A MetaAnalysis That Shows if You Take Antidepressants, You're More Likely to Die, and Affects 1 in 10 People
A study came across my desk recently that really made me think about the impact of the use of antidepressants. As you might know, I am not the biggest fan of antidepressants, but I have always felt like they had their place in helping patients who need a stop-gap measure to get them over a challenge with mood that is significantly interfering with life. In this meta analysis of 17 studies, the investigators looked at the effect of antidepressants on all-cause mortality and cardiovascular events in the general population and in patients with cardiovascular complaints. They found that in the average person, the risk of death from all causes was increased by 33%! That is a huge effect to find in a study, especially to find it across such a wide patient base. The investigators concluded by saying that it was too big of an effect to ignore, due to the fact that 1 in 10 patients in the US are on antidepressants (yes, you read that right -- 10% of patients).
Why Is the Risk of Death So Increased with Antidepressants?
So with that many people on antidepressants, it makes a doctor wonder -- why would the risk be so significantly increased? As I have often explained to patients, antidepressants are usually just masking feedback from your own body about where things are at, both physically and emotionally. Each organ and tissue feeds back information from your body to your brain, where there is some level of interpretation about how you feel at both levels. You can have an emotion from tissue damage as well as from having a life experience. We have language that describes these very particular associations. For example, you can have butterflies in your stomach, someone can make you want to puke or is a pain in the neck, you can be scared poop-less! Every feeling can therefore be a two edged sword. What you thought was anxiety could be an ulcer. What you thought was an ulcer could be anxiety. Your brain can't often tell the difference between the distress signal and a physical problem.
So perhaps herein is the issue -- what if people assume all of their emotions are just not being able to handle life, but that there are times where it is the feedback from the body that the brain is trying to interpret? That could put a person in the position of using antidepressants where another option would have been more healing.
Good News Though -- Antidepressants Don't Increase Risk of Death if You Already Have Cardiovascular Disease
Now, the other thing that was found in this study is that there wasn't an increased risk of dying if you already had cardiovascular disease and then took antidepressants. The proposed reason is that antidepressants might have anti-clotting effects. I think that is an interesting hypothesis, considering that this doesn't appear to have any beneficial effect on the rest of the patient populations, many of whom should be able to benefit from this effect!
One of my observations is that when people have cardiovascular disease where there has been damage to the heart or large vessels they are highly likely to have suffered depression before it and in the recuperation from a cardiovascular event. This is because the heart is really the centre of not just blood flow regulation, but also of joy and trust. When a person has had a cardiovascular event, part of the creation of that event is a problem with joy and trust in life. Putting antidepressants into a situation like this might actually be stabilizing an aspect of heart health that we don't normally look at with respect to cardiovascular disease.
So What Can We Take Away From This?
Spending the time to identify where a feeling or symptom is coming from is crucial in making the most appropriate choice for care and treatment. Whether it is anxiety, depression, a vague feeling of unease, all of your perceptions are important in a health evaluation. If you find yourself experiencing emotions that are uncomfortable, whether you can identify the source or not, we can explore together how to best use the information to put you to right. The human experience is a complex one. Sometimes I have observed that patients are very eager to quickly "get over" a trouble, and in their eagerness, miss the whole message behind the journey.
I have this favourite poem that I think alludes to the use of our emotions as a starting point. It is by Rumi and I like it so much that I put it up in my office with one of my favourite hiking photos:
