Antidepressants. Or diet?

ratanxious

“Why are so many people on antidepressants these days?” a failsafer asked.

It’s true. Antidepressant use has increased dramatically in recent times - nearly 65% over 15 years in the US - and again this year due to Covid-19 anxiety.
 
This is a worry because antidepressants are not as safe and effective as previously thought.

New studies have shown that antidepressants seem to have minimal benefits, can double the risk of suicide and increase the risk of violent crime while reducing the chance of long-term recovery, and withdrawal symptoms are more common, more severe and longer lasting than previously thought.

More harm than good

Such findings have led independent experts – those with no financial ties to the pharmaceutical industry - to suggest these drugs do more harm than good:

It is absurd to use drugs for depression that increase the risk of suicide and homicide when we know that cognitive behavioural therapy can halve the risk of suicide in patients who have been admitted after a suicide attempt and when psychotherapy does not increase the risk of murder” – Prof Peter Gøtzsche, 2019

 “… in every single one of these trials it has produced more harms than benefits … it has made children become suicidal who wouldn't have become suicidal if they hadn't been put on these drugs” - Prof David Healy, 2018

There are more than 6,000 media articles about antidepressants and suicides, solder suicides, murder-suicides, murder, assaults, school shootings, road rage and air rage on the SSRI Stories website.

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Non-drug options

Alternatives that have been found to work as well or better than medication include talk therapies such as cognitive behaviour therapy (in Australia, NewAccess offers 6 free sessions of low intensity CBT with a trained coach),  exercise, meditation, and the RPA elimination diet that we support.

Bill’s story

Recently, a fiftyish American – I’ll call him Bill - asked for help with the elimination diet. He was surprised when our recommended US dietitian refused to accept him as a client because he was taking too many medications.

Guidelines for the RPAH diagnostic elimination diet include “AVOID NON-ESSENTIAL MEDICATION” because failsafers are likely to react to drug ingredients such as salicylates, amines or additives eg colours, flavours and preservatives.

Sure enough, Bill discovered one of his daily meds contained tartrazine (artificial yellow colour E102, Yellow 5 in the US) and switching to a colour-free brand helped.

However, Bill was also taking a much more dangerous drug. He was suffering from suicidal thoughts every morning and had been taking an antidepressant for 15 years, thinking this would stop him from killing himself.

So he was shocked to learn that some antidepressants and other medications can actually cause depression and suicidality and realised “… any medication that comes with a warning... ‘May cause suicidal side effects’ … I have always gotten suicidal thoughts”.

Bill then started careful tapering of his antidepressant medication, monitored by a health professional to manage withdrawal symptoms, as is now recommended by new guidelines for doctors since the end of last year. He wrote:

"I’m feeling better than I have in a few years thanks so much to your information about these food sensitivities and the antidepressant. I never knew what a horrible drug that was ...  I’m sticking with this. I am half way there. I have no choice but to keep this up as what a change it has done for me. Thanks so much for all of your help.”

Reader stories

Our readers agree that diet works better than medication for depression.

We could not believe the change in my 11 year old son’s mood as a result of the diet – he was suffering from frequent feelings of depression, accompanied by episodes of weeping and rage at the same time and an anti-depressant was a disaster. After six months, depression is a thing of the past – from story [368]

I was on anti depression medication for 7 years - once on fs & eliminating sals I found my fog lifted & I'm no longer dependant on tablets. While my overall diet was a healthful one by anyone’s standard the sals were in fact detrimental to me – Jennifer from story [1326]

After years of thinking I had a mental illness, being told I had bipolar, filling my body with hideous drugs that made my hair fall out, gave me acne and basically turned me into a zombie and got me to a point where I was totally ready to end my life, I have been totally drug free, symptom free, depression free and manic free since we started FS!... – from story [1227]

I had depression over a period of forty years … medication from my GP did not have any effect … I was becoming suicidal … I decided to eliminate (my favourite) foods ... three weeks later I woke up with a clear head ... I was normal!!!!!! – Brian, aged 80, retired dispenser in retail pharmacy, from the UK – from story [1291]

I was diagnosed with PND … I was on varying doses of Seroxat or similar medication altogether for 6 years … eighteen months ago I went totally FAILSAFE and regained my life! … Over 5 months I weaned myself off the tablets totally…. The medication really just masked the problem … I am managing well so long as I keep failsafe - from story [340]

At age 29, I sank into a deep depression … I was prescribed Prozac and stayed on this medication for seven years during which time I tried to come off twice with very bad results …  The diet has changed our lives … When we tested salicylates …  I could feel the return of my helpless, hopeless, awful black depression … -  from story [342]

Today I saw an 11 year old boy who had been so depressed and anxious that the paediatrician had prescribed anti-depressants … there had been quite a rapid onset over 9 months or so of bedwetting, violence at school, terrible anxiety and sadness. We delayed starting the anti-depressants until he had tried salicylate exclusion and 4 weeks later, he sat in my consulting room laughing and smiling. All bed wetting had ceased and mood was back to normal.  He said to me “I am not going to eat those salicylates ever again- they make me feel so bad”! His mum said “I have my beautiful boy back –a supportive GP from story [1417]

When drugs don’t work (“treatment-resistant depression”)

A case history in a medical journal described a 25 year old with a history of ADHD, anxiety, social phobia, panic attacks, OCD and five years of severe depressive episodes.

  • psychotropic drugs were not effective
  • after 4 weeks on the RPAH elimination diet, his mood and other symptoms improved considerably
  • challenges showed he was affected by salicylates and food additives

At follow-up after 12 months, he had stayed symptom free on the low-salicylate diet and had been able to return to full time work.

Researchers commented:

“Clinicians should be aware of the possible syndrome (food intolerance)
and that it may be worsened by psychotropic medication”

 – from Treatment-resistant depression: When antidepressant drug intolerance may indicate food intolerance. (Parker and Watkins, 2002) http://www.ncbi.nlm.nih.gov/pubmed/11982551


WARNING:
people who have been prescribed antidepressants should not suddenly stop taking their medication. Gradual tapering is advisable. Anyone considering altering the dosage of their medication, or withdrawing from it, needs to seek medical advice first.


References and further information

Antidepressant use increasing

In the US, antidepressant use increased nearly 65% over a 15-year time frame, from 7.7% in 1999–2002 to 12.7% in 2011–2014. https://www.cdc.gov/nchs/products/databriefs/db283.htm

Antidepressant increase due to COVID-19 https://www.abc.net.au/news/2020-07-06/covid19-linked-increse-antidepressant-medication-use-anxiety/12417100

Not as safe and effective as previously thought

Suicides are increasing – and so are antidepressant prescriptions by Martin Plöderl PhD & Michael P Hengartner PhD, August 23 2018 https://www.madinamerica.com/2018/08/suicides-are-increasing-and-so-are-antidepressant-prescriptions/  

Plöderl M and Hengartner MP, Antidepressant prescription rates and suicide attempt rates from 2004 to 2016 in a nationally representative sample of adolescents in the USA, Epidemiology and Psychiatric Sciences, 2018,28(5);589-591 https://doi.org/10.1017/S2045796018000136

Antidepressants: minimal beneficial effects

Researchers: “Antidepressants should not be used for adults with major depressive disorder” by Peter Simons, October 1, 2019 https://www.madinamerica.com/2019/10/researchers-antidepressants-not-used-adults-major-depressive-disorder/

Jakobsen JC et al, Should antidepressants be used for major depressive disorder? BMJ Evid Based Med, 2019;bmjebm-2019-111238. “Antidepressants seem to have minimal beneficial effects on depressive symptoms and increase the risk of both serious and non-serious adverse events.”  https://ebm.bmj.com/content/early/2020/03/16/bmjebm-2019-111238

Antidepressants can increase the risk of suicide and violent crime

SSRI Stories website  https://ssristories.org/

Antidepressant use more than doubles risk of suicide attempts - A new study found that those taking antidepressants were 2.5 times more likely to attempt suicide than those taking placebo by Peter Simons
July 9, 2019 https://www.madinamerica.com/2019/07/antidepressant-use-doubles-risk-suicide-attempts/

Michael P. Hengartner and Martin Plöderl, Newer-Generation Antidepressants and Suicide Risk in Randomized Controlled Trials: A Re-Analysis of the FDA Database Psychother Psychosom,2019;88(4):247-248. https://www.karger.com/Article/FullText/501215

Study finds SSRIs associated with increased risk for violent crime - study finds an apparent connection between SSRIs, the most commonly prescribed type of antidepressant, and increased risk of violent crime by Ashley Bobak MS June 17, 2020 https://www.madinamerica.com/2020/06/study-finds-ssris-associated-increased-risk-violent-crime/

Lagerberg T et al, Associations between selective serotonin reuptake inhibitors and violent crime in adolescents, young, and older adults – a Swedish register-based study, European Neuropsychopharmacology, 2020;36:1-9.  https://doi.org/10.1016/j.euroneuro.2020.03.024

In the past decade, suicide has become an epidemic plaguing the military and veteran community, with upwards of 20 suicides a day by veterans, service members, Guard Members and Reservists by Amanda Burrill https://www.madinamerica.com/veterans-2/

Military veterans are especially at risk because so many are given antidepressants for combat stress and PTSD -

“They’ve never medicated the way they’re medicating now …
it’s ridiculous, and the incidence of suicides has coincided
with the increase in the amount of psychiatric medications…”
 

­ Bart Billings, Ph.D., Retired Colonel and former military psychologist, author of Invisible Scars: How to Treat Combat Stress and PTSD without Medication  https://bartpbillings.com/about-the-book/

Antidepressants decrease the chance of long-term recovery

Rigorous study finds antidepressants worsen long-term outcomes by Peter Simons October 31, 2017 https://www.madinamerica.com/2017/10/rigorous-study-finds-antidepressants-worsen-long-term-outcomes/

Vittengl JR, Poorer long-term outcomes among persons with major depressive disorder treated with medication, Psychother Psychosom 2017;86:302-304, https://doi.org/10.1159/000479162

Withdrawal symptoms worse than previously thought

Systematic review finds antidepressant withdrawal common and potentially long-lasting - prominent researchers conduct a review of antidepressant withdrawal incidence, duration, and severity. Results lead to call for new clinical guidelines by Zenobia Morrill October 8, 2018 https://www.madinamerica.com/2018/10/systematic-review-finds-antidepressant-withdrawal-common-potentially-long-lasting/

Davies J and Read J, A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based? Addict Behav,2019;97:111-121. Of people coming off antidepressants, 56% experienced withdrawal symptoms; 46% experienced severe symptoms and some people reported problems lasting for up to 79 weeks after stopping their medication. https://www.sciencedirect.com/science/article/pii/S0306460318308347?via%3Dihub

Independent experts

No financial ties to Big Pharma - Many of the worlds most influential medical leaders too cosy with pharma by Ray Moynihan, 5 June 2020

This influence contributes to a medical culture that overstates treatment benefits, downplays harms and labels far too many healthy people as sick. https://johnmenadue.com/medical-leaders-and-drug-companies-by-ray-moynihan/  

Similarly, when English Professor Dr Christopher Lane started researching why so many of his students were on antidepressants, he found medical colleagues who helped him with the maths insisted their names not appear in his book because it could jeopardize their connections to drug companies that were funding their studies. Thats just one indication that theres a strong disincentive to be critical of drug companies from Christopher Lane interview Whats wrong with psychiatry by Arnie Cooper, Sun magazine, March 2002  https://www.thesunmagazine.org/issues/435/side-effects-may-include

More harm than good

Prof Peter Gøtzsche “It is absurd to use drugs for depression that increase the risk of suicide and homicide …”  Peter C Gøtzsche, Antidepressants and murder: case not closed, BMJ 2017;358:j3697  https://www.bmj.com/content/358/bmj.j3697/rr-4

“… we know that cognitive behavioural therapy halves the risk of repeated suicide attempts … It should be the preferred treatment for all patients with depression” Peter C Gøtzsche and Pernille K Gøtzsche, Cognitive Behavioural Therapy Halves the Risk of Repeated Suicide Attempts: Systematic Review, J R Soc Med. 2017;110(10):404-410 https://pubmed.ncbi.nlm.nih.gov/29043894/

Prof David Healy “in every single one of these trials (medication) has produced more harms than benefits in the sense that it has made children become suicidal who wouldn't have become suicidal if they hadn't been put on these drugs” Teenage antidepressants 'doing more harm than good' By Shelley Jofre BBC Scotland health correspondent, 5 February 2018, https://www.bbc.com/news/uk-scotland-42917452

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Non-drug options that have been found to work as well as - or better than - medication

CBT

Talk therapy such as CBT (cognitive behaviour therapy) is as effective as medication and seems to reduce the risk of relapse in the long-term. A simpler, cheaper version was found to be just as effective (1) DeRubeis RJ et al, Cognitive therapy versus medication for depression: treatment outcomes and neural mechanisms, Nat Rev Neurosci, 2008;9(10):788-96. (2) Richards D et al, Cost and Outcome of BehaviouRal Activation (COBRA): a randomised controlled trial of behavioural activation versus cognitive-behavioural therapy for depression, Health Technol Assess, 2017;21(46):1-366 https://pubmed.ncbi.nlm.nih.gov/18784657/  

Since 2013, in Australia a program called NewAccess has offered six free sessions of low-intensity CBT with a qualified coach. Of 11,000 participants so far, 68% have recovered.

https://www.beyondblue.org.au/get-support/newaccess

Exercise

Exercise was found to be as effective as Zoloft (sertraline) medication in the famous Duke university study of 2000 where 30 minutes of brisk exercise three times a week were just as effective as drug therapy in relieving the symptoms of major depression in the short term, and continued exercise greatly reduced the chances of the depression returning. "For each 50-minute increment of exercise, there was an accompanying 50 percent reduction in relapse …”said lead author Dr Blumenthal https://today.duke.edu/2000/09/exercise922.html  Blumenthal JA et al, Exercise and Pharmacotherapy in the Treatment of Major Depressive Disorder, Psychosom Med. 2007; 69(7): 587–596. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2702700/

More recently, an analysis of RCTs found that supervised aerobic exercise - 45 minutes of moderate intensity 3 times a week – “showed a significantly large overall antidepressant effect compared with antidepressant medication and/or psychological therapies.” Morres ID et al, Aerobic exercise for adult patients with major depressive disorder in mental health services: A systematic review and meta-analysis, Depression and Anxiety, 2018; DOI: 10.1002/da.22842 https://www.sciencedaily.com/releases/2018/10/181018125207.htm

Meditation

Meditation “appeared to provide as much relief from some anxiety and depression symptoms as what other studies have found from antidepressants” - Goyal M et al, Meditation Programs for Psychological Stress and Well-being, JAMA Internal Medicine, 2014  https://www.sciencedaily.com/releases/2014/01/140106190050.htm
 
A review of studies on the effects of relaxation techniques found most of the treatments produced similar effect sizes except that transcendental meditation had significantly larger effect size.  Eppley KR et al, Differential Effects of Relaxation Techniques on Trait Anxiety: A Meta-Analysis, J Clin Psychol,1989;45(6):957-74. https://pubmed.ncbi.nlm.nih.gov/2693491/ 

A quick intro to meditation

Meditation plus exercise

A 2016 study found that 30 minutes of focused attention meditation followed by 30 minutes of aerobic exercise, twice a week for 2 months reduced the symptoms for a group of students by 40 percent – “there is a striking improvement in depressive symptoms along with increases in synchronized brain activity" https://www.sciencedaily.com/releases/2016/02/160210134834.htm

Tai chi

A 12-week program of instruction and practice of Tai chi led to significantly reduced symptoms of depression in Chinese-Americans not receiving any other treatments … "Finding that tai chi can be effective is particularly significant because it is culturally accepted by this group of patients who tend to avoid conventional psychiatric treatment" https://www.sciencedaily.com/releases/2017/05/170525103816.htm

Yoga

An 8 week randomised trial found 2 sessions per week of yoga led to significant reductions in depression severity in adults with mild-to-moderate major depression, Prathikanti S et al, Treating major depression with yoga: A prospective, randomized, controlled pilot trial, PLoS One, 2017;12(3):e0173869. https://pubmed.ncbi.nlm.nih.gov/28301561/

Diet

The RPAH diagnostic elimination diet worked for treatment resistant depression – where drug treatment failed – and has helped for many of our readers.  Parker G and Watkins T, Aust N Z J Psychiatry Treatment-resistant depression: when antidepressant drug intolerance may indicate food intolerance, 2002;36(2):263-5. https://pubmed.ncbi.nlm.nih.gov/11982551

Many studies have shown that ultra-processed food intake is linked to risk of depression - “a positive association between UPF consumption and the risk of depression that was strongest among participants with low levels of physical activity” Gómez-Donoso C et al, Ultra-processed food consumption and the incidence of depression in a Mediterranean cohort: the SUN Project Eur J Nutr. 2020 Apr;59(3):1093-1103. https://pubmed.ncbi.nlm.nih.gov/31055621/

A 12 week controlled trial of a Mediterranean style diet found that a healthful diet could improve depression symptoms within three weeks. Jacka FN et al, A randomised controlled trial of dietary improvement for adults with major depression (the 'SMILES' trial), BMC Med, 2017;15(1):23. https://www.smh.com.au/lifestyle/health-and-wellness/diet-could-improve-depression-symptoms-in-three-weeks-study-finds-20191008-p52yme.html

“AVOID UNNECESSARY MEDICATION”

RPAH Diagnostic Elimination Diet Handbook, https://www.slhd.nsw.gov.au/RPA/Allergy/resources/foodintol/handbook.html

200 common medications can actually cause depression and suicidality

"More than a third of American adults are using medications that have the potential to increase their risk of depression ... The 203 drugs the researchers identified include some of the most commonly prescribed medications around like birth control, beta blockers for high blood pressure, and proton pump inhibitors for acid reflux ..."

Depression and suicide risk are side effects of more than 200 common drugs, Julia Belluz, June 15, 2018, https://www.vox.com/science-and-health/2018/6/14/17458726/depression-drugs-suicide-side-effect See full list at the end of article.

Qato DM et al, Prevalence of prescription medications with depression as a potential adverse effect among adults in the United States, JAMA, 2018;319(22):2289-2298. doi: 10.1001/jama.2018.674

New guidelines for doctors

“... guidance on treating depression in adults now states that withdrawal symptoms may be severe and protracted in some patients” compared to guidelines published in 2009 stating that withdrawal symptoms were “usually mild and self limiting over about one week”.  Iacobucci G,  NICE updates antidepressant guidelines to reflect severity and length of withdrawal symptoms, BMJ, 2019;367:l6103. https://www.bmj.com/content/367/bmj.l6103

See also recommendations by UK psychiatrist Professor David Healy to manage withdrawal symptoms https://www.benzo.org.uk/healy.htm

More information

Do antidepressant drugs really work? Michael Greger MD FACLM 6 min truly outstanding video

Management of withdrawal symptoms by UK psychiatrist Professor David Healy https://www.benzo.org.uk/healy.htm  

Benzodiazepine Dependence, a hard habit to kick by American pharmacologist Joe Graedon https://www.peoplespharmacy.com/articles/benzodiazepine-dependence-a-hard-habit-to-kick

Psychiatric drugs are doing us more harm than good by Professor Peter C. Gøtzsche, DMSc, MD, MSc – who possibly knows more about medications than anyone on the planet having worked both as a pharmacological researcher for the drug industry and then, after retraining, as a doctor. https://www.theguardian.com/commentisfree/2014/apr/30/psychiatric-drugs-harm-than-good-ssri-antidepressants-benzodiazepines

The Pill That Steals Lives, A Family's Nightmare on Mental Health Street - 2 min video - from award winning documentary film-maker Katinka Blackford Newman who nearly lost her own life due to antidepressants “Over 100 million people worldwide take antidepressants and for 1-4% the side effects can be lethal …” https://www.youtube.com/watch?v=M1rAAPklkGQ  

In Australia, NewAccess offers 6 free sessions of low intensity CBT with a trained coach

More info about diet

Introduction to food intolerance

Our list of supportive dietitians

Our 51 page collection of readers’ success stories about depression, anxiety, panic attacks and self-harm 

BLOG The suicide report 
 
BLOG Diet for depression