Many Doctors Don't Take Treating the Side Effects of Antidepressants Seriously Enough

Like most psychiatrists, I was excited in the late 1980s when drug manufacturers began introducing a new type of antidepressant called selective serotonin reuptake inhibitors (SSRI). These drugs, which include Prozac, and Paxil, offered tremendous relief from the devastating effects of depression with negligible side effects.

Unfortunately like many "wonder drugs," SSRI antidepressants have proven to be a mixed blessing. For the majority of depressed people, these medications offer a desperately needed bridge back from crippling and sometimes suicidal despair. But their record on side effects has not been so good. For some patients they have left daunting roadblocks to full recovery in the form of serious side effects, including physical and mental lethargy, loss of sexual drive and performance and significant weight gain.

These side effects erode the fragile wellness and self-esteem that most patients have been working so hard to rebuild. Faced with such fundamental impediments to their health and happiness, many people taking antidepressants become discouraged and discontinue taking their medication, usually with the result of renewed symptoms.

Sadly, some doctors do not appreciate, or may even dismiss, their patients' complaints about side effects. "You're so much better than you were before you started on medication," patients have been told as they are encouraged to accept their fate as the lesser of two evils. "Every drug has side effects. You'll just have to learn to live with them," they are counselled.

This all-too-common response by physicians not only lacks compassion, it's also bad medicine. By dismissing antidepressants' side effects as something patients must learn to live with, doctors are forfeiting their patients' chances for full recovery. If a primary symptom of depression is an inability to enjoy life, then finding pleasure in relationships and work is the ultimate goal of recovery. Who among us can expect to be desirable to others if we feel undesirable? How can we expect to fully enjoy the pleasures of intimacy without a healthy sex drive, full sexual function or a positive body image? Who can hope to compete on the fast track of life and work with reduced vitality and mental alertness?

These questions are hardly peripheral concerns; they go to the heart of recovery from depression.

For years, I treated patients for depression, with both psychotherapy and drugs, only to find their progress diverted by a new set of obstacles. They gained weight - sometimes so much that they resigned themselves to the sidelines of social life. Their sex drives deserted them - love relationships and marriages foundered amid sexual apathy and dysfunction. Most critically, they lacked the energy to keep up with their jobs and fully engage the everyday challenges of life. Over and over again, patients told me that although their depression was controlled, they could not fully enjoy life.

I began working hard with individual patients, searching for a regimen that offered help. We looked at diet, stress levels, exercise and hormones. Today, more than 300 of my patients - about 80 percent of those who tried the program we developed - have found relief from their depression and the side effects of the medication.

More than 25 million Americans are currently on antidepressant medication to treat depression and a wide range of non-depressive disorders, including: anxiety and panic disorders, obsessive/compulsive disorders, chronic pain syndrome, irritable bowel syndrome, migraine headaches and chronic fatigue.

Yet depending on the survey and the side effects being reported, anywhere from 30 to 80 percent of patients on medication suffer such severe side effects that they are significantly impaired in their ability to function in their jobs or relationships.

(As for the so-called "natural" remedies: A lot has been written recently about St. John's wort. And indeed, this herbal supplement helps many people cope with mild to moderate depression. But it doesn't work for many people with more severe depression. Also, St. John's wort has troublesome side effects of its own - and, unlike SSRIs - has no effect on the non-depressive disorders mentioned above.)

The medical underpinnings of side effects are complex and not fully understood, but this much is clear: Antidepressants are powerful agents that can cause widespread changes in the body's neurochemical and hormonal systems. When one of the body's metabolic systems goes out of balance, it tends to create disequilibrium in others - which is, in part, why so many people suffer from multiple side effects. When imbalance occurs, the body struggles to compensate and to reassert its natural balance and healthy order. This innate drive toward equilibrium is your body's hidden gift.

I believe that no one should resign themselves to half a life simply because they're on antidepressant medication. Everyone recovering from depression should aspire to the happiness and fulfillment that comes with vitality, a positive body image, a healthy sex life and the higher-quality relationships they foster. In the end, it's not enough merely to survive depression.

You can thrive.

Robert J. Hedaya is a clinical professor of psychiatry at Georgetown University. He maintains a private practice in Chevy Chase. This article is adapted from "The Antidepressant Survival Guide : The Clinically Proven Program to Enhance the Benefits and Beat the Side Effects of Your Medication".