There’s an uncanny similarity between antibiotic and antidepressant prescribing in the US. If you’re currently taking one or both, took them in the past, or are considering taking one or both now, know that the odds are very strong you don’t need either of them.
Numerous clinical studies confirm that both antibiotics and antidepressants are vastly and inappropriately overprescribed, with some estimating that 70% to 80% of prescriptions for these drugs are completely unnecessary and potentially dangerous.
Ponder these probabilities…
- Most likely you would have recovered from your depressed mood or infection (often caused by a virus, which antibiotics can’t help) on your own.
- Any benefit you felt from either drug was likely a placebo effect.
- Had you in either case been handed a dummy pill and told it was an antibiotic or antidepressant, again, statistically speaking, you probably would have recovered at the same rate you did when using an actual medication.
- Your recovery with the placebo would have been even faster had it been formulated to cause some harmless side effects (called an active placebo). That’s because the side effects would have convinced you the drug was doing something.
Quick disclaimer. Both antibiotics and antidepressants, when carefully and thoughtfully prescribed, are highly valuable treatments. I’ve certainly prescribed both throughout my professional career. But with each passing year, I found myself prescribing them less and less often.
Why antibiotics are overprescribed
Both parties involved, patient and physician, have specific agendas. The patient wants a treatment for his infection ASAP. After all, he made the appointment, drove to wherever, spent too much time in the waiting room, was examined, and then finally told he has an infection, which he knew all along. He expects some help for all this effort.
The physician wants to help, but she’s pretty much been trained to view antibiotics as a powerful tool. This kind of training/thinking has led to the estimate that 80% of inpatient and outpatient antibiotics are prescribed inappropriately.
Antibiotics have a specific, fixed number of days they’re to be taken. Generally a week and you’re finished and, if you did have a bacterial infection, it’s been wiped out (along with your microbiome, but that’s another story). No refills.
Antidepressants always come with refills
Here’s a second scenario: you’re having a miserable time in your life. Job, school, relationship, money—whatever the cause you’re feeling overwhelmed. Or you feel physically exhausted and no one can find anything wrong with you. Everybody you know seems to be taking an antidepressant.
Finally, your primary care doctor says, “You must be depressed. Try this.” You leave the office with some samples and a prescription and, a month or so later, you notice you’re in fact feeling better. “Maybe I was depressed,” you think. But rather than set up visits with a psychotherapist (which your insurance may not cover and you don’t have time for anyway), you keep renewing your antidepressant.
Soon, months turn to years. “Wow!” you think, “I’ve been on this a long time.” But while you may not even clearly remember why you started taking the drug in the first place, you’re a bit apprehensive about stopping it because you don’t want to go back there (wherever “there” was). A big problem here is that you may well be among the 70% to 80% of antidepressant users who never met the criteria for clinical depression in the first place. In reality, you’re taking a brain-altering chemical you didn’t ever need.
It may interest you to know that psychiatrists who spend a lot of time in talk therapy with patients actually prescribe far fewer antidepressants than primary care physicians, who need to work fast and make snap diagnoses and thus offer a handful of antidepressant samples and a prescription before moving on to the next patient.
Psychologists, prohibited by law from prescribing medicine, are trained to treat depression without meds. They rarely refer patients to MDs in order to prescribe. In other words, the better the diagnostician, the less likely an antidepressant will be prescribed.
Brain-altering drugs
Virtually all selective serotonin reuptake inhibitor (SSRI) antidepressants work by increasing serotonin, a brain chemical (neurotransmitter) that acts as a stress buffer. If you’re feeling miserable–depressed or anxious–because something awful has been happening in your life, after a few weeks on an antidepressant allegedly up goes your stress-buffering system and you feel less depressed. I say allegedly because studies have shown that placebos, especially active placebos replete with side effects, can treat depression just as well, though obviously they do so without affecting serotonin levels.
With genuine SSRIs, because your stress buffer has been boosted, the most common complaint is feeling numb, the buffer having been increased too much. This includes numbness to sex, which becomes a fond but not particularly sought-after memory. Many SSRI users replace sex with food and thus gain weight.
Other antidepressants increase, along with serotonin, brain levels of a second neurotransmitter, norepinephrine, which may help with mental clarity and physical energy. Common side effects of the enhanced norepinephrine are nausea, dry mouth, excessive sweating, and increased heart rate and blood pressure.
Talk therapy
What antidepressant-prescribing physicians forget, and what psychologists grasp intimately, is the value of the proverb “time heals all wounds” when it comes to treating depression and anxiety.
Rather than focusing on raising serotonin, psychologists offer new perspectives on managing the stress that triggered the symptoms in the first place.
“Maybe,” a psychologist might sensibly suggest, “It’s better for you to leave your toxic relationship or explore the source of your anxiety rather than take a handful of meds every morning in order to endure it.”
How to quit/avoid antidepressants or be sure you’re using them appropriately
- Think you’re depressed? If you feel depressed or chronically anxious, consider a psychologist first. Ask your primary care doctor for a referral. A psychologist will be more skilled in diagnosing depression and/or anxiety than your primary, more willing to spend time with you, and less prone to write you a prescription. At WholeHealth Chicago, psychologists Meghan Roekle and Janet Chandler rarely ask one of our MDs to write a patient prescription. Our integratively trained psychiatrist, Marisa Serrato, MD, likewise only rarely turns to medications for her patients.
- Self-education is important Click here for the official diagnostic criteria for a major depressive disorder (MDD), the diagnosis for which the FDA approves an antidepressant. Five symptoms in a two-week period are needed for the diagnosis.
- Mild relief If a physician or psychologist suggests you take a mild antidepressant, consider St. John’s wort (450 mg twice daily). The effect is roughly the same as taking half a 50-mg Zoloft or half a 20-mg Prozac, but with virtually no side effects. The effect of St. John’s wort can be enhanced with a product called L-methylfolate, which is derived from the B vitamin folic acid. It’s a vitamin that requires a prescription, but has no reported side effects. L-methylfolate works by improving the efficiency of your own serotonin manufacturing system.
- Want to quit? If you’re currently taking antidepressants and wish to stop using them, spend a little time reflecting on why you started on them initially. Are you a chronically depressed or anxious person? If so, maybe you’re in the 20% to 30% of people who do need to take them. Or, when you were prescribed the antidepressant, were you simply going through a particularly rough patch and things have turned around nicely? Also ask yourself if any improvement from the antidepressant has been worth the drug’s side effects. Is it possible you were prescribed antidepressant too hastily?
- Share your intentions If you’re uncertain about making this decision, set up an appointment with a psychologist to discuss your goals. She might give you the tools and confidence you need to tackle your life on your own, without the pharmaceutical industry.
- Taper slowly If you’ve decided you want to go off your antidepressant, that’s admirable and almost–but not quite–OK. Patients stop their antidepressants on their own every day, but I really wish they wouldn’t. Your brain has grown accustomed to your new serotonin and norepinephrine levels. If you suddenly yank the carpet out from under your neurotransmitter support, you might feel pretty crappy (depressed, anxious, not sleeping, headache-y). These are all euphemistically called “drug discontinuation syndrome” as opposed to the more blunt “drug withdrawal,” which is what’s actually happening. The best choice is a slow taper: ask your physician for pills of varying strengths and reduce by about 50% a week until you’re down to none.
Antidepressants and antibiotics. Odds are you don’t need them, or didn’t need them in the first place. And for most of you on antidepressants, good news, you can get off them.
Be well,
David Edelberg, MD