A Mind of Your Own: The Truth About Depression and How Women Can Heal Their Bodies to Reclaim Their Lives

In order for a drug to be approved, it must be shown to be superior to placebo. As you can imagine, drug companies despise placebo effects. They will do everything in their power to minimize the impact of placebo in their studies. That the FDA allows them to use these techniques is wrong, another example of Big Pharma’s shameless misconduct.

Because the FDA database contains all of the data from initial trials, both published and unpublished, analyzing its data is exceptionally useful. Keep in mind that drug companies normally don’t publish negative results. They prefer to file away those studies in a drawer where they will never be found; hence the “file drawer” phenomenon.

A fascinating 2014 study published in the Journal of Clinical Psychiatry, one of my field’s most respected journals, explored—­and exposed—­the real power of belief in psychiatric treatment. A group of researchers at Columbia University analyzed data from two large, multicenter discontinuation trials encompassing 673 ­people diagnosed with major depressive disorder and who were taking fluoxetine (generic Prozac) for twelve weeks.

After those three months, they were told that they’d be randomized to either a placebo or continued fluoxetine. So while they all knew they were taking the antidepressant in the first three months, they didn’t know if what they were given afterward was an active antidepressant or a sugar pill. The results spoke for themselves: both groups—­the ones still taking the fluoxetine and those on the placebo—experienced a worsening of depressive symptoms. This outcome suggests two significant interpretations: (1) the initial effect during the first three months was attributable to placebo, as all patients knew they were receiving treatment; and (2) the worsening of symptoms upon the mere possibility of getting just a placebo is indicative of the undoing of the placebo effect, what’s sometimes called the nocebo effect.

Identifying a tremendous placebo effect has been further echoed by other meta-analyses. The power of belief and the expectation of healing cannot be dismissed when medical treatments appear to work. In my opinion, the use of medications associated with serious short- and long-term side effects and which primarily ride the placebo effect represents an ethically questionable practice.

I work with the placebo effect every day in my office because I aim to inspire a different set of beliefs. Even ­people who claim to be suicidal can experience the placebo effect under my care. The decision to consider taking your own life is not a trait that would have been selected for over the millennia of human evolution. It’s more logical to assume it has roots in physiological imbalances, which is where I like to spend my time searching for solutions with my patients. I look for problems like nutrient deficiencies, endocrine disruption, and autoimmunity. The first and most important thing I like to convey to patients is that they are in charge. They have agency. This sensibility can go a long way, because they’re coming to me thinking I have what they don’t have—­a quick fix. A quick fix is a lovely idea, and if one existed, it could be great. Unfortunately, the weight of the data suggests that it doesn’t and that we may be doing more harm than good by collectively pretending it does. The challenge is that it’s human nature to feel better after doing something we think will make us feel better. But sometimes inaction is the best medicine.

LONG-TERM SIDE EFFECTS: MORE MEDS, MORE DEPRESSION, MORE DISABILITY . . . AND DEATH?

But you might ask, “What if these drugs are in fact working some of the time for some ­people?” They still wouldn’t be worth the consequences for the placebo effect, particularly given their side effects, which are notoriously hidden from the lay public. I find it outrageous that drug companies can use any number of tactics to establish efficacy, including the suppression of data, and then use those tactics to legitimize long-term prescribing with no thought or attention to the real side effects over time.

When I lecture on the futility and perils of antidepressants, I like to employ the following analogy courtesy of Dr. David Healy, an internationally respected psychiatrist based in the UK: Let’s say you’re somebody who experiences a lot of social anxiety. You have a ­couple glasses of wine at a party as a preemptive strike. A sense of calmness washes over you and your symptoms evaporate. Through deductive reasoning, you could say, “Well, I must have an alcohol deficiency, so I should continue to consume alcohol every time I have this symptom, and I might want to drink regularly to prevent it altogether.” This analogy is emblematic of the practice of dishing out antidepressants without any consideration of their long-term consequences.

We’ve arrived at a place in psychiatry’s abuse of antidepressants where we have a half-baked theory in a vacuum of science that the pharmaceutical industry raced to fill. We have the illusion of short-term efficacy and assumptions about long-term safety. The potential emerging side effects are nothing short of horrifying, from suppressed libido and sexual dysfunction, abnormal bleeding, insomnia, migraine, weight gain, and blood sugar imbalances to risk of violent, irrational behavior and suicide. Before I get to the ugliest of side effects and withdrawal complications, let’s focus on how your ability to function long ­term in the world with depression is significantly sabotaged by treating that first episode of depression with medication. This too has been expertly explored by Robert Whitaker, whose website (www.madinamerica.com (http://www.madinamerica.com)) is a virtual library of published data and thoughtful reviews of multiple long-term studies that have followed large groups of ­people taking antidepressants. Time and time again these studies demonstrate poor functional outcomes for ­people treated with antidepressants relative to those with minimal to no medication treatment.

They are at greater risk for all the acute side effects I’ve already listed, as well as increased risk of relapse, cognitive impairment, secondary diagnosis and medication treatments (first a depression diagnosis followed by a bipolar one), and recurrent hospitalization.

A breathtaking 60 percent of patients are still diagnosed with depression one year into treatment, despite temporary improvement within the first three months.

Two prospective studies in particular support a worse outcome in those prescribed medication. In one such British study, an unmedicated group experienced a 62 percent improvement by six months, whereas the drug-treated patients experienced only a 33 percent reduction in symptoms.

And in another study of depressed patients conducted by the World Health Organization (WHO) in fifteen cities across the UK, it was found that at the end of one year, those who weren’t exposed to psychotropic medications enjoyed much better “general health,” their depressive symptoms were much “milder,” and they were less likely to still be “mentally ill”!

Now let’s consider the more serious possible side effects of violent behavior, relapse, and crippling withdrawal among those who try to escape their grip. Antidepressants have a well-established history of causing violent side effects, including suicide and homicide. In fact, five of the top ten most violence-inducing drugs have been found to be antidepressants.

Over the past three decades there have been hundreds of mass shootings, murders, and other violent episodes that have been committed by individuals on psychiatric drugs. Big Pharma spends around $2.4 billion a year on their direct-to-consumer television advertising for drugs like Zoloft, Prozac, and Paxil. The networks can’t afford to run negative stories about prescription drugs, as they would lose tens of millions of dollars in ad revenue (no wonder the connection is habitually downplayed or ignored entirely). The Russian roulette of patients vulnerable to these “side effects” is only beginning to be known and may have something to do with how their bodies (and actions of their unique genetic code) metabolize these chemicals and preexisting allostatic (stress) load. Dr. Healy has worked tirelessly to expose data implicating antidepressants in risk of suicide and violence, maintaining a database for reporting, writing, and lecturing about cases of medication-induced death that could make your soul wince. And what about our most vulnerable: new mothers of helpless infants? I have countless patients like Kate in my practice who report never-before thoughts of suicide within weeks of starting an antidepressant for postpartum depression.

In a population where only a few randomized trials have examined the use of antidepressants for postpartum depression, I have grave concerns for women who are treated with drugs before more benign and effective interventions such as dietary modification, thyroid treatment, and addressing their sleep habits during this period when sleep deprivation runs high are explored. We already know that “low mood” is likely to resolve on its own within three months without any treatment, and upward of 70 percent of ­people will be free of depression without any medication whatsoever within a year.

Yet we reflexively turn to these drugs and their unpredictable effects that can rob us of the ability to find permanent relief through the body’s own powerful systems, even though, by their own claims, they take six to eight weeks to “take effect.”

In 2004, the U.S. Food and Drug Administration (FDA) revised the labeling requirements for antidepressant medications with a warning that: “Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders.”

The FDA was pushed to revise the labeling following a bevy of lawsuits in which pharmaceutical companies were forced to reveal previously undisclosed drug data.

You’d think such labeling would give ­people—­and parents—­pause. But since 2004, antidepressant use has only increased among both children and adults. I am routinely helping women who want to have a baby either avoid or taper from antidepressants, despite having been “specially trained” to prescribe for this population. For many of them, the first step is simply accepting the fact that they’ve been lied to about the value of antidepressants and their alleged benefits. Meanwhile, their downsides are not only downplayed but actively concealed.

All you have to do is spend a few minutes on SurvivingAntidepressants.org (http://SurvivingAntidepressants.org), BeyondMeds.com (http://BeyondMeds.com), or SSRIstories.org (http://SSRIstories.org) to appreciate that we have created a monster. Millions of men, women, and children the world over are suffering side effects, including complicated withdrawal routinely dismissed by their prescribing clinicians. Contrary to what Big Pharma would have you believe, weaning off antidepressants is extremely difficult, so choosing to take them could be signing up for a lifetime of medication use that creates and sustains abnormal states in the brain and entire nervous system. As a clinician who once believed in these medications, I have been humbled by what they are capable of. In fact, even when I have tapered women off of Celexa at extremely low increments of .001 mg a month, it can be hard to imagine another class of substances on earth so potentially complicated to discontinue.

I first became aware of the habit-forming nature of these medications when I worked with a patient who wanted to become pregnant in the coming year to taper off of Zoloft. She experienced about six months of protracted withdrawal that began at about two months after her last dose. My training did nothing to prepare me to deal with that.

The truth is that we have very little idea about what these medications are actually doing! At the same time, though, we need to acknowledge that the complexity of neurophysiology is overwhelming. Although the appeal is to think that we’ve cracked the code on human behavior and all of its intricate physiology, we’re far from it. For example, ten years ago we didn’t even know that the brain had an immune system, and two years ago we didn’t know it had lymphatics—­basic anatomy. We used to think that immune activity in the brain only happened under certain pathological circumstances. But now we’ve identified microglia—­billions of cells that play a specific role in managing inflammatory responses in the brain based on perceived threats from the rest of the body.

And it’s not just about tinkering with chemical levels in the brain or the body for that matter.

We like to cling to simple explanations, but even the categorical name of the various antidepressants, selective serotonin reuptake inhibitors, is misleading. They are far from selective. In September 2014, an alarming new study from the Max Planck Institute in Leipzig, Germany, showed that even a single dose of an antidepressant can alter the brain’s architecture within three hours, changing the brain’s functional connectivity.

The study, published in the journal Current Biology, was shocking not only to the health journalists who reported on it, but also to the doctors who prescribe these drugs.

An important analysis by the former director of the NIMH and published in the American Journal of Psychiatry shows that antidepressants “create perturbations in neurotransmitter functions,” causing the body to adapt through a series of biological events that occur after “chronic administration,” leading to brains that after a few weeks function in a way that is “qualitatively as well as quantitatively different from the normal state.”

In other words, the brain’s natural functionality is assaulted by the medication to the point that it can become permanent. That said, everything we will explore in this book speaks to the body’s tremendous and almost unstoppable resilience when properly supported.

Dr. Paul Andrews of the Virginia Institute for Psychiatric and Behavioral Genetics demonstrated through a careful meta-analysis of forty-six studies that a patient’s risk of relapse is directly proportionate to how disruptive the medication is to the brain.

The more disruptive the medication, the higher the risk of relapse upon discontinuation. He and his colleagues challenge the whole notion of relapse, suggesting that when you feel terrible upon stopping an antidepressant, what you’re experiencing is withdrawal—­not a return of your mental illness. And when you choose the medication route, you’re actually extending the duration of your depression. Andrews writes: “. . . unmedicated patients have much shorter episodes, and better long-term prospects, than medicated patients . . . [T]he average duration of an untreated episode of major depression is twelve to thirteen weeks.”

In a retrospective ten-year study in the Netherlands, 76 percent of those with unmedicated depression recovered without relapse relative to 50 percent of those treated.

Unlike the mess of contradictory studies around short-term effects, there are no comparable studies that show a better outcome in those prescribed antidepressants long term.

Harvard researchers have also concluded that at least 50 percent of drug-withdrawn patients relapsed within fourteen months.

In the words of one team of researchers led by Dr. Rif El-Mallakh from the University of Louisville: “[L]ong-term antidepressant use may be depressogenic . . . it is possible that antidepressant agents modify the hardwiring of neuronal synapses [which] not only render antidepressants ineffective but also induce a resident, refractory depressive state.” Dr. El-Mallakh and his colleagues wrote this bold statement in a letter to the editor of the Journal of Clinical Psychiatry in 1999.

Then, in 2011, they published a new paper including eighty-five citations proving that antidepressants make things worse in the long run.

(So when your doctor says, “You see, look how sick you are, you shouldn’t have stopped that medication,” you should know that the data suggests that your symptoms are signs of withdrawal, not relapse.)

In Anatomy of an Epidemic, Robert Whitaker summarizes the matter succinctly:

We can now see how the antidepressant story all fits together, and why the widespread use of these drugs would contribute to a rise in the number of disabled mentally ill in the United States. Over the short term, those who take an antidepressant will likely see their symptoms lessen. They will see this as proof that the drugs work, as will their doctors. However, this short-term amelioration of symptoms is not markedly greater than what is seen in patients treated with a placebo, and this initial use also puts them onto a problematic long-term course. If they stop taking the medications, they are at high risk of relapsing. But if they stay on the drugs, they will also likely suffer recurrent episodes of depression, and this chronicity increases the risk that they will become disabled. The SSRIs, to a certain extent, act like a trap in the same way that neuroleptics [tranquilizers] do.

More than twenty years have passed since clinicians and researchers started collecting evidence against antidepressants. Although these drugs may offer relief in the short term thanks to the placebo effect, they lead to chronic, persistent depression that resists treatment when taken for an extended period of time. In some ­people, stopping the drug can cause a slow and gradual lightening of the mood, but this doesn’t always occur, and depression can become more or less permanent. Remember the alcohol effect.

Not surprisingly, the powers that be in my field have not looked into this matter or launched a serious investigation. And yet the studies keep emerging. In early 2015, yet another headline hit that Big Pharma turned a blind eye to. It read “Stopping SSRI Antidepressants Can Cause Long, Intense Withdrawal Problems” and referred to the first systematic review of withdrawal problems that patients experience when trying to get off SSRI antidepressant medications.

A team of American and Italian researchers found that withdrawing from SSRIs was in many ways comparable to trying to quit addictive benzodiazepine sedatives and barbiturates.

They also discovered that withdrawal symptoms aren’t fleeting; they can last months or even years. Moreover, entirely new, persistent psychiatric disorders can surface from discontinuing SSRIs.

The authors analyzed fifteen randomized controlled studies, four open trials, four retrospective investigations, and thirty-eight case reports of SSRI withdrawal. Paroxetine (Paxil) was found to be the worst, but all the SSRI antidepressants were documented as causing a wide range of withdrawal symptoms from dizziness, electrical shock sensations, and diarrhea to anxiety, panic, agitation, insomnia, and severe depression. They write: “Symptoms typically occur within a few days from drug discontinuation and last a few weeks, also with gradual tapering. However, many variations are possible, including late onset and/or longer persistence of disturbances. Symptoms may be easily misidentified as signs of impending relapse.”

In their conclusions, they state what should be the obvious: “Clinicians need to add SSRIs to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with benzodiazepines, barbiturates, and other psychotropic drugs.” An accompanying editorial to their paper notes that “This type of withdrawal consists of: (1) the return of the original illness at a greater intensity and/or with additional features of the illness, and/or (2) symptoms related to emerging new disorders. They persist at least six weeks after drug withdrawal and are sufficiently severe and disabling to have patients return to their previous drug treatment. When the previous drug treatment is not restarted, post-withdrawal disorders may last for several months to years.”

The editorial also states that “With SSRI withdrawal, persistent postwithdrawal disorders may appear as new psychiatric disorders, in particular disorders that can be treated successfully with SSRIs and SNRIs. Significant postwithdrawal illnesses found with SSRI use include anxiety disorders, tardive insomnia, major depression, and bipolar illness.”

This bit of news is extremely unsettling to current practices in psychiatry. According to the current American Psychological Association treatment guidelines for major depressive disorder, “During the maintenance phase, an antidepressant medication that produced symptom remission during the acute phase and maintained remission during the continuation phase should be continued at a full therapeutic dose.” Such a guideline merely promotes more drug sales, and more crippling side effects.

DON’T GO DOWN THE RABBIT HOLE

We need to break out of the spell that the pharmaceutical industry has put us under. Psychiatry’s swan song has been sung; listen for its plaintive wail. We must reject the serotonin meme and start looking at depression (and anxiety, and bipolar disorder, and schizophrenia, and OCD) for what they are: disparate expressions of a body struggling to adapt to a stressor. There are times in our evolution as a cultural species that we need to unlearn what we know and change what we think is true. We have to move out of the comfort of certainty and into the freeing light of uncertainty. It is from this space of acknowledged unknowing that we can truly grow.

From my vantage point, this growth will encompass a sense of wonder—­both a curiosity about what symptoms of mental illness may be telling us about our physiology and spirit and a sense of humbled awe at all that we do not yet have the tools to appreciate. For this reason, honoring our coevolution with the natural world and sending the body a signal of safety through movement, diet, meditation, and environmental detoxification represents our most primal and most powerful tool for healing. We also need to identify vulnerabilities and chemical exposures and support basic cellular function, detoxification, and immune response. This is, ultimately, personalized medicine.