Medications like Prozac and Zoloft, known as selective serotonin reuptake inhibitors (SSRIs), rank among the most frequently prescribed psychiatric drugs worldwide. These antidepressants benefit numerous individuals. However, they are not always effective. In fact, certain experts argue that they are prescribed too often.
Selective serotonin reuptake inhibitors (SSRIs) are among the most commonly prescribed antidepressants globally.
Drugs including Prozac, Zoloft, and Lexapro are utilized to address depression and anxiety disorders in countless individuals.
Yet, some specialists contend that society has grown excessively dependent on these medications, leading some physicians to treat normal human distress as a medical condition.
"We have turned all emotional suffering into a medical issue," stated Allen Frances, professor emeritus of psychiatry at Duke University School of Medicine in the United States.
"Eighty percent of antidepressants in the US are prescribed carelessly by hurried primary care doctors as a simple method to get patients out of the office within 15 minutes," Frances informed DW.
"There is no pill for every psychological and social problem," he added.
How do selective serotonin reuptake inhibitors (SSRIs) function?
As their name indicates, SSRIs prevent, or block, the reuptake (also referred to as "absorption") of serotonin. Blocking serotonin reuptake raises its levels in the body. When serotonin levels are low, it can disturb a person's emotional balance.
Serotonin is a neurotransmitter, a chemical messenger that transmits signals between nerve cells throughout the body.
It is one of the four so-called happiness hormones, and the one most linked to stabilizing mood. It controls anxiety and sleep patterns, and fosters a general sense of well-being.
"We understand that in depression, if you take SSRIs, you boost the amount of serotonin that cells can use to communicate. And this is the initial step," explained Carmine Pariante, a professor of Biological Psychiatry at King's College London, UK.
"Serotonin is a chemical that brain cells use to interact with each other. It is especially important for emotions," Pariante said.
Thus, maintaining a proper level of serotonin is viewed as crucial for preventing or managing depression.
"The individual starts to evaluate their environment," said Pariante, "so, they become less negative about it."
However, some experts argue that depression involves more elements than just a single chemical imbalance—low serotonin levels—in the brain.
Are antidepressants prescribed too much?
Joanna Moncrieff has long contended that SSRIs are overprescribed. "Psychiatry allowed people to believe that depression was caused by a serotonin deficiency and that antidepressants corrected this, even though this had not been proven," said Moncrieff, a professor of Critical and Social Psychiatry at University College London, UK.
"There was never strong evidence—some findings here and there but never a consistent picture," Moncrieff told DW, adding that their perceived effectiveness might instead be due to a placebo effect. This occurs when the mere act of taking a medication leads the person to think it is helping, when in reality, it has no effect.
Most psychiatrists and organizations like the American Psychiatric Association reject the notion that SSRIs work primarily as a placebo. Pariante is one of them.
"There is overwhelming evidence showing that antidepressants are effective in reducing depressive symptoms and, specifically, reducing the core symptoms of depression," said Pariante, while also acknowledging that serotonin is only one factor in depression.
When to use SSRIs
Pariante stated that SSRIs should only be prescribed for individuals with clinical depression, a "constellation of symptoms" that goes beyond ordinary sadness.
"There must be an impact on life that goes beyond just feeling sad for a few days or a couple of weeks because of something that has occurred," said Pariante.
"Their life needs to be suffering or deteriorating due to the depression," Pariante said. "For example, they cannot return to work, or relationships within the family start breaking down because of the depression."
The chemistry of happiness
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Do SSRIs always help? No.
SSRIs do not always work, or work immediately, or all of the time. It depends on the patient—and it is very important to get the best medical help you can.
In about one-third of cases, the first SSRI a person tries will not help them. Trying a second type of SSRI may help, but in 70-80% of cases they are ineffective.
"There is currently no way to predict who will respond or who will not respond to antidepressants, or to SSRIs in particular, or to any specific SSRI.
"They do not work in everyone. There is a range of responses. It is trial and error, but it is still the best option we have at the moment until we find something that allows us to tailor treatment," said Pariante.
Consensus on antidepressants: 'minimize SSRI-use'
Moncrieff said that the risks and side effects of SSRIs are often downplayed.
"They are a drug that interferes with our brain chemistry and other biological systems," said Moncrieff.
Moncrieff noted that side effects can include sexual dysfunction, dependence, osteoporosis, weight gain, bleeding, and pregnancy complications. "We really should be minimizing their use as much as possible," she said.
SSRIs may also dull emotional responses broadly—causing a general emotional numbness, which some individuals find useful. But "many don't like it," said Moncrieff.
Pariante agrees that SSRI use should be limited: When they do work, they should not be taken indefinitely.
"In an ideal scenario, for the first episode of depression, you start on the antidepressant—maybe you start feeling better after six to eight weeks," Pariante said.
"Then, six months, nine months, one year later at most, the antidepressant should be slowly tapered off and then stopped. Someone does not need to be on antidepressants lifelong just because they had one episode of depression."
Edited by: Zulfikar Abbany
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