On April 10, 2001, 16-year-old Cory Baadsgaard woke up for school feeling out of sorts. After informing his parents that he was not well, he went back to bed for a nap. According to subsequent narrative, he regained awareness that evening in a juvenile detention center with no idea why he was there or any memory of having left his bed. During the interim, police reports indicate that Cory got out of bed, dressed himself, brandished a big-game hunting rifle, snuck through the side door of his school and held 23 of his classmates and a teacher hostage for over half an hour while alternately threatening murder and suicide. Mental health experts who worked with Cory after the incident (and later testified at his trial) claimed that he suffered from REM sleep disorder, a rare but serious condition that, given the circumstances, could have been triggered by a transition between two popular antidepressants.
Are psychotropic medications really a factor in provoking such abnormal behavior?
Many mental health professionals report that antidepressants alleviate suffering and prevent suicides — especially when used in conjunction with psychotherapy. Other experts raise the red flag on what they claim is rampant overuse of medication. Though antidepressants have been around since the 1950s and studied extensively for over 20 years, science has a long way to go to answer all the questions.
ANTIDEPRESSANTS IN AMERICA
According to the National Centers for Health Statistics and for Disease Control and Prevention (CDC-NCHS), the rate of antidepressant use in the United States has increased nearly 400 percent since 1988. One in 10 Americans over the age of 12 use an antidepressant, with 14 percent of that number continuing treatment for more than 10 years.
HOW DO ANTIDEPRESSANTS WORK?
The current generation of antidepressants is thought to relieve symptoms of mental illness by increasing levels of neurotransmitters such as serotonin in the brain. Restoring balance to neurotransmitters that are disrupted as a result of mental illness can improve communication between nerve cells, which can lead to relief from symptoms.
WHAT ARE THE HAZARDS ASSOCIATED WITH USING ANTIDEPRESSANTS?
Examining the question of benefits vs. risks in antidepressants is a difficult undertaking. Nathan P. Greenslit, a lecturer at Harvard University, sums up the conundrum in the Yale Journal of Biology and Medicine.
“The science of depression has become a contest between scientists, pharmaceutical marketing, physicians, professional medical organizations, regulatory agencies and patients,” he says. “In this controversial arena, the science of antidepressants has become uncertain, and physicians, policymakers and consumers are left with few brute facts about if and how antidepressants work.”
As important as the efficacious value of antidepressant medications is, the question is whether they pose a credible risk to those who use them and, if so, what percentage of patients is affected. In a study published in the International Journal of Risk and Safety in Medicine, Dr. Peter Breggen cites numerous instances of abnormal behavior observed in a study group who used antidepressants.
“Adverse drug reactions include a stimulant profile that ranges from mild agitation to manic psychoses, agitated depression, obsessive preoccupations that are alien or uncharacteristic of the individual and akathisia,” he says. “Each of these reactions can worsen the individual’s mental condition and can result in suicidality, violence and other forms of extreme abnormal behavior.”
Despite a 2006 study published in the American Journal of Psychiatry that indicates a decline in suicide among children aged 5-14 coinciding with increased use of SSRI antidepressants, some doctors claim that improved motor functions resulting from stimulation to neurotransmitters can actually increase the risk of suicide in patients suffering from major depressive disorder (MDD) who lack improvement in cognitive function. Enough evidence supporting the possibility of serious side effects in children existed in 2004 to prompt the Federal Drug Administration to require a warning on all antidepressants alerting physicians and patients to increased risk of aggression and thoughts of suicide in some patients, specifically those between 18- to 24-years-old. The warning label on a popular selective serotonin reuptake inhibitor antidepressant states: antidepressants increased the risk of suicidal thoughts and behavior in pediatric and young adult patients in short-term studies. Closely monitor all antidepressant-treated patients for clinical worsening, and for emergence of suicidal thoughts and behaviors. This warning is alarming considering that the CDC estimates less than half of patients taking multiple antidepressants have seen a mental health professional during the course of a year’s treatment. Primary care practitioners are now prescribing 62 percent of the total antidepressants used.
Risks for adverse reactions to the most popular antidepressant medications are heightened during three phases of treatment:
- Inductive phase when medication commences
- Dosage increases
These warnings and observations seem to support the argument used by mental health experts during Cory Baadsgaard’s trial defense. A young man with pre-existing social and mental problems had an adverse reaction to a transition between two commonly prescribed psychotropic medications, which nearly ended in disaster. The subjective nature of the incident poses a challenge for science, and researchers are left scrambling for a definitive answer as to whether or not the current trend in antidepressant use is advisable.
Unfortunately, we don’t fully understand the mechanisms of psychotropic medications on the human mind. Until science sheds greater light on the subject, the pathway of prudence seems safest.
“Our society likes a quick fix,” says Dr. Victoria Dunkley, author of Mental Wealth. “But it is wise to obtain an evaluation from a mental health professional first, including a psychiatrist, if medication is being considered. Medication isn’t necessary most of the time. When it is, the decision shouldn’t be taken lightly and careful monitoring should take place.”