Writer: Ilham Ahmed
My Stance
Antidepressants can alter the brain chemistry of people facing severe depression and anxiety. However, these drugs can only temporarily change the mood, and cannot permanently fix the underlying problem.
Challenging the Status Quo
The effectiveness of antidepressants is like that of putting a band-aid on a broken leg. It may heal the scars and provide temporary relief but won’t heal the underlying broken bone. Antidepressants simply relieve the patient by temporarily increasing the serotonin levels in their brain. However, for most antidepressants like SSRIs (Selective Serotonin Reuptake Inhibitors), it almost takes six weeks to show improvements which is why patients are recommended to continue their treatment over time with varying doses. [1] Moreover, low serotonin may not always be the reason for depressive symptoms and negative emotions, other external and internal forces can cause it, in which case the patients would rather experience the side effects or the placebo effect of the medication instead of its benefits. [2]
Antidepressants on Trial
Pharmacogenomics studies how our genes affect how our bodies respond to medications. [3] Pharmacogenomic testing aims to provide “the right drug, for the right patient at the right dose”. [3] Psychiatrists and family doctors agree that pharmacogenomics-guided depression treatment can improve depression treatment over antidepressant therapy as it can help identify variations in genes that affect metabolizing or clearing certain medications in the body. With this information, doctors can examine their patient’s genetic profile and predict if a certain medication will benefit them more than harm them. [3] A recent study looked at 213 outpatients with major depressive disorder and/or generalized anxiety disorder. [4] These patients were then randomly treated with either the pharmacogenomics-guided or standard antidepressants for six months. Patients who received pharmacogenomics-guided treatment improved their depression severity and anxiety more than the patients who received the standard treatment. [4]
Although the previous study involved drug recommendations based on the patient's drug profiles and medical history, treating depressive disorders should be patient-oriented and more culturally informed, especially for cases involving conventional pharmacological options that might conflict with the patient’s religious values and obligations. For example, in Judaism, the utmost importance is given to safeguarding well-being. For a period health experts have consistently maintained the view that recreational drugs pose risks and hold no medicinal benefits. [5] A cross-sectional survey was conducted on 616 Jewish Israeli adults who were struggling with depression and/or anxiety disorder. [6] The participants comprised a mixture of secular, traditional, religious, and orthodox Jews. [6] Most patients didn’t use their prescription medications but were more inclined towards natural remedies and weren’t concerned with medical evidence. [6] Additionally, all four groups of Jewish Israeli participants had consulted with professionals and tried both prescription and herbal medication. Still, the orthodox group had also utilized psychological interventions instead of pharmacological ones. [6]
Although antidepressants and conventional drugs are vastly available in the market, their effectiveness is often questionable due to potential side effects and the influence of the placebo effect. Therefore natural remedies have been sought after as a healthier and safer alternative to synthetic antidepressants. For example, Chinese medicine, with approved herbal remedies, is a safer and more effective alternative to pharmaceutical drugs. Chinese herbalism uses medicinal herbs to improve health and is delivered in the form of granules or capsules, teas, liquid extracts, powders, etc. [7] Chinese herbalism aims to treat patterns of symptoms such as allergies, cancer treatment side effects, digestion issues, immune system regulation, etc. [7] This study examined the antidepressant-like activity of four herbs on stressed mice and compared the activities of each herb along with novel herbal treatment (NHT) and Lexapro. [8] Results indicated that the herb Shan Zha had a similar antidepressant-like effect to NHT. Moreover, Shan Zha is currently available as a nutritional supplement, facilitating its transition to clinical trials. [8]
Our understanding of how antidepressants and conventional drugs are used to treat depression work and their impact on our health remains incomplete. Medications similar to antidepressants can improve human livelihood, but can also cut short other aspects. For example, antidepressants such as SSRIs and SNRIs can potentially lead to sexual side effects in individuals of both genders. [9] These side effects may manifest as a decrease in desire, a reduction in the intensity of pleasure, delays or difficulties in achieving orgasm, decreased sensitivity, persistent sensations of genital arousal, challenges with obtaining or maintaining an erection, or enduring and painful erections. [9] Recent research investigated the toxicity of antidepressants on mouse sperm cells, aiming to provide molecular evidence of irreversible disorders in the development of mature sperm cells. [10] In this study, to test the reproductive toxicity directly, the spermatogenic cells were incubated for 48 - 96 hours with SSRIs such as fluoxetine (Prozac) and escitalopram (Lexapro). Their findings suggested that antidepressants may cause DNA damage response in germ cell lines and further research is needed to understand their toxicity. [10]
Verdict on Antidepressants
The problem isn’t that antidepressants don’t work, but rather it’s because conventional drugs are stigmatized and skewed. The studies above arguing against the use of antidepressants and conventional drugs have the most support. They promote unorthodox ways of improving depression severity like counseling, taking herbal medication instead of pharmaceutical ones, or simply taking a vacation to reduce stress. Moreover, there have also been research investigations of the off-target side effects of antidepressants that might have severe health impacts on humans such as the loss of sex drive.
Sources & Works Cited
[1] Hageman, D. (2024, September 27). How long do antidepressants take to work? Improve the wait by setting accurate expectations. Greenbrook. https://www.greenbrooktms.com/how-long-do-antidepressants-take-to-work-improve-the-wait-by-setting-accurate-expectations
[2] Perlmutter, A. (2022, July 22). Inflammation, the gut-brain connection, and other possibilities. Psychology Today. https://www.psychologytoday.com/us/blog/the-modern-brain/202207/if-serotonin-doesnt-cause-depression-then-what-does
[3] Mayo Clinic. (2017, February 20). Pharmacogenomics: the right drug, for the right patient, at the right dose [Video]. YouTube. https://www.youtube.com/watch?v=WSf6vyP11aQ
[4] Papastergiou, J., Quilty, L. C., Li, W., Thiruchselvam, T., Jain, E., Gove, P., Mandlsohn, L., van den Bemt, B., & Pojskic, N. (2021). Pharmacogenomics guided versus standard antidepressant treatment in a community pharmacy setting: A randomized controlled trial. Clinical and translational science, 14(4), 1359–1368. https://doi.org/10.1111/cts.12986
[5] My Jewish Learning. (2022, December 26). Jews and drugs. https://www.myjewishlearning.com/article/jews-and-drugs/
[6] Burstein, O., Shamir, A., Abramovitz, N., & Doron, R. (2022). Patients' attitudes toward conventional and herbal treatments for depression and anxiety: A cross-sectional Israeli survey. The International journal of social psychiatry, 68(3), 589–599. https://doi.org/10.1177/0020764021992385
[7] Cleveland Clinic. (2024, July 2). What you should know about Chinese herbs. https://health.clevelandclinic.org/what-you-should-know-about-chinese-herbs/
[8] Nitzan, K., David, D., Franko, M., Toledano, R., Fidelman, S., Tenenbaum, Y. S., Blonder, M., Armoza-Eilat, S., Shamir, A., Rehavi, M., Ben-Chaim, Y., & Doron, R. (2022). Anxiolytic and antidepressants' effect of Crataegus pinnatifida (Shan Zha): biochemical mechanisms. Translational psychiatry, 12(1), 208. https://doi.org/10.1038/s41398-022-01970-6
[9] Allen, N. (2024, August 24). Antidepressants: Which cause the fewest sexual side effects? Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/antidepressants/faq-20058104
[10] Sołek, P., Mytych, J., Tabęcka-Łonczyńska, A., & Koziorowski, M. (2021). Molecular Consequences of Depression Treatment: A Potential In Vitro Mechanism for Antidepressants-Induced Reprotoxic Side Effects. International journal of molecular sciences, 22(21), 11855. https://doi.org/10.3390/ijms222111855
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