Now a study that analyzes data from the Canadian National Population Health Survey (NPHS), a longitudinal study of a representative cohort of household residents in Canada, finds a strong correlation between the use of SSRIs, Effexor, and the development obesity. Lest you think that this is because depression makes people fat, this same study found no correlation between a history of a major depressive episode and the development of obesity.
It's the drugs, folks.
Here's the study:
Major Depression, Antidepressant Medication and the Risk of Obesity
Scott B. Patten et al. Psychother Psychosom 2009;78:182-186 (DOI: 10.1159/000209349) Vol. 78, No. 3, 2009
How widespread use of these antidepressant drugs is, is very hard to pin down. Anecdotally, it sometimes seems like everyone who has good health insurance is on them.
A report published in 2005 that analyzed Canadian data reported that "...one in five women (19%) in the province over the age of thirty received at least one prescription for SSRIs in the period between August 1, 2002 and July 30, 2003."
Canada's public health system controls access to prescriptions in the way the US system does not. The data for the US is 7 years old and at that time the CDC reported that 1 in 10 American Women were taking antidepressants which were the single most highly prescribed class of drugs in the US. That 2002 report also reported that antidepressant use had tripled over the previous decade, which makes it likely that antidepressant use has risen significantly in the 7 years since those statistics were analyzed.
The Canadian report also points out that
Prior to the introduction of SSRIs, depression was considered to affect only 100 people per million. Since the introduction of SSRIs, prevalence rates for depression are now considered to be in the range of 50,000 to 100,000 cases per million (a 500 to 1,000 fold increase).One reason for this huge spike in prescriptions is, of course, the heavy marketing by pharmaceutical companies of these drugs--especially to family doctors not trained in psychiatry who are the doctors most likely to prescribe them.
It has long been known to psychiatrists that fully 1/3 of all people who experience episodes of depression recover naturally without any treatment. This is close to the rate of recovery experienced with the antidepressant drugs, however, the drug companies suppressed publication of the studies that would have made it evident that their drugs were often not any more effective than placebo.
You can read one study documenting the impact of drug company suppression of unfavorable research evidence HERE.
In addition, drug marketers deceptively promoted the factoid that that repeated episodes of depression are likely to lead to a form of permanent brain damage resulting in permanent depression. This is a twisted rendering of data that applies only to extremely severe depression of the kind that results in people being institutionalized because they cannot function at all. That kind of depression does not result from negative life experiences but appears to be a brain syndrome like schizophrenia. It is a very different kind of psychiatric condition from the bouts of sadness most people experience at some point of their lives when they suffer a serious loss or find themselves trapped in a situation, like a bad marriage or dead end career.
But this idea that one depressive episode, if not treated, will condemn a person to a life of worsening depression, has been used to scare family doctors into treating the normal periods of sadness characteristic of young people, who are facing the emotional challenges of growing up, as if they were medical emergencies.
People experiencing the normal struggles of adolescence and young adulthood are told that if they don't take the antidepressant drugs they'll end up permanently depressed. When they start feeling better after a month or two on the drugs--as they would without drugs--they are convinced that the drug saved them and are terrified to stop taking it.
Anyone who went through adolescence in the pre-antidepressant days knows it is not true that the periods of depression so common in early life invariably turn into severe psychiatric disease. Most of us grew out of the miseries of adolescence and have normal happy lives no matter how miserable we were when we broke up with our first serious boyfriend.
For many of us, depression was a signal that we needed to get help to learn why we made bad choices or to take the steps needed to get ourselves out of the dead end situations we had become trapped in. Sometimes therapists were helpful in giving us tools that made it possible to do this. Medicating the bad feelings away may prevented us taking those steps or making those changes which improved our lives and eliminated the causes of our depression.
But for the past decade any teen (or adult woman, for that matter) who experiences overwhelming sadness after breaking up with a boyfriend--or after failing to find an exciting career after earning a college degree in English--is very likely to be put on a powerful, mind altering SSRI drug that numbs their emotions--a drug, moreover, that can be extremely hard to stop since it causes withdrawal symptoms. Any teen with insurance, that is, since these drugs can be very costly.
And once people are, essentially, addicted to these mind-altering drugs, they do what all people who are dependent on mood-altering drugs do--defend their need to take the drugs very strongly and often with anger at any one who would take them away from them.
Because people who take these drugs have not learned that depression can be healed without drugs, and have not been taught the psychologically proven strategies that could help them cope with depressive episodes on their own, they are very frightened of what would happen if they stopped the drugs. Since the withdrawal symptoms when they do stop the drugs can be extremely unpleasant and long lasting, they may interpret this as proof that they need these drugs.
The common analogy--promoted heavily by the drug merchants, is that people with depression need SSRIs the way people with diabetes need insulin. This makes it sound like these drugs supply some essential, missing hormone.
In fact, this is completely untrue. The drugs don't supplement serotonin. It is not even clear if they actually raise serotonin levels long term. As the Canadian report point out, "there have been no studies that assess the effects of blocking serotonin over months or years. Most of the forty-two clinical trials for Prozac, Paxil, Zoloft, Celexa, Serzone and Effexor lasted only six weeks." Studies of other impacts of altering Serotonin levels in the gut suggest that long term use of SSRIs may actually lower Serotonin levels.
Some recent research suggests that these drugs actually work by remodeling the neurons in the hippocampus.You can read about what SSRIs really turn out to do, long term HERE.
Other drugs that affect Serotonin levels include Ritalin, Cocaine and Ecstasy. We know these drugs are addicting, but somehow the drug companies have been able to convince doctors that their mood-altering drugs are "habit forming" but not "addicting" though doctors also warn patients that it is dangerous to suddenly stop these drugs,just as it is with addicting drugs.
What all makes this relevant to diabetes is this: There has always been evidence that the SSRI drugs make people gain weight. Now this latest analysis of the Canadian health survey data makes it clear that the weight gain is almost certainly a side effect of the drugs, not of the depression that might have led to the prescription of the drug.
Obesity raises insulin resistance even in people with normal genes. For those of us who have the genes that lead to diabetes--genes that mean that even when we are thin our beta cells are barely keeping up with our insulin needs--the increase in insulin resistance obesity can push us into full fledged diabetes and by the time that diabetes is diagnosed, the high blood sugars we have lived with for years may have killed off so many of our beta cells we don't have a chance of regaining a normal blood sugar metabolism through weight loss.
Indeed, it is not irrational to wonder if the fact that these drugs are the single most frequently prescribed class of drugs in the US may have something to do with the development of the so-called "Obesity epidemic." SSRIs began to be prescribed in the late 80s. The "obesity epidemic" started catching the public's attention a decade later.
Yes, there are many other contributing factors to the obesity epidemic, including a huge growth in portion size. But when you mess with the brain chemistry involved in the pleasure response, one of the things you also do is mess with the in-built brain mechanisms that control satiety--the feeling that you've eaten enough.
A person with an intact brain satiety function is not likely to be able to eat a whole 10.5 ounce cinnamon roll at once. If they do, they will experience unpleasant emotional responses that are the body's way of teaching them that this is NOT something they should do again. Block those emotions, and they will do it again.
If you have become inadvertently addicted to mood altering drugs and believe that they are contributing to your weight problem and worsening your blood sugar control, you will probably need some help to get off them. A therapist who can help you deal with the emotions you will feel when you stop anesthetizing your feelings can be essential. A doctor who knows how to help you deal with the withdrawal symptoms in a way that does not involve putting you on another addictive drug is also essential.
Unfortunately, doctors have been prescribing antidepressants to pregnant women for the past decade too, which may have something to do with the concomitant epidemic of toddler obesity. How is it possible doctors have not considered the long term physiological consequences of exposing fetuses to a drug that remodels the neurons in their brain that control essential brain structures, while the brain is forming?
One reason is that few doctors have the time to read the research about the drugs they prescribe and so they don't understand what SSRIs really do, since they get all their information about these drugs from the drug company reps and the "education" the drug companies sponsor.
But thinking people cannot help but realize that thanks to aggressive drug company marketing a huge sector of the population--much of it young and female--and their babies--have been the subject of a decades long experiment to find out what it is that these drugs really do. The signal that is emerging out of the the very small amount of research NOT funded by the makers of these powerful, profitable drugs, is that they make people obese.
Note: In the comments that respond to this post, I'm asking you to limit your comments to discussion of the relationship between antidepressants, obesity and diabetes and the research connecting these topics. I am not going to make public the fervid and often hostile personal testimonials that are always provoked by any attempt to discuss the research that examines the true impact of these drugs. So don't waste your energy or mine posting them here.