5 Reasons Antidepressants are Not the Best Choice

Antidepressants are one the first lines of treatment for depression. While antidepressants are invaluable for many depression sufferers, they're not always the best choice for some people.

Children, Adolescents, and Young Adults

In 2004, a well-publicized study linked an increase in thoughts of suicides, or suicide attempts, to young people taking antidepressants. This prompted the Food and Drug Administration to issue a "black box warning" (its most serious), that antidepressants may have unintended effects on some people, especially adolescents and young adults.

While a National Institutes of Mental Health study suggests the benefits of antidepressants likely outweigh the risks for children and adolescents with major depression and anxiety disorders, it may not be the best option for those with mild to moderate depression.

Pregnant and Breastfeeding Women

There is conflicting data on the safety of antidepressant use in pregnant or breastfeeding wome n.

A recent study reported that pregnant women taking antidepressants, especially Paroxetine and Venlafaxine, had a 68 percent higher risk of miscarriage than women who don't; other studies raise additional concerns.

At the same time, physicians fear not treating depression might cause significant short- and long-term health problems in women and their children. When antidepressants are warranted, physicians should start with low doses and gradually increase them as needed. If possible, waiting until after the first trimester to begin antidepressants may further minimize potential risks.

Older Adults

Depression is common in older adults. However, some studies link antidepressant use to other health problems prevalent in this population. For example, adults over 50 who use a daily antidepressant had double the risk of a clinical fragility fracture. Osteoporosis and other health conditions weaken aging bones, putting seniors at risk for serious fractures. Another study found that seniors who take SSRI (selective serotonin reuptake inhibitors) antidepressants were 15 percent more likely to develop cataracts.

Patients with Mild to Moderate Depression

Antidepressants seem to be most effective for those with moderate to severe depression, while individuals with less serious depression may achieve good results with psychotherapy and other lifestyle changes.

Alcohol Use

Alcohol use or abuse often occurs in people with depression, so it bears mentioning. Physicians warn against drinking while taking antidepressants. The combination can worsen depression and medication side effects, and drinkers are more likely to become intoxicated.

Every medication has side effects and associated risks. You should always discuss the pros and cons of depression treatment options with your physician, especially if you fall in one of the above categories.


National Institutes of Mental Health. "FDA Warnings On Antidepressants." Web. 5 August 2010. http://www.nimh.nih.gov/health/publications/eating-disorders/fda-warnings-on-antidepressants.shtml

National Institutes of Mental Health. "What medications are used to treat depression?" Web. 13 September 2010. http://www.nimh.nih.gov/health/publications/mental-health-medications/what-medications-are-used-to-treat-depression.shtml

Hackley, Barbara CNM, MSN. "Antidepressant Medication Use in Pregnancy." Journal of Midwifery & Women's Health 55(2) (2010): 900-100. Medscape Medical News. Web. 25 March 2010. http://www.medscape.com/viewarticle/717972

Brauser, Deborah. "Antidepressant Use During Pregnancy May Increase Miscarriage Risk." CMAJ online May 31, 2010. Medscape Medical News. Web. 7 June 2010. processing....


Goldberg, Joseph F. MD, Pollack, Mark H. and Nierenberg, Andrew A. MD. "How Effective are Antidepressants?" Medscape Medical News. Web.11 March 2010. http://www.medscape.com/viewarticle/718270

Brauser, Deborah. "Broad Review of FDA Trials Suggests Antidepressants Only Marginally Better than Placebo." Psychotherapy and Psychosomatics 79 (2010): 267-279. Medscape Medical News. Web. 24 August 2010. http://www.medscape.com/viewarticle/727323

Atlantis, Evan, Grayson, Dave A., Browning, Colette, Sims, Jane and Kendig, Hal. "Cardiovascular disease and death associated with depression and antidepressants in the Melbourne Longitudinal Studies on Healthy Ageing (MELSHA)." International Journal of Geriatric Psychiatry online 5 August 2010. Web.


Richards, J. Brent MD, Papaioannou, Alexandra MD, MSc, Adachi, Jonathan D. MD, Joseph, Lawrence PhD, Whitson, Heather E. MD,  Prior, Jerilyn C. MD, and Goltzman, David MD. "Effect of Selective Serotonin Reuptake Inhibitors on the Risk of Fracture." Archives of Internal Medicine 167 (2007): 188-194. Web .http://archinte.ama-assn.org/cgi/reprint/167/2/188

American Academy of Ophthamology. "Antidepressants Linked to Cataract Risk; Parkinson's Drug May Cause Corneal Damage." Press release 1 June 1010. Web. http://www.aao.org/newsroom/release/20100601.cfm