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Should Antidepressants Be Given Prophylactically to Nondepressed Individuals?

Mental health appears to be dwindling across the globe, with depression now being the leading cause of ill health and disability worldwide.1,2 Over the past decade alone (2005-2015), rates of depression increased by 18 percent.3 In the U.S., more than 16 million people struggle with the condition, including 6 million seniors,4 and 11 percent of Americans over the age of 12 are on antidepressant drugs. Among women in their 40s and 50s, 1 in 4 is on antidepressants.5

Clearly, something is very wrong. Part of the problem, I believe, is the fact that the go-to solution simply doesn’t work, and the psychiatric field is slow to branch out into more effective yet less financially rewarding strategies. Antidepressants tend to be the first-line treatment, even though studies have proven they work no better than placebo.6,7,8,9

Now, researchers are investigating whether antidepressants might be prophylactically useful. The idea that taking a potent brain altering drug that has the clinical effectiveness of a placebo to prevent depression is suspect in the extreme. There are many other strategies with far better track records that can both prevent and help treat depression.

Could Antidepressants Be Used Preventively? 

According to The Washington Post:10

“Some studies have estimated that up to half of patients with head and neck cancers may experience depression. A group of researchers … examined what would happen if non-depressed patients were given antidepressants before receiving treatment for head and neck cancer.

Published in 2013, the results of the randomized, placebo-controlled trial11 were startling: Patients taking an antidepressant were 60 percent less likely to experience depression compared with peers who were given a placebo. In medicine, this approach is often referred to as prophylaxis, or a treatment used to prevent disease.”

Other studies assessing the benefits of prophylactic antidepressants include:

A 2014 analysis, which concluded antidepressants reduced incidence of major depression among patients treated for hepatitis C by 40 percent12

A 2004 study concluded post-stroke depression, which affects up to 40 percent of stroke victims, could be reduced through prophylactic treatment with the antidepressant mirtazapine. Forty percent of nontreated patients developed depression, compared to less than 6 percent of those receiving the drug13

A 2008 study also found nondepressed stroke patients given escitalopram (brand name Lexapro) were significantly less likely to develop depression compared to the placebo group over 12 months of treatment.14 However, it was later revealed the lead author had undisclosed financial ties to the manufacturer of the drug, which cast doubt on the results15

Other small studies have also concluded that pretreatment with antidepressants may reduce the likelihood of depression in patients receiving treatment for melanoma16,17

According to the featured article, “These findings provide compelling reasons for physicians and patients to consider using these medicines to pre-empt ­mental-health issues.”18

I couldn’t disagree more vigorously with this distorted view of reality. Just because an antidepressant might help prevent drug- or chemo-induced depression does not mean that nondepressed individuals will benefit from taking antidepressants prophylactically. In fact, it may well have the opposite effect. There’s really no telling what kind of devastating societal health effects such a trend might create.

Antidepressants During Pregnancy Increase Child’s Risk of Psychiatric Disorders

Antidepressants are particularly hazardous for children, teens (who are more prone to self-harm on certain antidepressants) and women of childbearing age. Recent research19 shows use of antidepressants during pregnancy raises the child’s risk of developing a psychiatric disorder.20,21 The study evaluated data collected from more than 905,000 Danish children born between 1998 and 2012. The follow-up period lasted for nearly 17 years. The results showed that:

Among children whose mothers did not use antidepressants during pregnancy, the 15-year risk of psychiatric problems was 8 percent

Those whose mothers took an antidepressant prior to but not during pregnancy had a risk of 11.5 percent

Among those whose mothers had started taking an antidepressant prior to pregnancy and continued taking the drug during pregnancy, the risk for psychiatric problems was 13.6 percent

Children whose mothers started taking an antidepressant during pregnancy had the highest risk of a psychiatric disorder — 14.5 percent

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