Acupuncture questions about drugs used in depression, are the drugs helpful?

It is acknowledged that in many instances the diagnosis of depression may not, in fact, be a valid one. This is alarming considering the adverse effects of antidepressant drugs can be harmful.

Metzl (2003) and Shorter (1997) have reported that there is a tendency to both over-diagnose depression as well as to over-prescribe antidepressant drugs.

The vested interest by multinational pharmaceutical companies in depression and their wide influence over health professionals is also a concern.

The medications that are normally prescribed by western medical doctors come from a group of drugs called Selective Serotonin Reuptake Inhibitors (SSRI). Those commonly prescribed in Australia are Prozac, Paxil, Zoloft, Celexa, Lexapro, Luvox, Eflexor and Sarafem; the major differences between them being related to the individual side effect profile.

We know that these drugs can be very helpful for some people who seek acupuncture to ease the manifestations of depression; but on the other hand, the adverse side effects that can be associated while taking these drugs plus the problems that can be caused when stopping the medication is very challenging to the clinician.

It is worthwhile to know that according to the manufacturer’s product information, these drugs have around 240 different side effects. An American review of spontaneous adverse drug reactions reporting found that “during a ten year period Prozac was associated with more hospitalisations, deaths or other serious adverse effects reported to the FDA than any other drug in America.”

Spigset (1999) found that the following were the most common classes of adverse events associated with these SSRI drugs:

1. Neurological (22%)

2. Psychiatric (19.5%)

3. Gastrointestinal (18%)

4. Dermatological (11.4%)

Furthermore, a study by Vanderkooy et al (2002) found that 10% to 32% of patients taking Paxil, Zoloft and Eflexor experienced nervousness, agitation, tremor, dizziness, myoclonus, headaches or problems with sleep.

Some side effects such as nausea, diarrhoea, headache and agitation are transient and remit after the first 2 to 3 weeks. However, in a number of patients these adverse effects are severe enough to discontinue treatment. This is a problem because usually 2 to 6 weeks at a therapeutic dose level are needed to observe a clinical response.

There are more significant long term side effects, such as:

• Increased risk of suicide, which is almost four times higher than for other forms of treatment. (Healey 2003)
• Increased risk of violent behavior
• Insomnia (15-20%)
• Weight gain (18-50%)
• Sexual dysfunction, generally decreased libido and delayed or absent orgasm

Withdrawal symptoms can mimic the very reason for which the drug was initially prescribed. Abrupt cessation of the drug gives the appearance of a relapse, hence additional drugs or higher dosages of the original drug may be prescribed.

So in acupuncture we need to carefully assess the patient when diagnosing depression. We must also refer patients to their western medical doctor if they express a desire to discontinue their medications.

Back to acupuncture and depression

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Dr Pier Tsui-Po Acupuncture and Chinese Herbal Medicine Clinic
Berwick Specialist Suites,
Level 1, Suite 8, 50 Kangan Drive, Berwick 3806,
Melbourne, Victoria, Australia. Telephone: 9796 2388