Posted 23 August 2011; updated 17 December 2011
Edition 10 of a local magazine ‘Health Intelligence’ has on its cover a headline: ‘Antidepressant dangers exposed – The sad facts about happy pills’ – an article written by Morné Malan who has a PhD in English.
(The original article being deconstructed can be read here:
Sad Facts About Happy Pills – Health Intelligence Edition 10 page14)
UPDATE (17 December 2011)
Comment 8 of the comments section below contains the following statement by Brent Murphy the editor of Health Intelligence magazine: “Therefore we will be publishing the following statement in edition 12 (edition 11 is already in circulation so it can’t appear in that)”. (emphasis added) This is followed by the promised “CLARIFICATION” which reads:
“In an article Sad Facts about Happy Pills featured in Health Intelligence 10, it was reported as “FACTS” that antidepressants cause death, brain damage and cancer. Whilst we believe it is correct that the research referred to in the article raises concerns that antidepressants may be associated with cardiac-related mortality, brain nerve damage, and ovarian and breast cancer, this research is preliminary, mostly performed on animals, and needs confirmation with larger human based data. Therefore these effects should not have been reported as “FACTS” implying certainty, but rather “CONCERNS” implying possibility. The writer also suggested that people who suffer from mood disturbances should consider stopping accepting prescriptions for antidepressants based on this evidence. The editorial board of Health Intelligence does not believe that people who are taking antidepressants should discontinue their therapy based on the possibilities mentioned in this article. Furthermore, should antidepressant therapy be discontinued or changed it should be done so under medical supervision and over a gradual weaning-off time period. It is also the opinion of our board, based on current evidence, that the risk vs. benefit ratio favours treatment of people who suffer from severe depression (as opposed to mild/moderate depression), with antidepressant medication.”
Did Mr Murphy keep his word? Here is a copy of what was actually published in Health Intelligence magazine edition 12 on page 11:
Access the text of the Update by Brent Murphy – Editor of Health Intelligence here.
Not quite the same is it? In ‘fact’ it is rather watered down, leaves out a couple of important statements that were in the original ‘clarification’, and adds an invalid ‘excuse’ (in this context) for unethically using animal studies to present inaccurate, misleading and unproven FACTS about antidepressants to the public.
It is worth repeating that in severe major depression, antidepressants save lives because people with severe major depression are such a high suicide risk. I wonder why the opinion of the magazine’s editorial board that people with severe depression should be treated with antidepressants is no longer reflected in published update. Was this the actual opinion of the editorial board – or is the editorial board perhaps only a token body?
Here is the rest of the original critique of the article (first posted 23 August 2011) referred to on the cover as ‘Antidepressant dangers exposed – The sad facts about happy pills’ in Health Intelligence Edition 10 page 14:
The headline inaccurately refers to all antidepressants, whereas the article deals only with one class of antidepressants – the ‘selective serotonin reuptake inhibitors’ or SSRIs.
On the contents page the article has a subtitle: ‘Side effects include brain damage, cancer and heart attacks’. Again this is inaccurate in that it refers to all antidepressants. It is only when reading the article (on page 14) that a different subtitle ‘New study results highlight how SSRI antidepressants work by damaging the brain’. SSRIs work by increasing the amount of serotonin in the brain. Serotonin is believed to ‘assist the innate healing power of the body’ in overcoming depression.
Malan does not distinguish between ‘mild’ depression and ‘moderate to severe’ depression in the magazine article which is one of its ‘fatal flaws’. The article implies that people taking antidepressants are likely to be harmed (damaged) more than they would benefit from the medication. At the end of the article a list of alternative substances as part of a completely unproven ‘Natural Antidepressant Protocol’ is recommended. The dangers of a person with moderate to severe depression who may read the magazine article and suddenly stop taking their prescribed medication to change to the ‘protocol’ promoted in the magazine are very serious, particularly as no acceptable evidence exists that the ‘natural protocol’ is any better than prescription antidepressants for moderate to severe depression. The ‘protocol’ may even result in the depression getting worse. We can’t be sure, and what’s even more serious is that the promoters of this ‘protocol’ cannot be sure either.
The most extreme consequence of severe depression is suicide. The magazine article is an example of irresponsible health information as it does not include any warnings about the important process medical doctors refer to as ‘weaning off’ antidepressants, and doing so under medical care. Self-treatment of moderate to severe depression is not recommended.
NB: The normal variation in human emotions of ‘feeling sad’ is not depression and should not be treated with antidepressants.
The evidence behind the ‘facts’ quoted in the article.
The article states: ‘a recent study reported that anti-inflammatory medication reduces SSRIs’ effectiveness by as much as 14%’. This statement is not made by the authors and does not apply to human beings. The information comes from a study done in mice with data from humans added on – not controlled human clinical study data. To quote from the Discussion section of this article:
Because the clinical analyses were conducted as post hoc analyses, it would be informative to evaluate the effects of NSAIDs [Non-Steroidal Anti-Inflammatory Drugs] and other analgesics on SSRI antidepressant response in a prospective, double-blind, randomized clinical study. Specifically, it will be important to standardize medications to better evaluate their role in determining treatment outcome. In the present study, no adjustments were made for multiple comparisons in the analyses.
In other words the authors themselves indicate the need for further research!
Fact: The statement about anti-inflammatory medications is not supported by the evidence.
The magazine article then states:
“FACT 1: THEY [Antidepressants] CAUSE BRAIN DAMAGE”
The evidence (three references) for this statement is based mainly on animal studies (rodents and primates) and some human studies (including post-mortem brain studies). The only human component that has any real bearing on this claim is stated as follows:
These results, together with . . . the increased BDNF [brain-derived neurotrophic factor] levels in patients treated with antidepressants, suggest a central role for this neurotrophin and its receptor in the molecular mechanisms of antidepressive therapy.(emphasis added)
In other words this is still an hypothesis about the mechanisms of action of antidepressive therapy. These 3 references cannot be used to support the claim of ‘brain damage’ stated in the magazine article and further investigation is needed.
Fact: Fact 1 is not supported by the evidence provided.
The next ‘fact’ is:
FACT 2: THEY [Antidepressants] CAUSE CANCER
The evidence (one reference) has the following conclusion in the abstract of the report:
Both the pre-clinical and clinical data are mixed in terms of showing an association between AD [antidepressant] use and breast and ovarian cancer. The possibility that ADs may exhibit a bi-phasic effect, whereby short-term use and/or low dose antidepressants may increase the risk of breast and ovarian cancer, warrants further investigation. Industry affiliations were significantly associated with negative conclusions regarding cancer risk. The findings have implications in light of the 2009 USPSTF guidelines for breast cancer screening and for the informed consent process.(emphases added)
In other words, again, this is not a fact but needs further investigation.
Fact: Fact 2 is not supported by the evidence provided.
The last ‘fact’ is:
FACT 3: THEY [Antidepressants] CAUSE DEATH
This statement seems intended to induce fear in readers, and is frankly irresponsible. Two references are used in making this statement. The first reference has the following conclusion:
In this cohort of women without baseline CHD [coronary heart disease], depressive symptoms were associated with fatal CHD, and a measure of clinical depression including antidepressant use was specifically associated with SCD [sudden cardiac death]. Although antidepressant use might be a marker of worse depression, its specific association with SCD merits further study.(emphasis added)
In other words – this is not yet a fact! The second reference has the following conclusion:
In postmenopausal women, there were no significant differences between SSRI and TCA use in risk of CHD, stroke, or mortality. Antidepressants were not associated with risk of CHD. Tricyclic antidepressants and SSRIs may be associated with increased risk of mortality, and SSRIs with increased risk of hemorrhagic and fatal stroke, although absolute event risks are low. These findings must be weighed against quality of life and established risks of cardiovascular disease and mortality associated with untreated depression.(emphases added)
The authors of this latter reference commented on the research in the first reference quoted above that ‘the possibility of residual confounding by depression cannot be ruled out.’ In other words, the possibility of the depression in some women still being a factor in developing the cardiovascular effects cannot be excluded. The authors also emphasise the crucial point about the risks of untreated depression.
The fact is neither of these studies can be used as evidence that antidepressants are the reason for sudden cardiac deaths. The subtitle on the contents page which includes ‘heart attacks’ is actually contradicted by the authors who stated that antidepressants were not associated with risk of coronary heart disease. (Not all sudden cardiac death is necessarily due to coronary heart disease.)
Fact: Fact 3 is not supported by the evidence provided.
The main facts we should be worrying about are that selective use and misinterpretation of scientific references is unacceptable and irresponsible; and that the promotion of unproven remedies which have not been independently evaluated for their quality, their safety or whether or not they work can be considered immoral and unethical.
Antidepressants are not just ‘happy pills’: in moderate to severe depression they are life-saving when used correctly.
The magazine article then concludes with a potentially thoroughly dangerous, irresponsible and untested statement that: ‘perhaps its time for all those suffering from mood disturbances beyond their control to stop accepting prescriptions for dangerous medicine, and to turn to safer, more natural alternatives’.
This is followed by a heading:
‘Natural Antidepressant Protocol’
The following substances are listed:
5-HTP (100mg three times per day)
SAMe (400mg once or twice daily)
Tyrosine (1,000mg twice daily)
Phosphatidylserine (100mg two to three times per day)
Magnesium glycinate (400mg twice daily).
No information is given about this ‘protocol’ or how to implement it. The ‘protocol’ appears to have been tagged on to the article as an afterthought. There is no evidence that this combination of substances in the recommended dosages has been tested or been proven to be effective. According to the website associated with the publisher and the editorial director of Health Intelligence, when 5-HTP is combined with Vitamin B6, it is said to increase the amount of serotonin in the brain by 60% when compared to taking 5-HTP alone. No evidence for this statement is provided and if correct, it is highly likely to have come from animal studies. [This statement remains on 17 Dec 2011 – RJ]
It would be interesting to find out if anti-inflammatories interfere with the ‘effectiveness’ of the serotonin produced by 5-HTP as is claimed happens with SSRIs. Perhaps the company is planning to do research to disprove this possibility? Of course, as the magazine article points out for ‘Fact’ 2 above, where financial ties with researchers appeared to influence the results, the company would have to ensure that completely independent researchers carry out such studies. (It should also be noted that the magazine contains advertising for the company associated with the publisher [Colin Levin] and the editorial director [Brent Murphy], who must be considered fully accountable for the content of the magazine. The magazine can even be purchased directly from the company’s website.) [This link is still operative on 17 Dec 2011 and stocks are still available – RJ]
The ‘natural protocol’ includes SAMe which is the abbreviation for S-adenosylmethionine. It would seem from the article that all the substances in this protocol should be purchased and taken together. However on the website for 5-HTP under the heading ‘Interactions’ the following statement is made: ‘[t]he use of 5-HTP together with the following products may result in adverse effects, and concomitant use should be avoided’(emphasis added) followed by a list of antidepressant medications. Under a sub-heading ‘Herbs and supplements’ of substances to be avoided, SAMe is listed! So while the magazine article seems to recommend using 5-HTP and SAMe together – the website of the company associated with the magazine recommends against it. [This statement contradicting the presumptive advice in the natural antidepressant protocol in the magazine article remains on the website on 17 Dec 2011 – RJ]
The ‘antidepressant dangers exposed’ in the magazine article are not factual, but misleading and irresponsible information which could have serious consequences for a person suffering from moderate to severe depression.
[Copies of references available on request. It should be noted that the editors and reviewers of the different articles would ‘de facto’ be in agreement with the conclusions quoted.]
This analysis was prepared by Professor Roy Jobson. Professor Jobson is a medical doctor and Associate Professor of Pharmacology in the Faculty of Pharmacy at Rhodes University. He has previously served as a Council member of the Medicines Control Council (MCC), was the inaugural Chairperson of the MCC’s Pharmacovigilance Committee, and a member of its Clinical Trials and Complementary Medicines Committees. He is an Associate of the College of Clinical Pharmacologists of the Colleges of Medicine of South Africa. He is a Council member of the Allied Health Professions Council of South Africa as a community representative. His analysis of this article does not reflect an official viewpoint of any of these institutions.