The Most Widely Prescribed Medication in the USA in 2007

Side effects or not, antidepressants were the most widely prescribed medications in the USA in 2007. Increased antidepressant use is said to result from direct consumer advertising which leads people to request antidepressants from doctors. There is some question as to whether antidepressants are over-prescribed, but many physicians believe it's better to over-prescribe than under-prescribe since depression can lead to suicide.

WHAT THEY DO

Antidepressant medications are based on the theory that low levels of the brain neurotransmitters serotonin and norepinephrine cause depression. They are thought to work by raising these neurotransmitter levels. Because antidepressants may stabilize emotions, they are also prescribed for panic disorder, chronic pain, mood disorders, eating disorders and obsessive-compulsive disorder.

COMMON ANTIDEPRESSANTS

(1) Selective serotonin reuptake inhibitors (SSRIs) are believed to increase serotonin levels in the brain. Common SSRIs are Prozac, Paxil and Zoloft. Side effects may be sexual dysfunction, nausea, decreased appetite, anxiety and insomnia.

(2) Serotonin norepinephrine reuptake inhibitors (SNRIs) such as Effexor, Pristig and Cymbalta increase both serotonin and norepinephrine. Side effects include those of SSRIs along with vivid dreams.

(3) Norepinephrine and dopamine reuptake inhibitors (NDRIs) increase norepinephrine and dopamine levels. Side effects of agitation and raised blood pressure have been noted. This drug is marketed under the trade names Wellbutrin (for depression) and Zyban (for smoking cessation).

(4) Norepinephrine and specific serotonergic antidepressants (NASSAs) like Tolvon and Remeron are newer drugs which increase norepinephrine and serotonin but may have fewer (although different) side effects, like drowsiness, increased appetite, and weight gain.

(5) Norepinephrine reuptake inhibitors (NRIs) like Edronax increase norepinephrine levels only and are thought to improve concentration and motivation.

(6) Antidepressants with combined neurotransmitter effects like Desyrel (trade name Trazodone) may be helpful for panic disorders, anxiety and restlessness. But Remeron may cause birth defects, premature birth and miscarriage, while Serzone may worsen preexisting liver conditions.

ADDITIONAL CONSIDERATIONS

A new theory proposes that the decreased sexual arousal and desire produced by raised serotonin levels from SSRIs may inhibit the processes of falling in love, bonding with a mate and developing feelings of love and affection in general.

Some antidepressants may increase suicidal thoughts and behavior in those under 25, and Paxil can increase hostility and aggression. Although antidepressants may relieve depression they do nothing for mania, and may even trigger manic episodes in bipolar patients.

Because they suppress Rapid Eye Movement (REM) sleep, intense nightmares may develop when antidepressant medications are terminated. SSRIs and especially SNRIs can cause severe withdrawal symptoms if not gradually discontinued.

DO ANTIDEPRESSANTS WORK?

Regardless of phenomenal sales, there is little evidence to show that antidepressants actually work. Of all studies submitted to the FDA between 1987 and 2004, only half showed any significant effect of antidepressants over placebos, while up to half of those treated with antidepressants showed no improvement whatsoever.

In February 2008 a study of the most commonly prescribed antidepressants was released in the Public Library of Science Medicine, an online medical journal, by Professor Irving Kirsch of the University of Hull in the UK. Subjects receiving antidepressants showed only a "very small" improvement of 2 points on the Hamilton Depression Scale compared to those receiving a placebo.