Integrative Medicine – Treating Depression with SSRIs (Part 2)
The rising prevalence of mental illnesses has seen increased sales of neurological drugs such as Selective Serotonin Reuptake Inhibitors (SSRIs). They can help treat moderate to severe depression and are thought to be relatively safe, with fewer side effects than other types of anti-depressants.
Depression is linked to low levels of serotonin, dopamine, norepinephrine, and other neurotransmitters. SSRIs work by blocking the reuptake, i.e. more serotonin is available, which leads to higher levels of serotonin in the brain, which is postulated to relieve depression.
An Inconvenient Truth – What all Integrative and Conventional Medicine Practitioners Need to Consider
However, the use of SSRIs drugs remains controversial.
It is essential for all practitioners of conventional and integrative medicine to make sound clinical and scientific judgements before prescribing SSRIs. Issues to consider include:
1. Many Integrative medicine practitioners are aware that several weeks of SSRI treatment are required before clinical improvement is observed.
2. Other issues conventional medicine and integrative medicine doctors face is that only 50 % of patients respond to SSRI drugs and effective remission occurs less than 30% of the time. So, is it still appropriate to prescribe SSRIs?
3. Some scientists have questioned the Serotonin hypothesis. A case in point is Nautiyal & Hen (2017), who stated, “There is a lack of strong evidence supporting a direct correlation between low serotonin signalling and depression. While some studies report an association between levels of platelet serotonin and depression, this has not been a consistent finding in large sample sets, and it is also unclear how platelet levels are related to brain levels of serotonin.”
4. Jakobsen et at 2017 research paper published in BMC Psychiatry, further concluded that SSRIs significantly increase the risk of both serious and non-serious adverse events; however, they concluded that the potential small beneficial effects seem to be outweighed by harmful effects.
5. The U.S. Food and Drug Administration (FDA) admitted in 2007 that SSRIs are dangerous. (BMJ 2017).
6. The BMJ article mentioned above by Professor Peter C Gøtzsche in 2017 also stated, ‘We showed for the first time that SSRIs in comparison with placebo increase aggression in children and adolescents, odds ratio 2.79 (95% CI 1.62 to 4.81) (2). This is an important finding considering the many school shootings where the killers were on SSRIs.’
Integrative Medicine Treatment Required for Depression
While conventional drugs are best suited to treat severe forms of depression, it is undeniable that better pharmaceuticals are required for treatment to mild to severe forms of depression. A research paper in Int J Risk Safe Med. Published in 2011 by Nielsen stated, ‘the current level of use of SSRIs may not be evidence-based, which is supported by studies showing that the effect of SSRIs has been overestimated’.
There should be caution when prescribing SSRIs only. There is also an increased risk of suicide when prescribing such drugs.
At the very least, all conventional medicine practice that prescribes anti-depressants should consider integrative medicine framework. A simple answer is the inclusion of cognitive behavioural therapy (CBT) which is regarded as the gold-standard psychological treatment and has no side-effects. The major challenge for policymakers is that approximately only 50% of pharmaceuticals anti-depressants work, but as they are out of patent, they are cheap.
Future blogs will discuss several alternative treatments that are currently used in the treatment of depression.