Primum non nocere: antidepressants

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open access:

Primum non nocere: an evolutionary analysis of whether antidepressants

do more harm than good. <http://www.ncbi.nlm.nih.gov/pubmed/22536191>

s PW, Thomson JA Jr, Amstadter A, Neale MC.

Front Psychol. 2012;3:117. Epub 2012 Apr 24.

http://dx.doi.org/10.3389/fpsyg.2012.00117

Antidepressant medications are the first-line treatment for people

meeting current diagnostic criteria for major depressive disorder. Most

antidepressants are designed to perturb the mechanisms that regulate the

neurotransmitter serotonin - an evolutionarily ancient biochemical found

in plants, animals, and fungi. Many adaptive processes evolved to be

regulated by serotonin, including emotion, development, neuronal growth

and death, platelet activation and the clotting process, attention,

electrolyte balance, and reproduction. It is a principle of evolutionary

medicine that the disruption of evolved adaptations will degrade

biological functioning. Because serotonin regulates many adaptive

processes, antidepressants could have many adverse health effects. For

instance, while antidepressants are modestly effective in reducing

depressive symptoms, they increase the brain's susceptibility to future

episodes after they have been discontinued. Contrary to a widely held

belief in psychiatry, studies that purport to show that antidepressants

promote neurogenesis are flawed because they all use a method that

cannot, by itself, distinguish between neurogenesis and neuronal death.

In fact, antidepressants cause neuronal damage and mature neurons to

revert to an immature state, both of which may explain why

antidepressants also cause neurons to undergo apoptosis (programmed

death). Antidepressants can also cause developmental problems, they have

adverse effects on sexual and romantic life, and they increase the risk

of hyponatremia (low sodium in the blood plasma), bleeding, stroke, and

death in the elderly. Our review supports the conclusion that

antidepressants generally do more harm than good by disrupting a number

of adaptive processes regulated by serotonin. However, there may be

specific conditions for which their use is warranted (e.g., cancer,

recovery from stroke). We conclude that altered informed consent

practices and greater caution in the prescription of antidepressants are

warranted.