired, the rest of the body follows, and then when you’re stressed, you’ll get irritable and depressed. If you think your depression might be fatigue, try cutting out all sugar for three weeks and see what happens. And yes, alcohol counts as sugar. Artificial sweeteners such as NutraSweet (aspartame) found in diet sodas are also not allowed, as they are brain stimulants and may even give the adrenals the same signals that sugar does.
Is Your Medication Making You depressed?
One of the most common causes of depression is prescription drugs. Here is a list of some of the most common prescription drugs that can cause depression.
Amphetamines (including antihistamines)
Antibiotics
Anticonvulsants
Antidepressants (!)
Barbiturates
High-blood-pressure drugs (beta-blockers, diuretics)
Hormones (estrogen, including Premarin, and synthetic progestins such as Provera)
Narcotics
Painkillers
Sleeping pills
Systemic corticosteroids (prednisone, cortisone, etc.)
Tagamet and Zantac
Tranquilizers (Halcion, Librium, Restoril, Xanax, etc.)
Some research has shown that in depressed people the balance of essential fatty acids is off. Supplementation with high-quality fish oil, as well as eating plenty of fish, walnuts, pumpkin seeds, and dark leafy greens (all sources of omega-3s), can help return the body to balance and give some relief. Harvard professor Andrew L. Stoll, M.D., has discovered that high-dose fish oil—in the neighborhood of 1.5 to 12 grams of eicosapentaenoic acid (EPA) per day—has had powerful healing effects on study subjects who suffer from bipolar disorder, depression, and postpartum depression. His findings are detailed in his book, The Omega-3 Connection (Simon & Schuster, 2001).