The bitter pill

New antidepressiva like prozac seemed to be wonderpils when they were introduced ten years ago. Now they are under attack and countless of these matters are taken to court nowadays.
David Hawkins was happily married for fifty years. However, he got depressed at his 76th. Attracted by the success-stories about antidepressiva he went to his doctor. He would be very pleased if a pill would take him out of this dark tunnel. His doctor gave him Zoloft, medicine related to Prozac. To be sure he was prescribed 250 mg instead of 50 mg. One day later Hawkins called the police and spoke to the answering machine: "I have killed my wife. Yesterday I got tablets from the doctor and I think they were too strong. I grew totally wild. I don't know. I was crazy. I cannot say anything anymore. I have to go. I will go outside and commit suicide. Nobody, nobody can help me right now." The judge judged that the use of Zoloft was responsible for the murder.

The new 'antidpressiva' are not the miracle drugs anymore they used to be ten years ago. The side-effects can be very serious, they don't do what they promise and sometimes in the beginning the moods can improve followed by a depression which is deeper than any depression before which is hard to cure.
For millions of people being depressed word-wide, this is the bitter pill. The WHO estimates depression will be the disease most suffered from in 2020. The European Depres2-research puts that about 22% of the people in France and England is depressed. In the Netherlands the amount is about 17%. Only the abscense through depression costs in the Netherlands about 2,7 billion Euros a year. All people paid from a disablement insurance act, 10% has depressive complains. In the Netherlands 1000-1500 people commit suicide, two times more men as women. A depression has become the most wide-spread brain-disorder. Depression is an illness that is not official for that long. People used to be called dejected, melancholy or having sorrows or grief. The diagnose 'depression' cannot be compared with diabetes or pneumonia. With those diseases diagnoses can be concluded from fysical survey. This cannot be done with depression, although some doctors will let you know they can. But they are sometimes under pressure of the pharmaceutical industries.

That doesn't take away the fact that depression is a serious disorder, as well for the patient as for his or her environment. Via consensus-meetings psychiatrists try to reach consensus about what is a depression exactly like. That is a very difficult question. Some people are happier and more optimistic than other. Moreover, nobody has the same mood. With most of the people happy periods are changed by less happy periods. In spring and autumn it can be noticed; people are subject to seasonal influences with their depression react fiercely about the amount of sunlight they receive. In winter, when days are short, they are extremely dejected. They get negative thoughts, sleep much longer and eat more than normally. They can gain weight in those short periods. The symptoms of classical depression are almost opposite. Somebody being depressive, sometimes awakes in the middle of the night and cannot sleep for the rest of the night. The appetite disappears and loose of weight is the result. Everything seems to happen very slowly and nothing draws the attention, interest or enthousiasm. Liking sex or the courage to undertake actions are lacking.

A depression can originate spontanuously, but a few events can be the cause of it, like the losing of a friend or a family member, illness, continuous failing and fear for refusal. Next to that, there is the bipolar disorder. With that disorder there are large changes of the mood. Somebody who suffers it, is sometimes dejected, another time extremely active and exited. It can result in an enormous eagerness to buy. These periods can last long as well as short. In some families depressions are widely spread. There are indications that inheritance plays a role, but the question remains if it is learned behaviour; the way of treating the difficulties of life within a familiy may be taken over by the rest of the family. Negative experiences from the past and the blocking of negative feelings coming with it, can contribute to the existence of depression. Also the use of alcohol and drugs like cocaine, amfetamin or XTC can start or worsen a depression. While growing older the amount of depressions rises, as well in count as in gravity. From research in known that 15-20% from the people older than 65 is depressed, what not seldom leads to suicide. Depression with older people is often not recognized. The sleeping disorders which come with depression and the declination of the mind seem to be normal at that age.

The last few years American psychatrists have introduced 'mood disorder', as an umbrella under which a lot of forms of depressions are placed. In that there is a great danger, because depressions are looked like as if there were only one possible depression. For the doctors it can be very easy to treat all the depressions in one way! With prozac or for example with seroxat. The risk of somebody going complete out of his mind, just like Hawkins, is growing bigger when doing so. The producers from Prozac and Seroxat claim that the cause of depression is a disturbance in the biochemical balance in the brains: too little production of serotonine. The causes of depression are a lot more complex, as is obvious in the difference of a 'classical' depression and the season-bonded depression. The way of treatment should be different.

The idea exists that depressions are going away when you wait long enough. Often that is the case. The mean duration of a depression is four till six months. But there are examples of depressions not going away. 12% of the older people suffering from depression are obviously depressed after five years. Simply giving Prozac is no good doctor's job. For light and medium arts of depressions antidepressiva are not more effective than placebo's. Psychotherapy without medicine is for light and medium depressions very effective. Just like body-movement. Swiss research under 28 people shows that a daily morning walk from an hour can take away or reduce the complaints of seasonal depression. Also with light and medium depressions movement is effective. Light-therapy, in the form of daylight lamps at home or in hospital, is with seasonal depressions a good alternative. Saint John's Wort can have a positive effect on light and medium depressions. The side-effects are inconsiderable and it is hardly possible to overdose. The use of this product rapidly rose after it became clear that it is effective. Recently there are problems while taking it next to some pharmaceutical products. Antidepressiva work a lot better in combination with psychotherapy, but that costs money, time and emotional investment. For some people eating a pill seems to be done more easily.

Prozac (Fluoxetine) came on the market in 1988. Wordwide over 39 million people have swallowed. The pill has been on the frontpages of newspapers and magazines. At first the news was only positive. Prozac seemed to be safe at use because it is not possible to commit suicide with an overdose (which is possible with classical antidepressiva - tricyclic antidepressiva or tca's) The medicine belongs to the group of Selective Serotonin Reuptake Inhibitors, or ssri's. These means cause the body to loose less of the mood-hormon serotinine. It should have a positive effect on the mood. But how they work against depression., nobody understands! Relative medicine are paroxetina (seroxat), sertraline (zoloft) and fluvoxamine (fevarin). New research has shown what some scientists already stated right from the beginning of antidepressiva: users can, just like Hawkins, get very confused. Among users who try to do themselves harm - by means of <<any known possible means>> - are more people using these antidepressiva than among those who use the classical tca's. But the pharmaceutical industry says more people die because they didn't get treatment against depression, that by the side effects or poisoning with antidepressiva. Even as users don't try to do themselves harm, they can suffer from side-effects who are severe and sometimes staying. One of those side effectts is tardive dyskinesy, a damage to the nerve-system putting somebody who suffers it from constantly unwillingness muscle contractions and little mustle-shocks.

During clinical studies, 15% of the users of prozac stops it because of the side-effects, says Fank van Meerendonk from the Prozac Survivors Support Group. The American Food and Drug Administration had registered 40.000 side-effect records in 1997, from which 10.000 are very severe. "That is very disturbing, because the FDA has only access to 1 - 10% of the side effects of medicine ever reported. Most ssri-swallowers suffer from a psychosis, for example a manic episode. A recent study at Yale University shows that 8% of all psychiatric patients were in hospital because of a psychosis as a result of ssri's. People with such a manic episode feel great, but give away all their money, or are disputing with everybody. And then, there are prozac-poopouts, with who the substance is effective at first. But after a while it doesn't work anymore. Then the dosis prescribed are growing higher. That happens until nothing is working anymore. Scientists believe the amount of serotoninereceptors in the brains has dropped permanently, resulting in the patient to be chronical depressed....

Other side effects are sexual problems and stomach complaints. A Canadian research among 317.842 older people followed between 1992 and 1998, there was shown a coincidence between ssri's and the chance of stomach-bleedings. How older the user, how bigger the chance. Doctors keep prescribing ssri's. In year 2000, 800.000 people in the Netherlands used this antidepressiva, two times more women than men. In 1994 it was half that much.

Even children seem to be put to that pill. A survey showed that 72% from a group of house-doctors and children-doctors sometimes prescribed ssri's for a child. Those antidepressiva work not better as a placebo with children. It is about time that the medical world gets prescriptions to separate commercial interests better from the health interests to make the difference between hype and sane mind.

A familymember depressed?

Being with depressed people is not easy. At first there can be compassion and understanding, but when a depression lasts longer the patient can put the atmosphere into negative and with partners of familymembers there can be irritation and doubt-feeling. Hans Ulrich Wittchen from the Max Planck Institute in München developped directives for association with depressed people. It is for patients very important that others accept their negative emotions. Amusement is very important. Depressed people may not seem to be able to do very much, but try to encourage them to undertake thingss. Depressed people can use very much patience and support. Don't put sad emotions on them. Don't tell them they are wrong. It is not the fault of the patient that he is depressed. When somebody tells he wants to commit suicide, take that information always seriously! Tell the patient to go to the doctor or go with him.
Een depressief familielid?

Shortage of neurotransmitters

although there are much causes for a depression, it remain a mystery why somebody is depressed and another is not depressed. Scientists search the cause in the brains. Researchers of the Washington-university in St. Louis found two years ago that the hypocampus with depressed people is smaller that with people not depressed. The hypocampus is a little area in the brains which is very important to the memery. Also the amygdala, involved with emotions, grows smaller after repetitive depressions. They think it is because a disturbed balance in the amount of neurotransmitters between nervecells and the brains. A shortage of those neurotransmitters should make depressed.

Lawsuits against Prozac-producers

The WHO tells that Prozac is on the seventh place of medicine about users are complaining from 60 countries. Seroxat from GlaxoSmithKline is at the first place. They know for some time that the side-effect caused by ssri's is leading to aggressive behaviour and suicide with some people. Ever since Prozac is prescribed, Eli Lilly got a lot of lawsuits, put onto them by people who thought their psychical complaints were caused by Prozac. In 1994 in America there were 160 lawsuits. With half of the people Eli Lilly came to an arangement to prevent from negative publicity, other claims were dismissed. In 2000 the turning point was there. For the first time in history two judges said the complainers were right. Now there is a case againstt GlaxoSmithKline where 35 people claim to suffer from the side-effects of seroxat. Their lawyers have already had 1500 reactions from people who want to do with those 35. They are people who got it prescribed with mild depression or anxiety-disorders. When they wanted to stop it, they got the complaints: headaches, dizzyness or influenza-feelings. Very interesting was that their doctors were so convinced of the safety of the medicine that they never thought of the side effects of Seroxat. The complains agains producer GlaxoSmithKline is that they didn't tell doctors and patients about the possible negative side-effects of Seroxat. The English Daily The Guardian published the information that there was no proper research done about the safety of seroxat and other ssri's. Psychiatrist David Healy discoverd that in the archives of GlaxoSmithKline. Those means were so popular because their "safety".

From: Ivan Wolffers: University teacher - Farmacie on the VU in Amsterdam.