A heated debate over antidepressants

September 27, 2022

By Courtney Wise

Good morning, MindSite News readers. In this edition: A close look at claims that the raging debate over antidepressants is putting patients at risk. How quality mental health care in prison can prevent returns. New Jersey looks to community schools to meet neighborhood needs. Plus: More evidence that exercise is good for your mind.

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Is the debate over antidepressants putting patients at risk?

“I’m one of the millions that takes an SSRI—one called sertraline, to manage symptoms of anxiety, depression and obsessive compulsive disorder. Before I talked with a psychiatrist about getting on this medication, I dealt with feelings of impending doom and dread that appeared on a whim, as well as dozens of intrusive thoughts and emotions every minute. Basically, it’s like having your very own heckler yell at you all day long. Taking the medication has been immensely helpful for me, as it has for many others.”

So reads, in part, the opening of a fascinating article in The Daily Beast by science writer Simon Spichak, who is glad – very glad – to be taking an SSRI, or selective serotonin reuptake inhibitor, a drug widely used to treat depression and some other mental health conditions. Serotonin in the brain helps regulate mood, and at normal levels people appear to feel calmer, more focused and happier. Selective serotonin reuptake inhibitors have long been thought to function by blocking the amount of serotonin that’s reabsorbed by nerve cells in a process called reuptake, which then increases the flow of serotonin in the brain. However, the idea that low levels of serotonin lead to depression is “very simplistic,” Yale psychiatrist Gerard Sanacora told Spichak.

While researchers no longer think the cause of depression is that simple (there is general agreement that multiple genetic, social, and biological factors contribute to depression), the idea that it may be caused by a dysregulation of the body’s entire serotonin system has emerged, leading to “a full-on debate, pitting mainstream psychiatry against a minority of researchers who don’t think antidepressants actually work,” Spichak said. Researchers in a field called critical psychiatry have presented research suggesting that SSRIs function by blunting emotions.   The pharmaceutical industry’s “shady history” of covering up evidence that didn’t fit its narrative about SSRIs fueled further distrust, the author noted.

Still, that isn’t enough to discredit all the good that SSRIs do, Spichak argues, especially since at least one member of the Critical Psychiatry Network has espoused COVID-19 vaccine conspiracy theories. With therapy waitlists months long in some areas, Spichak warns that advocating against antidepressants is dangerous: For some people, they’re the only available help right now. 

The headline “How the Debate Over Antidepressants Puts Millions in Danger”– likely written by an editor – appears a bit overblown nonetheless. There is little danger that antidepressants will suddenly be taken off the market, and also little risk that millions of psychiatric patients will learn of the controversy and decide to stop taking antidepressants on the spot (a risk in itself, as suddenly quitting SSRIs can lead to the risky condition serotonin syndrome.) The fact is that scientific debate, however uncomfortable, heated or vitriolic, is essential to the advance of scientific knowledge.

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Mental health Rx can keep people out of prison

Twenty-five years ago, Luis Garcia was stuck in a cycle of recidivism until he met a forensic psychologist who recognized that he struggled with mental illness and wasn’t “just a criminal.”

“I began to feel a sense of hope,” Garcia wrote in an essay for the Los Angeles Times. “I shared my actual feelings with her and was vulnerable—the first time I’d really done that with a mental health professional.” Thanks to that encounter, Garcia came to understand that though he struggled with alcohol addiction and clinical depression, he could be well and live well. He hasn’t been back to prison since. Today, he hopes for a mental health transformation of the prison system, that those incarcerated now may one day have a story like his.

Garcia’s journey isn’t all that uncommon. He grew up in a middle-class home with two loving parents who tried to help when he began abusing alcohol and acting out. They sought counseling for his mental health, but their medical insurance refused to pay for it, telling his parents that he’d have to take care of his substance abuse problem first. He didn’t get the help he needed until that chance encounter with a psychiatrist—after years of cycling in and out of the criminal justice system.

Citing estimates that half the people housed in federal and state prisons are in need of mental health treatment, Garcia wrote, “Our correctional systems often are called the de facto provider of mental health treatment — but that characterization suggests people actually get care in carceral settings. Everyone who needs mental health services deserves access to quality, humane treatment, especially those who are incarcerated or who are returning home. It saved my life, and I know it can save many more, when actually available.”

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New Jersey lawmakers propose “community schools” for student wellness

In an effort to offer students more vital mental health and social-emotional support as the nation emerges from the COVID-19 pandemic, New Jersey legislator Mila Jasey (D-Essex) introduced a bill to create “community schools” that meet neighborhood needs throughout the state, according to the public radio station WHYY. The idea is that they’ll serve as mini-community hubs for children, offering students and families access to nonprofits, health professionals, and other social services for youth. The effort is getting bipartisan support.

Michele Matsikoudis (R-Morris) said that she had three children, one of which went through the special needs program, partnering with the school, local churches and the school counselor with success. “When I look at this piece of legislation, I absolutely love it,” she said. “And I think it is going to help so many children, and it’ll give them a stronger fighting chance than they may have had.” New Jersey is just the latest state to lean into the trend; 39 states are already home to community schools. 

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In other news…

A link between ADHD and heart disease? According to Medical News Today, a recent Swedish population study published in World Psychiatry suggests that adults with ADHD were associated with two times the risk of heart disease as those without it. People with ADHD often have co-occurring mental conditions, like anxiety and depression, and physical conditions, like obesity.

Science continues to document that exercise is good for your mind, and a column in Psychology Today seeks to explain what the latest study in Scientific Reports suggests about its benefits. Low-intensity “easy” workouts are good for stress-relief and lowering anxiety; mid-intensity workouts are ideal for sparking your ability to problem-solve; and high-intensity workouts help with verbal fluency and memory recall. (Those looking for stress relief in a fun, low-intensityl workout might want to try out YouTube’s Polish zumba version of Despacito.) 

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If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

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