How Safe Are Anti-Depressants?

An article in the UK's The Telegraph (London) poses that question in the wake of a well-known British philanthropist, Sir Peter Lampl, going through a change in anti-depressant medication (from what to what, the article does not say) and then going missing for several days. Sir Peter was later found at a train station. The case apparently got loads of attention in the UK and the fear among some was that regular Brits, learning of the story, might be scared away from taking their meds or away from visiting a doctor for a scrip.

Anyway, the answers to the question are interesting:

"Psychiatrist Dr William Shanahan, medical director at Capio Nightingale Hospital, London, is adamant that anti-depressants are safe. 'These drugs have their place. They work wonderfully for many people and lives have been transformed by them,' he says. He finds the case of Peter Stampl very unusual and difficult to explain without a full pharmaceutical history, but believes such an extreme reaction would probably be brought on by a combination of factors such as a build-up of medication, linked with another illness, stress or alcohol consumption.

"'This case may have scared people but these events are rare and often the result of other factors becoming involved,' says Dr Shanahan. 'You get interactions between substances, which leave the body in a state of toxicity and can create a feeling of confusion. And in this particular instance, there will be variables we know nothing about. It might be something unrelated to the depression.'

"But Dr Shanahan does warn of the 'normalisation' of taking anti-depressants, and that because they are so commonplace, we don't consider the risks. 'We are becoming too blasé about anti-depressants,' he says."

We are pretty darn blase about anti-depressants on this side of the pond as well. What amuses me about the doctors response is that he first defends them as safe, then admits there is much unknown about their interactions with other substances and their long-term build-up in humans (that kind of ignorance strikes me as being unsafe) and then says Brits are too blase about their use. That's barely a half-defense.

"Alison Cobb, senior policy and campaigns officer for Mind, the national association for mental health, believes that while the normalisation of anti-depressants is a good thing – 'depression is more acceptable; the taboo has been lifted' – there is a dangerous gap in public knowledge.

"'The names Prozac and Seroxat are so well known,' she says, 'that perhaps people don't recognise that they are serious drugs with side-effects, and the potential to cause withdrawal symptoms.'"

Mind is essentially like the US's NAMI National, except that it tends to be a bit more thoughtful in its pronouncements. You'd never hear NAMI describe anti-depressant as "serious drugs" with "withdrawal symptoms."

The only truly striking thing about the assessment of anti-depressant safety is this:

"There are real dangers in taking anti-depressants – notably the risk of death. Between 1993 and 2002, there were 4,767 deaths in England and Wales involving anti-depressant drugs, according to the Office of National Statistics."

The majority of those deaths--mostly due to overdose--were related to tricyclic anti-depressants, but about 10 percent involved SSRIs and other anti-depressants (ie, SNRIs and Wellbutrin), according to this study (pdf).

While I knew the old tricyclics were dangerous in overdose, who knew that about modern anti-depressants?

My own assessment of anti-depressant safety is that it's a mixed picture: Some people do roaringly good on the drugs and never have a problem. Others have horrible reactions to the drugs (heart attacks, suicide, suicidality, birth defects, incidences of violence, and so on and so on). And no one seems to be able to sort out why this dichotomy exists.

Not long ago, someone I know asked me to explain the wide range of responses to the drugs. I told her that the only analogy I could think of what alcohol: Some people take one drink and fall over and are drunks for life, crash cars, lose jobs and explode their livers. Others take a few drinks a day for life and nothing untoward happens to them.

Anti-depressants are weird like that. And just as with hooch, I doubt we ever get to a final answer.