Homeostasis: Antidepressants and Youth

Investigating the following: How do common antidepressants work? Why should people, especially young people, be carefully monitored when on such medications?

Click here to view Susan Perry’s article on the effects of antidepressants versus placebo pills on adolescents – this is the article that this blog post will be based off of.

Recall that neurotransmitters, such as serotonin and norepinephrine, are significant players in the parts of the brain that control mood and emotion (i.e., the limbic system or upper brainstem). In people with depression, levels of serotonin, dopamine and norepinephrine in these areas are insufficient or imbalanced, and this issue is linked to depression.

Antidepressants are drugs that treat moderate to severe symptoms of depression in people. Common antidepressants are re-uptake inhibitors; that is, in synaptic transmission, they block the re-uptake of neurotransmitters (serotonin, dopamine, or norepinephrine, for example) into the presynaptic neuron, over-stimulating the postsynaptic neuron and causing nerve impulses to be continually transmitted. The effect of the common antidepressant is an increase in a specific neurotransmitter; this can stabilize one’s mood or emotions, treating depression. The most frequently prescribed antidepressants are called selective serotonin re-uptake inhibitors (SSRIs), which, as the name suggests, increase levels of serotonin within the brain.

Another interesting way to help treat depression is through the use of placebos, “fake” medications that seem real, but do not actually contain an active ingredient that affects human health. Placebos are often used in research experiments designed to study the effects of a new drug on human behaviour or well-being in comparison to the placebo. Some people actually experience positive or negative responses to a placebo, and this is called the placebo effect.

Glen Spielmans’ Discovery

Glen Spielmans, an assistant psychology professor at Metropolitan State University, has been tracking clinical trial literature about the effects of common antidepressants versus placebos on symptoms of depression in youth. After reading each new study, he noticed that the views of psychiatrists involved in these trials were emphasized more than those of the young test subjects themselves – the psychiatrists said that antidepressants were improving symptoms in teens, while the teens themselves felt otherwise. Youth found no important differences between the ways in which SSRIs and placebos affected their depressive symptoms.

“We found no evidence that antidepressants offer any sort of clinically meaningful benefit for youth on self-report measures of depression, quality of life, global mental health, or parent reports of autonomy.” – Glen Spielmans and Katherine Gerwig

This is an extremely interesting discovery that we do not normally hear about – after all, antidepressants are being prescribed more often than ever before, so it is only natural for one to assume that they are having some sort of positive effect on sufferers of depression. However, it raises many concerns for me. If it is true that SSRIs and SSNIs are not actually positively benefitting youth with depression, why are they being prescribed to more youth today than ever before? Are psychiatrists supporting antidepressants  because money can be made off of them?

The Ethical and Legal Considerations

Again, if it is true that antidepressants are not having a significant positive effect on youth, it is my belief that they should not be prescribed to young people, at least not until alternative treatments have been considered (i.e., cognitive, behavioural, and interpersonal therapy). Stricter regulations on diagnosis should be considered, as prescription criteria may be too liberal for this age group.

Antidepressant Side-Effects and Youth

SSRIs/SSNIs are drugs – they “mess around” (for lack of a better term) with neurotransmitters in the brain, as do drugs like caffeine or alcohol, and this should not be taken lightly. For these antidepressants to be prescribed to youth, careful monitoring should be carried out for the following reasons:

1. Antidepressants come with side-effects and risks, and for teens/youth, one of these is a shocking increased risk of suicide. Visit this link to discover more side-effects!

2. These antidepressants may be getting prescribed to youth for no particular reason (i.e., because they may not be that effective after all) – we need to be cautious about what long-term effects antidepressants could one day have on our youth, because it turns out that they are more uncertain than we originally thought.

Discussion

Tell me what you think! Are we better off treating youth using placebos (recall that they contain no medicinal ingredients or drugs and, according to Spielmans’ findings, may have the same effect on youth as SSRIs/SSNIs) or should we stick to common antidepressants (i.e., Prozac, Zoloft, etc,)? Have you ever heard about Spielmans’ findings? If not, do you think people should know about them?

References:

Carter-Edwards, Trent. et. al. Biology 12. Toronto: McGraw-Hill Ryerson Limited, 2011. Print.

Freudenrich, Craig. “How Antidepressants Work.” How Stuff Works. HowStuffWorks.com. Sep 20. 2007. Apr 23. 2014. http://science.howstuffworks.com/life/antidepressant2.htm

Kiefer, David. “The Placebo Effect: What Is It?” WebMD. WebMD.com. Feb 10. 2014. Apr 23. 2014. http://www.webmd.com/pain-management/what-is-the-placebo-effect

Perry, Susan. “When children are asked, antidepressants are no more effective than placebo, study finds.” UCare. MinnPost.com. Apr 23. 2014. April 23. 2014. http://www.minnpost.com/second-opinion/2014/04/when-children-are-asked-antidepressants-are-no-more-effective-placebo-study-f