The dark side of antidepressants

July 15, 2008 in Depression | 7 comments

depressed personThis week’s article in my continuing series on depression and antidepressants will examine the physiological, psychological and social consequences of antidepressant use.

Although these drugs are generally considered to be safe by the media and amongst medical professionals and patients, a close look at the evidence suggests otherwise. Antidepressants have serious and potentially fatal adverse effects, cause potentially permanent brain damage, increase the risk of suicide and violent behavior in both children and adults, and increase the frequency and chronicity of depression. Chronic use of antidepressants also promotes dependency on drugs rather than empowering people to make positive life changes, and places a tremendous burden on healthcare systems in the U.S. and abroad – but I will discuss those issues in next week’s article.

Physiological side effects

The adverse effects of antidepressants include movement disorders, agitation, sexual dysfunction, improper bone development, improper brain development, gastrointestinal bleeding, and a variety of other lesser known problems. These are not rare events, but the most significant harm comes only after months or years of use, which leads to the false impression that antidepressants seem quite safe.

More than half of those beginning an antidepressant have one of the more common side effects (Brambilla et al. 2005).

While some side effects may not carry serious health risks, others do. Gastrointestinal bleeding can become a life-threatening condition, and improper bone development in children is a serious problem that can lead to increased skeletal problems and frequent bone fractures as they age. It has been shown that serotonin exposure in young mice impairs their brain’s cerebral development (Esaki et al. 2005), and many researchers believe that the use of SSRI medications in pregnant mothers and young children may predispose children to emotional disorders later in life (Ansorge et al. 2004).

Another problem with the side effects caused by antidepressants that is often not discussed is the likelihood that additional medications will be prescribed to control them. It is well-known that Prozac produces anxiety and agitation, so physicians often prescribe a sedative (typically a benzodiazapene) along with it. Since recent studies have shown that antidepressants cause gastrointestinal bleeding, doctors are starting to prescribe acid-inhibiting drugs such as Nexium to prevent this side effect. These drugs also inevitably cause side effects, which may lead to the prescription of even more drugs. (This is not uncommon, as I pointed out in last week’s article.)

Psychological side effects

Perhaps the best known psychological side effect of SSRIs is “amotivational syndrome”, a condition with symptoms that are clinically similar to those that develop when the frontal lobes of the brain are damaged. The syndrome is characterized by apathy, disinhibited behavior, demotivation and a personality change similar to the effects of lobotomy (Marangell et al. 2001, p.1059). All psychoactive drugs, including antidepressants, are known to blunt our emotional responses to some extent.

Clinical studies of SSRIs report that agitation is a common side effect. When Yale University’s Department of Psychiatry analyzed the admissions to their hospital’s psychiatric unit, they found that 8.1% of the patients were “found to have been admitted owing to antidepressant mania or psychosis” (Preda et al. 2001). Agitation is such a common side effect with SSRIs that the drug companies have consistently sought to hide it during clinical trials by prescribing a tranquilizer or sedative along with the antidepressant. Studies by Eli Lilly employees found that between 21% and 28% of patients taking Prozac experienced insomnia, agitation, anxiety, nervousness and restlessness, with the highest rates among people taking the highest doses (Beasley et al. 2001).

From their inception, antidepressants have been recognized as having a worrisome capacity to incite changes between episodes of depression (characterized by dysphoria, insomnia, low energy, poor concentration, reduced appetite and diminished libido) and episodes of mania (characterized by euphoria, increased activity, rapid speech, racing thoughts, diminished need for sleep, hypersexuality and diminished impulse control).

Several reports suggest that SSRIs are associated with movement disorders such as akathisia, Parkinson’s disease, dystonia (acute rigidity), dyskinesia (abnormal involuntary choreic movements) and tardive dyskiniesia (Gerber & Lynd 1998).

These movement disorders are serious enough on their own. However, what is even more alarming is the potential for akathisia to induce aggression and suicide. Akathisia, a condition of inner restlessness or severe agitation, is the most commonly occurring movement disorder associated with psychoactive drug use. Akathisia-related violence receives specific attention in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Akathisia has been shown to increase violent behavior and suicide, and antidepressants are known to cause akathisia.


After years of foot-dragging and thousands of excess suicides, the FDA finally admitted that “two to three children out of every hundred” could be expected to develop suicidal thoughts or actions as a result of antidepressant therapy (Harris 2004). The risk of suicide events for children receiving SSRIs has been three times higher than placebo. (Healy 2005). Amazingly, no bans or restrictions have been placed on their use in children in the U.S.

While the increased risk of suicide in children has become better known, most people are unaware that a similar risk exists for adults. When adult antidepressant trials were re-analyzed to compensate for erroneous methodologies, SSRIs have consistently revealed a risk of suicide (completed or attempted) that is two to four times higher than placebo (Healy 2005).

Turning short-term suffering into long-term misery

A growing body of research supports the hypothesis that antidepressants worsen the chronicity, if not severity, of depressive features in many subjects. Antidepressant therapy is often associated with the poorest outcomes. In a large, retrospective study in the Netherlands of more than 12,000 patients, antidepressant exposure was associated with the worst long term results. 72-79% of the patients who relapsed received antidepressants during their initial episode of depression. In contrast, only one of the patients who did not relapse received no antidepressants during or following the initial episode. (Weel-Baumgarten 2000)

Longitudinal (long-term) follow-up stuides show very poor outcomes for people treated for depression in both hospital and outpatient settings, and the overall prevalence of depression is rising despite increased use of antidepressants (Moncrieff & Kirsch 2006).

Epidemiological observations have long held that most episodes of depression end after three to six months. However, almost half of all Americans treated with antidepressants have remained on medication for more than a year (Antonuccio et al. 2004).

Long-term effects of antidepressants

Antidepressants have been shown to produce long-term, and in some cases, irreversible chemical and structural changes to the body and brain.

The administration of Prozac and Paxil raises cortisol levels in human subjects (Jackson 2005, p.90). Given the fact that elevated cortisol levels are associated with depression, weight gain, immune dysfunction, and memory problems, the possibility that antidepressants may contribute to prolonged elevations in cortisol is alarming to say the least.

In a study designed to investigate the anatomic effects of serotonergenic compounds, researchers at Thomas Jefferson University found that high-dose, short-term exposure to SSRIs in rats was sufficient to produce swelling and kinking in the serotonin nerve fibers (Kalia 2000). Research performed by a different team of investigators demonstrated a reduction in dendritic length and dendritic spine density, and in contrast to the previous study, these changes did not reverse even after a prolonged recovery period. The results were interpreted to suggest that chronic exposure to SSRIs may arrest the normal development of neurons.

I want to emphasize that what I’ve covered here is only the beginning of the story when it comes to the adverse effects of antidepressants. There are volumes of published research and many books which present this information with much more detail. I recommend Peter Breggin’s landmark “Brain Disabling Treatments in Psychiatry” and Grace Jackson’s “Rethinking Psychiatric Drugs” as resources if you are interested in pursuing this further.


Bob Taylor September 7, 2008 at 9:20 pm

Read the book, “The Dark Side of Mania” by Amy and William Dunn. It’s deftly constructed at 67 pages. It’s about a manic depressive and his dark moments iin mania and what his wife felt living with him. Great read.

Chris September 7, 2008 at 9:37 pm

Thanks, Bob. I’ll check it out – sounds like a great read.


barbara July 15, 2009 at 11:10 am

I’m having psicological and psysiological symptoms some of the ones you write of Effexor withdrawal, i’m now with 18 g I started taking last november with 2 capsules, but i had two other epiodes of depression with cold turkey in last 2 years.
I don’t like how antidepressants change my power and self confidence.
I was doing acupuncture for the last two monyhs but i had to quit because i felt going crazy.
A Ph. Dr. told me about a supplement with Griffonia simplicifolia extract, quelate magnesium, malic acid and apple extract.
I wrote to the laboratories that prepare them and told me that i can take it when i stop completely the antidepressants.

I don’t feel completely fine, i’m afraid to quit Effexor because of another depresive episode, and as you say each time my depression goes chronical and feel less power in myself.

It’s good time to leave Effexor and switch for this supplement it seems can help me enhance my self power and confidence? and maybe continue with Acupuncture.
I also made a SCIO and ORION test who made me feel a little better with my withdrawal. But i don’t live no more, i’m afraid to get a job, i’m semiparalyzed i lost my feelings and goals,i don’t now what to do. I also try positive thougts and meditation. But i want to be myself again! my baddest feelings are in the morning.

Thank you for your comment, i am pretty deseperate
I hope you can answer me soon

Dale January 22, 2011 at 5:48 am

After years of migraines (from The Pill), then quitting smoking, severe Candidiasis, hypoglycemia, severe depression, type 2 diabetes, at least a decade of antidepressants including Effexor, I awoke in 2000 with severe incapacitating chills. After several years (normal TSH) I was finally able to get enough thyroid desiccated hormone to bring my Free T3/T4 to the top of the range and start on bioidentical hormone replacement. I still have low temperature (average 95.5 am) and chills and severe depression. I quit Effexor about 3 years ago when it seemed more negative than positive. The low thyroid I thought was from many things BUT if it’s from antidepressants is it permanent? Can anything be done to repair the damage? Thanks.

Dale January 25, 2011 at 4:00 pm

And what about the GI bleeding? I had severe gutaches with Candida, thought it was cured with a year of nystatin, but my digestion has been worse and worse ever since and I am only able to eat few foods and digest few supplements. How do you know if you have GI bleeding?
I didn’t realize at the time (08) when I quit Effexor that the panic walking I had which resulted in Plantar Fasciitis was from withdrawal. My depression did not change except perhaps to get worse. I think I need a lot of a variety of hormones to try to get better.

Anonymous April 15, 2011 at 7:05 pm

Thank you. This is quite a helpful post. But lacks credability. It is very easy to generalize when talking about psychiatric drugs and their side effects. But the fact that so many millions of people find them useful and improve their quality of life mean that you need to qualify broad statements with more quality evidence and be specific and inclusive. For example, the experiments on mice were using doses of antidepressants 10 times that used on humans. In fact, it is now known that antidepressant drugs promote neurogenisis in the hippocampus and this has been suggested as the reason why antidepressants commonly take 4-6 weeks to work fully even though they raise synaptic serotinin levels within hours or days. Perhaps a more balanced view including all data and accurate statistics would be more useful for everybody since antidepressants are not going to go away in the near future and are very useful. Have you ever suffered from depression? It doesn`t sound like it. Show me the good quality evidence base that accupunture works for depression… There isn`t any..

Chris July 15, 2009 at 5:47 pm


I’m sorry to hear you’ve had such a hard time. As you are well aware, it can be very difficult to withdraw from these medications and the withdrawal symptoms often mimic the original symptoms of depression. My suggestion is to find a medical professional to supervise you through this process if possible. Pick up a copy of Peter Breggin’s book “Your Drug May Be Your Problem: How and Why to Stop Taking Your Psychiatric Drug“, and see if you can find a doctor or psychiatrist that will follow those principles. Good luck, Barbara.


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