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Tag: antidepressants

  • What data tells us about antidepressants and mass violence

    No study has shown that antidepressants known as selective serotonin reuptake inhibitors — SSRIs — cause people to be violent. 

    But for years, Health and Human Services Secretary Robert F. Kennedy Jr. has floated antidepressants as a potential cause of violence, including mass shootings. 

    The U.S. Centers for Disease Control and Prevention “is finally confronting the long-taboo question of whether SSRIs and other psychoactive drugs contribute to mass violence,” Kennedy said in a Nov. 4 X post. 

    Health officials have long monitored the side effects of such drugs, which millions of people use. Although future research could uncover new findings, existing data points don’t reflect that SSRIs cause mass violence. Here’s what we do know. 

    #1: Nearly 29 million U.S. adults took antidepressants for depression in 2023. 

    SSRIs treat mental health conditions such as depression, anxiety, post-traumatic stress disorder and obsessive-compulsive disorder. Brand name drugs such as Prozac, Zoloft, Celexa and Lexapro are all SSRIs. 

    Depression is common, and many people use SSRIs. 

    In 2023, the most recent year for which there’s CDC data, about 11% of U.S. adults took prescription medication for depression. The U.S. Census Bureau estimated about 262.3 million adults lived in the U.S. that year. That means that in 2023, about 28.85 million adults took prescription medication for depression. That number doesn’t include minors who took such medications, or adults who took antidepressants to treat conditions other than depression. 

    #2: Mass violence is rare.

    In the same way there’s no single definition of a mass shooting, there is no one definition of mass violence. 

    Experts who study it, however, say mass shootings are rare. They’re also what Dr. James Knoll, director of forensic psychiatry at SUNY Upstate Medical University and Dr. Ronald Pies, a psychiatry professor at Tufts University School of Medicine, described as “disproportionately an American phenomenon.” SSRI use, in contrast, is not unique to the U.S.

    #3: Since 1988, SSRI use has increased, but violent crime has not. 

    Prozac, the first SSRI available in the United States, launched in 1988. Since then, antidepressant use has increased significantly. From 1988 to 2008, the CDC reported a nearly 400% increase in antidepressant use.

    Although no one factor can explain national crime trends, an increase in SSRI use has not resulted in more violent crime. Violent crime rates rose from 1988 to 1991, but then began a more consistent downward trend. 

    In 1988, the violent crime rate per 100,000 people was 640.6. In 2023, it was 363.8. 

    We haven’t seen a massive increase in violent crime in the United States or Europe since SSRIs were introduced, despite millions of people being prescribed the drugs, said forensic psychiatrist Dr. Gwen Adshead. 

    #4: The people most likely to take SSRIs aren’t the most likely to perpetrate mass violence.

    If using SSRIs made a person more likely to commit acts of mass violence, we’d expect the demographics of SSRI users to better correspond with the demographics of people who commit mass violence. 

    That’s not the case. 

    “We have not seen an increase in violent crime by the general population of people with depression and anxiety,” Adshead said. “The demographic of people who kill or commit violent crimes have not changed.” 

    For example: Data shows men are more likely to perpetrate violence, but women are more likely to be prescribed SSRIs.

    “If there was a connection or link, one would expect it to be pronounced, or at least much greater than we are seeing,” Knoll previously told PolitiFact. “Why do we not see increased violence in women? People over 60?”

    If SSRIs were linked to mass violence, Dr. Ragy Girgis, a Columbia University clinical psychiatry professor who studies mass violence, said we’d expect people who perpetrate mass violence to be more likely to be treated with SSRIs than the general population. 

    “The data show that people who perpetrate mass violence are actually less likely to have received treatment with an SSRI,” Girgis said. 

    An analysis of Columbia University’s Mass Murder Database found that about 4% of mass shooting perpetrators in the past 30 years had used antidepressants in their lifetime — a rate below that of the general population.

    #5: Research has not proved SSRIs cause mass violence. 

    Some studies show an association between SSRI use and violence, but association is not the same as causation. 

    When Knoll and Pies reviewed existing data, they found no evidence establishing a direct causal connection between antidepressants and violence. 

    “Most violence, especially fatal violence, involves a complex interaction between two people,” Adshead said. “Drugs, prescribed or otherwise, can affect people’s mental states and are known to increase violence risk.”

    Some data shows that SSRIs can increase impulsivity for some people while other data has shown SSRIs help reduce it.

    RELATED: RFK Jr. has targeted antidepressants for kids. How do SSRIs work?

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  • RFK Jr. promised to ‘Make Our Children Healthy Again.’ Here’s how he plans to do it

    (CNN) — President Donald Trump’s strategy to ‘Make America Healthy Again’ includes investigating vaccine injuries and pharmaceutical practices but stops short of new regulatory action, for now.

    US Health and Human Services Secretary Robert F. Kennedy Jr. unveiled the MAHA strategy on Tuesday, joined by Agriculture Department Secretary Brooke Rollins, Environmental Protection Agency Administrator Lee Zeldin, and other top Trump officials.

    The report hews closely to a draft document circulated in August that cites earlier Trump administration announcements — developing a definition for ultraprocessed foods, educating the public about synthetic kratom — but largely bypassed industry crackdowns.

    Language around pesticides strategy also remained unchanged. Environmental and food activists had rallied for the administration to include steps to reduce pesticide usage and probe potential health risks of commonly used chemicals such as RoundUp.

    The report says that USDA, EPA and the National Institutes of Health will develop a framework to study cumulative exposures to chemicals including pesticides and microplastics. USDA and EPA will also invest in new farming approaches to reduce chemical use, and EPA will launch a public awareness campaign about the limited risk of approved products.

    The commission’s first report this May suggested a broad range of factors driving chronic disease in the US, including ultraprocessed foods, environmental exposures, and overprescription of pharmaceuticals like antidepressants.

    The report noted previous announcements that HHS, the NIH and the Centers for Medicare and Medicaid Services are studying the causes of autism. Kennedy had previously promised some answers on the root causes in September; NIH is expected to announce autism research grants this month.

    Recent reports suggest that HHS will issue a report that links the development of autism to taking Tylenol during pregnancy.

    Medicines and vaccines

    Kennedy has drawn criticism for suggesting antidepressants, particularly those that are part of a family known as SSRIs are as addictive as heroin and can be dangerous. Following the August 27 shooting in Minneapolis, he told Fox News that HHS is launching studies “on the potential contribution of some of the SSRI drugs and some of the other psychiatric drugs that might be contributing to violence.”

    SSRIs, or selective serotonin reuptake inhibitors, are the most prescribed class of antidepressants for depression, anxiety disorders and many other mental health conditions. Several SSRIs have been on the market in the United States since the 1990s, including Prozac, Zoloft and Celexa. Experts agree that there is no scientific evidence or correlation between these drugs and violence towards others.

    Tuesday’s report states that HHS will assemble a working group of federal officials to evaluate SSRI prescribing patterns, specifically among children. HHS will also “evaluate the therapeutic harms and benefits of current diagnostic thresholds,” or the current common practices doctors use to diagnose patients with mental health disorders.

    Dr. Theresa Miskimen Rivera, president of the American Psychiatric Association said access to care, not over-medication is the bigger problem when it comes to helping kids’ mental health in the country, and there is no mention of the issue in the report. The report said addressing a child’s nutrition, screen time, and exercise can improve their mental health, but can’t address everything. “Psychiatric conditions are complex in nature,” she said. Extreme poverty, post traumatic stress disorder, trauma-related factors should also be addressed, but there is no mention in the report of any of those issues either.

    “In terms of over medication, that’s not what we do. We have a comprehensive evaluation and we are evidence based. We diagnose than create a comprehensive treatment plan, “ Miskimen Rivera told CNN. “Medication can save lives, not only in children, but in adults and elderly.”

    When asked about whether or not the commission chose to consider gun violence – the leading cause of death for children – as one of the issues to be investigated, Kennedy doubled down on the issue of prescription drugs, saying “We are doing studies now, or initiating studies to look at the correlation and the connection, potential connection between over medicating our kids and this violence.”

    HHS will also work with the White House Domestic Policy Council on a new vaccine framework that, the report said, will ensure “America has the best childhood vaccine schedule” and ensure “scientific and medical freedom.”

    The report comes as Kennedy continues to defend his shakeup of the US Centers for Disease Control and Prevention over vaccine policy, including the ouster of CDC Director Dr. Susan Monarez.

    The administration will also increase oversight of “deceptive” direct-to-consumer advertising of pharmaceutical products, including from social media influencers and telehealth companies, it said.

    Food policy stays the course

    FDA will continue work on developing a definition for ultraprocessed foods, but the report bypasses recommendations, like those of former FDA Director Dr. David Kessler, to essentially order certain additives off the market until they are reviewed.

    Dr. Dariush Mozaffarian, director of Tufts Food is Medicine Institute said a definition of ultraprocessed foods would be “really important.” With more than half of calories in the food supply coming from ultraprocessed foods, addressing this and other issues involving the nation’s diet would mean a “massive fight with the industry and is going to be incredibly controversial, but is much needed.”

    “Overall, this is really quite thorough, quite specific, and even if parts of this are accomplished, this could have tremendous positive impact for Americans,” Mozaffarian told CNN.

    Other experts, like Marion Nestle, agreed the report was ambitious in scope, but noted it fell short on regulatory action. “What’s still missing is regulation. So much of this is voluntary, work with, promote, partner,” said Nestle, who is the Paulette Goddard professor emerita of nutrition, food studies and public health at New York University.

    The report also nods to new, user-friendly dietary guidelines expected later this year. Kennedy has promised a vastly shortened set of recommendations that will emphasize whole foods.

    The commission also cited ongoing work to reduce ultraprocessed foods in the Supplemental Nutrition Assistance Program (SNAP) and Head Start.

    While the report also touches on agriculture deregulation with the aim of making it easier for small farms to get greater access to markets and schools, Ken Cook, co-founder of the Environmental Working Group, a health advocacy organization said the report abandons earlier MAHA promises to ban toxic pesticides and instead “echoes the pesticide industry’s talking points.”

    “Secretary Kennedy and President Trump cynically convinced millions they’d protect children from harmful farm chemicals – promises now exposed as hollow,” Cook said in a statement.

    There were minor changes from the draft document leaked in August. For instance, the August 6 draft stated that the FDA and other agencies will crack down on “Illegal Chinese Vapes,” while the final version promises enforcement on vapes more broadly.

    “We support the goal of making children healthier and addressing and preventing chronic disease, but unfortunately, the recommendations fall short in some really critical ways,” Laura Kate Bender, vice president nationwide advocacy and public policy for the American Lung Association told CNN.

    “They continue to cast doubt on vaccines, one of the most, important, proven public health interventions that we can have for kids health. They don’t address some major contributors to diseases in kids like pollution, tobacco use, beyond the mention of vaping, and this report is coming out at the same time that we’re continuing to see dramatic cuts in staff and funding of a lot of the programs that could make the good parts of the report a reality.”

    The report’s emphasis on kids’ health can help overall, Dr. Michelle Macy, director of the Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center in Chicago told CNN. “I’m really trying to look for bright spots in this report, and I think that the focus on data and infrastructure for us to be able to answer big questions about what environmental and food exposures and medication exposures do to shape the trajectory of someone’s health and chronic disease across the lifespan is something that has promise and potential.”

    Dr. Richard Besser, pediatrician and president and CEO of the Robert Wood Johnson Foundation said that having a focus on preventing chronic disease in children is a good thing, but he said, with Kennedy’s track record that includes firing thousands of federal health employees, slashing millions in health research funding, dismantling entire offices that managed important issues like smoking and chronic disease specifically, in addition to his “assault on vaccinations” will undermine any potential good of this kind of report.

    “Neither RFK Jr.’s record, nor his policies outlined in the report give me confidence that he is going to make any difference whatsoever on chronic diseases in children,” Besser told CNN.

    Sarah Owermohle, Jen Christensen and CNN

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  • 11 Natural Depression Treatments

    11 Natural Depression Treatments

    Being depressed can make you feel helpless. You’re not. Along with therapy and sometimes medication, there’s a lot you can do on your own to fight back. Changing your behavior — your physical activity, lifestyle, and even your way of thinking — are all natural depression treatments.

    These tips can help you feel better — starting right now.

    1. Get in a routine.If you’re depressed, you need a routine, says Ian Cook, MD. He’s a psychiatrist and director of the Depression Research and Clinic Program at UCLA.

    Depression can strip away the structure from your life. One day melts into the next. Setting a gentle daily schedule can help you get back on track.

    2. Set goals. When you’re depressed, you may feel like you can’t accomplish anything. That makes you feel worse about yourself. To push back, set daily goals for yourself.

    “Start very small,” Cook says. “Make your goal something that you can succeed at, like doing the dishes every other day.”

    As you start to feel better, you can add more challenging daily goals.

    3. Exercise. It temporarily boosts feel-good chemicals called endorphins. It may also have long-term benefits for people with depression. Regular exercise seems to encourage the brain to rewire itself in positive ways, Cook says.

    How much exercise do you need? You don’t need to run marathons to get a benefit. Just walking a few times a week can help.

    4. Eat healthy. There is no magic diet that fixes depression. It’s a good idea to watch what you eat, though. If depression tends to make you overeat, getting in control of your eating will help you feel better.

    Although nothing is definitive, Cook says there’s evidence that foods with omega-3 fatty acids (such as salmon and tuna) and folic acid (such as spinach and avocado) could help ease depression.

    5. Get enough sleep. Depression can make it hard to get enough shut-eye, and too little sleep can make depression worse.

    What can you do? Start by making some changes to your lifestyle. Go to bed and get up at the same time every day. Try not to nap. Take all the distractions out of your bedroom — no computer and no TV. In time, you may find your sleep improves.

    6. Take on responsibilities.When you’re depressed, you may want to pull back from life and give up your responsibilities at home and at work. Don’t. Staying involved and having daily responsibilities can help you maintain a lifestyle that can help counter depression. They ground you and give you a sense of accomplishment.

    If you’re not up to full-time school or work, that’s fine. Think about part-time. If that seems like too much, consider volunteer work.

    7. Challenge negative thoughts. In your fight against depression, a lot of the work is mental — changing how you think. When you’re depressed, you leap to the worst possible conclusions.

    The next time you’re feeling terrible about yourself, use logic as a natural depression treatment. You might feel like no one likes you, but is there real evidence for that? You might feel like the most worthless person on the planet, but is that really likely? It takes practice, but in time you can beat back those negative thoughts before they get out of control.

    8. Check with your doctor before using supplements. “There’s promising evidence for certain supplements for depression,” Cook says. Those include fish oil, folic acid, and SAMe. But more research needs to be done before we’ll know for sure. Always check with your doctor before starting any supplement, especially if you’re already taking medications.

    9. Do something new. When you’re depressed, you’re in a rut. Push yourself to do something different. Go to a museum. Pick up a used book and read it on a park bench. Volunteer at a soup kitchen. Take a language class.

    “When we challenge ourselves to do something different, there are chemical changes in the brain,” Cook says. “Trying something new alters the levels of [the brain chemical] dopamine, which is associated with pleasure, enjoyment, and learning.”

    10. Try to have fun.If you’re depressed, make time for things you enjoy. What if nothing seems fun anymore? “That’s just a symptom of depression,” Cook says. You have to keep trying anyway.

    As strange as it might sound, you have to work at having fun. Plan things you used to enjoy, even if they feel like a chore. Keep going to the movies. Keep going out with friends for dinner.

    11. Avoid alcohol and other drugs. Substance misuse is common in people who have depression. You may be more likely to turn to alcohol, marijuana, or other drugs to deal with the symptoms of your depression. It’s unclear if drinking and using drugs causes depression. But long-term drug use could change the way your brain works and worsen or lead to mental health problems.

    When you’re depressed, you can lose the knack for enjoying life, Cook says. You have to relearn how to do it. In time, fun things really will feel fun again.

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  • Advances in Treatment for Major Depressive Disorder

    Advances in Treatment for Major Depressive Disorder

    Major depressive disorder is the most widespread mood disorder in the world. Also called clinical depression, or just depression, it’s when you have symptoms of low mood or hopelessness for at least 2 weeks. Scientists still don’t know what causes it. But they know that treating it is complex and that people who have it need more ways to feel better faster.

    For about half a century, scientists have put a lot of effort into improving medications that target a small set of neurotransmitters. Those are chemicals in the brain — serotonin, norepinephrine, and dopamine in particular — that affect how your nerve cells talk to each other, which then affects your mood.

    Most people respond to standard antidepressants. But at least 30% of people who try two different kinds of these drugs continue to have symptoms of depression. That’s called treatment-resistant depression.

    So, over the past 2 decades, scientists have changed how they think about treatment for major depressive disorder as their understanding of the brain biology behind depression has changed.

    The biggest change is that medication research has gone past only targeting certain neurotransmitters, says Gerard Sanacora, MD, PhD, director of the Yale Depression Research Program in New Haven, CT. “We’ve opened up a whole new vista of potential targets for new drugs.” 

    New Medications and Faster Results

    There’s a long-held idea that depression takes weeks or months to resolve. But new fast-acting treatments have “changed what we think is possible in the field,” Sanacora says.   

    In 2019, the FDA approved brexanolone (Zulresso). It’s the first drug specifically for postpartum depression, which is a type of major depression. Experts aren’t exactly sure how it works. But it’s a human-made version of a steroid your body makes naturally. It affects your GABA receptors, which help regulate mood.

    Brexanolone isn’t as easy to take as other antidepressants. You get it through a vein in your arm at a health care facility over the course of 60 hours. But it can work quickly. Your depression symptoms might start to lift by the end of your treatment.

    Another breakthrough drug came out that same year.     

    Esketamine is a prescription nasal spray. The low-dose psychedelic drug boosts the activity of glutamate in parts of your brain related to mood. Glutamate’s job is to excite cells in the brain and nervous system. Esketamine can trigger new connections in your brain too. You may start to see improvements in your depression within hours or days of using it, Sanacora says.

    Esketamine offers lifesaving hope for people with suicidal thoughts and relief for people with treatment-resistant depression. But used alone, symptom relief may only last a couple of weeks. That’s why experts agree you should take rapid-onset drugs alongside traditional treatments.

    As for those with mild or moderate depression, Sanacora still first suggests cognitive behavioral therapy, followed by conventional antidepressants also known as selective serotonin reuptake inhibitors (SSRIs). Doctors need more information on the safety and long-term effects of newer treatments for depression.

    “Over the past 20 years, we’ve had a transformative change in the way we treat depression,” Sanacora says. “But we still have to smooth it out to understand for which patients these treatments are best and when.”

    Improvements in Brain Stimulation

    Medications aren’t the only treatment for depression. Electroconvulsive therapy has been around for more than 70 years. It remains one of the most effective ways to manage major depressive disorder, especially if you don’t respond to other treatments. While it isn’t new, scientists have fine-tuned the procedure over the past decades.

    Today, electroconvulsive therapy uses less energy than it did in the past. The goal is to give you the same benefits but with less negative impact on your memory and thinking skills. “That’s been a huge improvement,” says Susan Conroy, MD, PhD, a psychiatrist and neuroscientist at Indiana University School of Medicine.

    Conroy also uses transcranial magnetic stimulation to treat depression, which has fewer side effects than electroconvulsive therapy. It works by sending magnetic pulses around your skull.

    Brain tissue translates these signals into electrical energy, Conroy says, which changes the way areas of your brain talk to each other. “By changing that circuitry, we think that’s how transcranial magnetic stimulation gets people better from depression.”

    These and other forms of brain stimulation aren’t right for everyone. But tell your doctor if other treatments don’t help and your depression keeps you from doing daily activities, you aren’t eating, and you have constant suicidal thoughts.

    “These are all signs your treatment needs to be escalated and pretty quickly,” Conroy says.

    Future Treatment

    Lots of other promising treatments for depression are on the horizon. Deep brain stimulation is one. In this treatment, a surgeon implants electrodes in your brain. These nodes send painless zaps that alter the electrical activity that’s causing your symptoms.

    You can think of this treatment kind of like a pacemaker for your mood. While it’s not approved for the general public, it might be soon. “Technology is advancing really quickly,” Conroy says.

    Researchers are also studying a drug called SAGE-217. Sanacora says there’s interest in how it might help prevent a serious relapse in people with a history of depression. The idea is that you’d take it as soon as your symptoms come back. “But you don’t wait until the symptoms are full-blown,” he says.

    There’s also a lot of buzz around drugs like psilocybin. Studies show these “magic mushrooms” can ease depression about as fast as ketamine — what esketamine is made from — with effects that may last longer. But when it comes to psychedelics, Sanacora says, “We need a lot more research before we can say anything with confidence.”

    In his 25 years in the field, Sanacora says he’s never seen such excitement around treatments for depression. But that doesn’t mean researchers have all the answers or that major depressive disorder has a cure.

    Still, you can take steps now to ease depression or guard against a relapse. That might include medication, different kinds of talk therapy, regular exercise, a good social life, and a healthy sleep routine. You should be doing “all the things we know you can do to protect yourself as much as possible,” Sanacora says.

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