No Reason to Use Antidepressants
SSRIs and Suicide Link
A recent article reminds us of the risk in prescribing patients antidepressants. Bringing a former cohort study1 from 2015 back to life, the increase in suicide rates among individuals on antidepressant medications should warn against the use of antidepressants in most cases of depression. Tricyclics, SSRIs, and other antidepressants have a long history of association with suicidality, which is why many of them have black box warnings to this effect.
The Study Says
The study specifically concluded “rates of suicide and attempted suicide were similar during periods of treatment with selective serotonin reuptake inhibitors and tricyclic and related antidepressants. Mirtazapine, venlafaxine, and Trazadone were associated with the highest rates of suicide and attempted suicide.”1 Caution should be taken when managing patients on these medications, as well as taking patients off of them. The risk of suicide attempt was the same during treatment, as up to 28 days post-treatment in the study.1 It is becoming generally understood, and accepted, that these pharmaceuticals should not be considered the starting point for most depression, as even JAMA has stated that the “benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms.”2
The concept of treating depression as a cluster of associated functional factors, instead of a purely biochemical imbalance, may be a more appropriate place to start. Advocating a healthy diet, increased sleep, exercise and mindfulness practices, are all becoming more conventionally respected frontline treatments for depression and should certainly be exhausted before medication solutions are sought. When these foundational components have been exhausted, as naturopaths, we still have a plethora of options, such as opening up emunctories, amino acid balancing using neurotransmitter precursors, homeopathic prescriptions, or herbal formulations. And of course, our most researched herb for depression, St. John’s Wort, has been shown to be significantly more effective than many pharmaceutical options for the treatment of mild to moderate depression.3
- Coupland C, Hill T, Morriss R, et al. Antidepressant use and risk of suicide and attempted suicide or self-harm in people aged 20 to 64: cohort study using a primary care database. BMJ. 2015;350:h517. doi: 10.1136/bmj.h517.
- Fournier JC, DeRubeis RJ, Hollon SD, et al. Antidepressant Drug Effects and Depression SeverityA Patient-Level Meta-analysis. JAMA. 2010;303(1):47-53. doi:10.1001/jama.2009.1943
- Ng QX, Venkatanarayanan N, Ho CY. Clinical use of Hypericum perforatum (St John’s wort) in depression: A meta-analysis. J Affect Disord. 2017;210:211-221. Doi: 10.1016/j.jad.2016.12.048.
Node Smith, associate editor for NDNR, is a fifth year naturopathic medical student at NUNM, where he has been instrumental in maintaining a firm connection to the philosophy and heritage of naturopathic medicine amongst the next generation of docs. He helped found the first multi-generational experiential retreat, which brings elders, alumni, and students together for a weekend campout where naturopathic medicine and medical philosophy are experienced in nature. Three years ago he helped found the non-profit, Association for Naturopathic ReVitalization (ANR), for which he serves as the board chairman. ANR has a mission to inspire health practitioners to embody the naturopathic principles through experiential education. Node also has a firm belief that the next era of naturopathic medicine will see a resurgence of in-patient facilities which use fasting, earthing, hydrotherapy and homeopathy to bring people back from chronic diseases of modern living; he is involved in numerous conversations and projects to bring about this vision.