Antidepressants - Effects on the Body
Effects on the Body
Neurotransmitters, such as serotonin and norepinephrine, are chemical substances that transmit information from one nerve to another. By the middle of the twentieth century, researchers had found that depressed people seemed to have lower concentrations of neurotransmitters coating the nerve endings in their brains. Antidepressants help stop the reuptake of these chemical substances in the brain, creating a kind of bath of neurotransmitters like serotonin for the nerve endings to soak in. Raising the concentration of neurotransmitters in the brains of depressed individuals works to reduce the symptoms of their depression.
The actions of antidepressants on the brain are not fully understood, but scientists are learning more about them every day. Studies show little difference in the effectiveness of the various antidepressants, but some individual patients appear to do better on one drug than another. In the search for the most effective drug for a particular patient, a physician may prescribe various antidepressant drugs or even try some in combination.
General side effects of antidepressants can include stomach upset, agitation, anxiety, dizziness, insomniaDifficulty falling asleep or an inability to sleep., and a dry mouth (which usually increases a user's thirst). Since SSRIs were discovered, the older MAOIs are prescribed less often for the treatment of depression. Side effects of MAOIs can be severe and include a sudden elevation of blood pressure. Tricyclics may cause dryness of the mouth and eyes. A dry mouth can lead to the formation of dental cavities, and dry eyes can result in blurred vision. Use of tricyclics may also result in reduced urine output, constipation, and weight gain. Older patients are cautioned against tricyclic use because the drugs can disrupt the normal rhythm of the heartbeat. SNRIs should not be used by people with heart problems.
The Question of Addiction
Until the early 2000s, antidepressants were not believed to cause addiction in users. A traditional feature of addictive substances is the "highDrug-induced feelings ranging from excitement and joy to extreme grogginess." or "buzz" they cause in users. "Antidepressants will not make you high," stated Andrew Weil and Winifred Rosen in From Chocolate to Morphine.
Ables and Baughman mentioned in 2003 that some degree of withdrawelThe process of gradually cutting back on the amount of a drug being taken until it is discontinued entirely; also the accompanying physiological effects of terminating use of an addictive drug. occurs with all antidepressants. This contradicts the belief that antidepressants are not addictive. The withdrawal symptoms, which are usually mild, begin about a week after the antidepressant medication is stopped. They include dizziness, nausea, headache, and flu-like symptoms, but agitation and even panic attacks may occur. Withdrawal symptoms usually end within three weeks for SSRIs. However, "withdrawal from paroxetine [SSRI Paxil]," explained Ables and Baughman, "was shown to cause more severe symptoms that may occur more quickly, even after the second missed dose."
Researchers in the United Kingdom noted similar findings. According to the Royal College of Psychiatrists, "up to a third of people who stop SSRIs and SNRIs have withdrawal symptoms. These include: stomach upsets, flu-like symptoms, anxiety, dizziness, vivid dreams at night, and sensations in the body that feel like electric shocks." These symptoms are more often associated with paroxetine (sold under the brand name Paxil in the United States and Seroxat in the United Kingdom) and venlafaxine (sold under the brand name Effexor in the United States and Efexor in the United Kingdom) than any other SSRIs and SNRIs. Research continues on the still-baffling question of addiction and withdrawal issues among antidepressant users.
Zoloft on Trial
Christopher Pittman threatened suicide and was hospitalized after his parents' final breakup in 2001. Pittman's mother had first left home when Pittman was just two years old. His parents' repeated attempts to get back together failed. After hearing that their relationship was really over, Pittman, then twelve years old, became desperate and ran away from his Florida home. After he was found, he spent a couple of weeks in a psychiatric hospital and was diagnosed with depression and defiant behavior. Doctors put him on Paxil, an SSRI, briefly. Days later he was prescribed Zoloft, a different SSRI. Zoloft was the most widely used antidepressant for both adults and teens in the United States at that time.
Pittman went to live with his father's parents in South Carolina later in 2001. He was there for only a matter of weeks, and life seemed to be going well for him. Then, one day that November, Pittman and his grandfather had a serious argument. They fought about some trouble that Pittman had caused on his school bus. Pittman was told that he might have to return to his father's home in Florida because of the incident. That night, the twelve-year-old boy shot his grandparents to death in their bed, set their home on fire, and drove away in their car with his dog. Pittman's lawyers argued that "the killings occurred for a reason beyond the boy's control—a reaction to the antidepressant Zoloft," noted Barry Meier in the New York Times. "Such defenses," Meier continued, have been used in the past but "have rarely succeeded."
Pittman's case did not go to trial until three years after the tragic incident. While in jail awaiting his trial, Pittman repeatedly claimed that he loved his grandparents. His own father even came to his defense, stating that the boy had always been especially
close to the couple. Pittman told police that on the night of the murders, he had heard voices urging him to kill his grandparents. Those voices in his head, claimed defense lawyers, were caused by the Zoloft, and possibly even the Paxil, he had been taking for depression.
The so-called "Zoloft defense" did not work for Christopher Pittman. On February 15, 2005, he was sentenced to thirty years in prison for the murders of his grandparents.
The Pittman case fueled the growing debate about the safety of antidepressants in children and teens. Between 2001 and 2004, the FDA stepped up its investigations into the effects of antidepressants on patients under the age of eighteen. In June of 2003, the FDA recommended against prescribing Paxil (the first medication prescribed by Pittman's doctors) for depression in children and adolescents.
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