Stuck on antidepressants

A Sunday Times investigation found that a quarter of women in their fifties and sixties take antidepressants, and 15% of women over 50 have been on them for longer than five years (see article). As the article also says, some people on antidepressants also experience emotional blunting and difficult withdrawal symptoms.

James Davies, who I have mentioned before (see eg. previous post), is quoted as saying, “[T]he evidence base [for antidepressants] suggests they’re no more effective than placebos. But unlike placebos, they have side-effects”. I pointed out to him in a tweet that placebos do have side effects, which are called nocebo effects. 

Antidepressants are inadvertent placebos. They are not usually intentionally prescribed for their placebo effects. Instead doctors tend to believe in antidepressants and that their efficacy has been proven, whereas this is at least open to question (see eg. previous post). Patients have also been encouraged to take them by the myth that the serotonin imbalance theory has also been proven, which is not the case (see eg. another previous post). 

Patients may therefore acquire attachments to their medication more because of what they mean to them than what they do. Many patients often stay on psychotropic medications, maybe several at once, even though their actual benefit is questionable. Any change threatens an equilibrium related to a complex set of meanings that their medications have acquired. No wonder they may have withdrawal symptoms. They have been made dependent on antidepressants and may well be frightened to try to manage without them. It’s easier to stay on antidepressants rather than upset any apparent equilibrium their medications have seemed to create.

Such nocebo effects also apply to emotional blunting. Antidepressants can tend to leave people feeling that there is a sense in which their psychosocial problems, which caused the depression, have not really been solved (see eg. previous post).  However much they may feel that antidepressants may have helped stabilise their mood, they may, therefore, also feel emotionally flat and not back to their real self. 

I am, of course, not saying that antidepressants do not block reuptake of catecholamines, such as serotonin, in the synaptic cleft between neurones. But how much the side effects of withdrawal symptoms and emotional blunting may well be due to nocebo effects remains to be determined.