Modern antidepressants are the go-to treatment for major depression.
About half of people who take antidepressants say that they feel better, yet many of them still struggle with symptoms of depression, including insomnia and difficulty thinking.
Those symptoms can make life miserable, and raise the risk of descending back into depression.
To find out just how bad this problem is, researchers at the University of Texas Southwestern Medical Center in Dallas combed through data from the STAR*D trial, one of the biggest studies ever done on depression treatments.
They looked at 428 people who took the antidepressant citalopram (brand name Celexa) for 12 weeks. (Citalopram is in the same family of antidepressants called SSRIs that was pioneered by Prozac.)
Those people said they got better, but also still had symptoms of depression. The researchers wanted to find out which symptoms were persisting, and which were popping up for the first time while taking the drug.
"We were surprised to see that thoughts of suicide didn't emerge," Shawn McClintock, a psychiatrist who led the study, tells Shots. "That's counter to popular belief that treatment with an SSRI increases suicidal ideation."
In 2004, the Food and Drug Administration made drugmakers add a black-box safety warning, the strongest type available, to SSRIs, saying that taking them could increase a person's thoughts of suicide. The risk is rare, however.
Indeed, in this study the participants' suicidal thoughts decreased by more than half while taking Celexa, as did their negative self-image, and feeling of being slowed down.
That's the good news. But what's striking about this new study is that many of the people taking the antidepressant continue to struggle with symptoms that can make life miserable, especially insomnia. Almost all of the people said they continued to have problems with insomnia, with 81 percent reporting being unable to sleep in the middle of the night, 71 percent reporting sad mood, and 40 percent reported a decreased lack of interest in activities.
Surprisingly, a lack of sex drive wasn't on the list, even though it's a common side effect of SSRIs.
In addition, people said that new problems cropped up while they were taking the antidepressant. Those included new bouts of insomnia and a lack of interest in daily activities.
The insomnia is particularly troubling, McClintock says, because lack of sleep can lead to more clinical depression — and because insomnia can be treated. Sleep medication or treatments like cognitive behavioral therapy can get the insomnia under control. "One medication may not always do the trick," he says.
His advice for people taking SSRIs: Monitor your symptoms, and work with your doctor to address each one. Don't figure that SSRIs are magic bullets — or that they are the only option.