Survey examines adverse personal and interpersonal effects of antidepressants and the impact of polypharmacy

“Holding onto sanity” by Autumn
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“Holding onto sanity” by Autumn
New research, published in Psychiatry Research, features personal accounts of antidepressant users and their experiences of negative side effects related to sex, work, socializing, and physical health. John Read and a team of researchers in the U.K. further explored informed consent and the impact of polypharmacy.

Staggeringly high rates of antidepressant prescriptions continue to climb. In England, prescriptions have doubled since 2005. Similarly, antidepressant use doubled in Australia between 2000 and 2014 becoming the most commonly used medication taken by 1 in 10 Australians each day. By 2005, antidepressants were the most widely prescribed drug in the United States, and by 2012, one in eight adults had incorporated their usage into their daily routine.

The efficacy of antidepressants for mild to moderate major depression, when tested in blinded, non-industry studies, are found to be no different from placebo. The authors cite meta-analytic evidence demonstrating that "the overall effect of new-generation antidepressant medications is below recommended criteria for clinical significance."

Researchers contend that the harmful costs of taking antidepressants outweigh any potential benefits, only demonstrated to have potentially greater than placebo effects on individuals exhibiting signs of very severe depression.

Negative symptoms that are most commonly reported by antidepressants users include nausea, headaches, dry mouth, insomnia, somnolence, diarrhea, dizziness, and constipation. Other findings from placebo-controlled studies has similarly focused on medically-related symptoms. While acknowledging the significance of these findings, the authors of this study sought to expand upon existing research to examine how antidepressants negatively impact people in terms of their personal and interpersonal lives.

Currently, the largest dataset covering antidepressant usage and its negative effects on one's personal life identified experiences of sexual difficulties, emotional numbness, feeling not like oneself, agitation, reduction in positive feelings, suicidality, and caring less about others. Very few studies have investigated how prescribers go about informing patients of adverse effects, and almost none have examined the effects of combining other psychiatric medications with antidepressants.

Read and co-researchers surveyed over 1,000 antidepressant users in the U.K. on their experiences of interpersonal and daily-life related symptoms. To address the gaps in the literature, they additionally questioned to what extent participants were informed of negative effects by prescribers and whether participants were simultaneously taking other psychiatric drugs. The online survey was designed and disseminated by Mind, a mental health charity located in England and Wales.

The majority of participants taking only antidepressants (85.9% of 484) reported side effects of antidepressant use. Of those effects reported, adverse symptoms related to sex life (43.7), work or study (27%), physical health (26.8%), and social life (23.5%) were most commonly endorsed, followed by negative effects in their close relationships (20.9%) and independence (10.5%). Additional participant comments about their experiences on antidepressants were included:

"I hate it. It makes me emotionally flat - for example, I had to stop taking them after a recent family bereavement to make sure I was able to cry at the funeral."

"The drugs make me totally disconnected from everything and lifeless."

"I think it is causing fatigue, amongst other things so I have had to drop my hours at work from full-time to 3 days a week."

"It affected my sexual relationship with my partner as I had no desire to have sex and we are still feeling the effects of this now as he is nervous to ask after knowing that I wasn't interested for such a long time."

"It is very hard to separate the effects of the meds and the effects of the illness."

The remaining 524 participants reported taking antidepressants alongside tranquilizers or sleeping pills, antipsychotics, and/or mood stabilizers. This indicates that just over half of the 1,008 survey respondents were taking two or more psychiatric drugs. Furthermore, the more medications being used, the more severe the reported side effects.

Polypharmacy, or the simultaneous use of at least 2 psychiatric drugs, more than doubled the rates of experiencing most of the negative symptoms listed and was found to be more common when drugs were prescribed by a psychiatrist rather than a general practitioner (GP).

"Despite its rapid increase polypharmacy cannot be described as an evidence-based approach," note the authors who address that almost no study has examined the impact of polypharmacy, much less found evidence to support it.

Approximately 48% of participants taking antidepressants indicated that they had been given enough information about the medication whereas about 40% reported that they had not received enough information.

The remaining percentage noted that they were unsure or could not remember. Interestingly, men (53.5%) were significantly more likely to report being given enough information than were women (46.8%). Age was positively related to not being given adequate information such that the older one was, the less informed they felt about adverse symptoms.

Additional participant comments regarding informed consent were as follows:

"In reality, psychiatrists refuse to answer questions and refuse to accept or discuss side effects."

"The side-effects weren't explained very well by the prescribing GP. Anorgasmia is a particularly bad side-effect."

"Would of liked to hear more about side effects..... I had to find out lots of information myself when I was in a difficult anxious state."

"I wasn't told of all the side effects; in fact, when I researched them myself and then told my doctor, she hadn't got a clue it could affect you in the way it affected me."

Overall, the results of this underscores how extremely common it is to experience negative symptoms when taking antidepressant drugs, particularly those related to personal and interpersonal functioning.
"In reducing the depression the drugs may also be reducing all feelings and thereby replacing painful feelings with an empty emotional void, both personally and, as a further consequence, interpersonally."
Interestingly, 85% of participants experienced antidepressant drugs to be at least "fairly effective." The authors offer the following context for this finding:

"Many people do feel less depressed when taking ADs [antidepressants] but it seems this is primarily because of the expectation raised by the processes involved in prescribing and taking the pills rather than by the chemicals therein."

They add that in the largest study conducted on antidepressant-related negative personal symptoms, "one of the strongest predictors of perceived efficacy was the perceived quality of the relationship between the prescriber and the patient."

Finally, the findings underscore the importance of informed consent, exploring symptoms beyond the bio-medical domain, and discouraging the growing rates of polypharmacy found, in this study, to be especially promulgated by psychiatrists.

Source:

Read, J., Gee, A., Diggle, J., & Butler, H. (2017). The interpersonal adverse effects reported by 1,008 users of antidepressants; and the incremental impact of polypharmacy. Psychiatry Research. http://dx.doi.org/10.1016/j.psychres.2017.07.003 (Link)