March 4, 2008<
Lately, it seems as though every few days there has been
something new in the news about antidepressant medication.
One report got the attention of the nation just a few weeks
ago as reports came out about the man who shot several
people before taking his own life at Northern Illinois
"Kazmierczak had stopped taking Prozac three weeks before
his shooting spree on February 14 and had been taking two
other medications, [Steven Kazmierczak's girlfriend,
Jessica Baty] said. Experts differ on whether Prozac and
other similar antidepressants might be linked to violence.
'There's very little likelihood that withdrawal from Prozac
could, by itself, cause someone to become violent,' said
Dr. Nada Stotland, professor of psychiatry at Rush Medical
College and president-elect of the American Psychiatric
Association. If people with other psychiatric illnesses had
a propensity to violence, then discontinuing drug use
'could make them irritable, and that could be one trigger,'
said Stotland, who has accepted speaking fees from the drug
industry, but not in recent years. But, she said,
'discontinuation syndrome' does not cause someone to become
violent. ... 'The explanations are seldom simple or
straightforward, and, especially when attempts to
understand would intrude on the confidentiality of medical
records, we seldom know enough about perpetrators' lives
and minds to determine just what caused their behaviors.'
She added, 'We have much, much more to fear from untreated
psychiatric illnesses than from the effects of psychiatric
The news that Kazmierczak stopped taking an antidepressant
just weeks before his shooting spree seems to have brought
up more questions than it has answered. While debate over
the safety of these medications has raged for years, few
question that abruptly stopping the medication is not a
good idea. With this recent report, different people are
trying to interpret this situation and see what the
behavior of this one person can prove.
Does this incident prove that antidepressants can be bad,
or does it prove how much this man needed these
antidepressants? Was the fact that he took Prozac the
issue, or was it the fact that he stopped taking it? There
are those who have concerns about the medications, and then
there are those who have concerns about the untreated
When confusion and questions reign, sometimes it can help
to go back to basics. What are antidepressants, and why
would someone take them in the first place?
"Antidepressants are medicines that treat depression. Your
doctor can prescribe them for you. They can improve your
mood, sleep, appetite and concentration. It may take
several weeks for them to help. There are several types of
antidepressants. You and your doctor may have to try
several before finding what works best for you. Medicines
sometimes cause unwanted side effects. For example, when
you first start your antidepressant you may feel tired,
have trouble sleeping or feel sick to your stomach. The
side effects usually go away after a short time. Tell your
doctor if you have any side effects. You should also let
your doctor know if you take any other medicines, vitamins
or herbal supplements. It is important to keep taking your
medicines, even if you feel better. Do not stop taking your
medicines without talking to your doctor. You often need to
stop antidepressants gradually."
Antidepressants are medicines that are used to treat
illnesses. As with any medication, there can be positive
effects that help people live more productive, enjoyable
lives, and there can be negative effects that need to be
weighed against these positives to determine whether or not
the patient will have a better quality of life with or
without the medication.
Each patient has different needs, reacts differently to
medications, and may have different priorities when looking
at how the positive and negative effects of each medication
will influence his/her daily life. Doctors need to take all
of these factors into consideration when trying to decide
which medication will be the best fit for each patient. No
matter how much research doctors and patients do, it can
still be difficult to find the right match.
"Teenagers whose initial drug treatment fails to combat
depression, which happens in four out of 10 cases, can be
helped by switching medicine and adding psychotherapy, a
U.S. study published on Tuesday said. 'The findings should
be encouraging for families with a teen who has been
struggling with depression for some time,' said Dr. David
Brent of the University of Pittsburgh who headed the
research. 'Even if a first attempt at treatment is
unsuccessful, persistence will pay off. Being open to
trying new evidence-based medications or treatment
combinations is likely to result in improvement,' he
Whenever patients try new medications, it is important for
them to keep in regular contact with their doctor to
discuss how they are adjusting. Some medications require a
gradual increase in dosages until the desired level is
reached. Others can cause severe side effects in a few
patients, and no doctor can know who those "few" will be
ahead of time.
While the many choices will mean that there is a higher
likelihood that there is a medication out there that will
prove to be a good fit for any given patient, they also
mean that doctors and patients have a lot of choices as
they attempt to find the right match.
"Major types of antidepressants include:
* Tricyclic antidepressants (TCAs) are some of the first
antidepressants used to treat depression. They primarily
affect the levels of two chemical messengers
(neurotransmitters), norepinephrine and serotonin, in the
* Monoamine oxidase inhibitors (MAOIs) are another early
form of antidepressant. These drugs are most effective in
people with depression who do not respond to other
* Selective serotonin reuptake inhibitors (SSRIs) are a
newer form of antidepressant. These drugs work by altering
the amount of a chemical in the brain called serotonin.
* Serotonin and norepinephrine reuptake inhibitors (SNRIs)
are another newer form of antidepressant medicine. They
treat depression by increasing availability of the brain
chemicals serotonin and norepinephrine."
Whatever the type, the purpose of an antidepressant is to:
"... improve symptoms of depression by increasing the
availability of certain brain chemicals called
neurotransmitters. It is believed that these brain
chemicals can help improve emotions."
In many cases, patients who suffer from depression can find
relief when they find the antidepressant match that is
right for them. The key is finding the right match, and it
takes doctors and patients working together, asking
questions, and engaging in honest conversations in order
for that match to be found.
That said, there are some who doubt their efficacy for all
"Researchers from the U.K., U.S. and Canada analyzed
results for fluoxetine (better known by the brand name
Prozac), venlafaxine (Effexor), nefazodone (Serzone) and
paroxetine (Paxil or Seroxat) -- all members of a class of
drugs known as selective serotonin reuptake inhibitors
(SSRIs). The researchers' paper, published this week in the
journal PLoS Medicine, claims that only patients who are
diagnosed 'at the upper end of the very severely depressed
category' get any meaningful benefit from the widely
prescribed drugs. For the others, the paper says,
antidepressants are barely more effective than a placebo
(although patients suffering from depression, like those
suffering from chronic pain, generally do see a substantial
Questions of the Week:
When do you think a patient should ask his/her doctor about
antidepressants? What do patients need to know about the
potential positive and negative effects of antidepressants
before deciding that they want to begin taking them? What
should doctors know about the individual needs of a patient
before deciding on a specific antidepressant? When starting
or stopping any medication, what do patients need to talk
about with their doctors? How can doctors help patients
know what to expect, and what warning signs to watch for,
when a new medication is prescribed?
Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.
I look forward to reading what you have to say.
Health Community Coordinator
Access Excellence @ the National Health Museum