Over the years I have noted a substantial number of my patients particularly with endometriosis have been taking antidepressant and antianxiety medication. These drugs predominantly belong to a class known as selective serotonin reuptake inhibitors (SSRIs). These agents are not without side effects and most patients would experience some issues. Additionally, people become in essence addicted to them. Most patients find it extremely difficult to come off them and need to decrease dosages very slowly to successfully wean off. This last issue may become critical as we enter a world where increasingly medication shortages are becoming a problem and supply of these agents may not be guaranteed.
For some time it has struck me that many patients taking SSRIs on a chronic basis are probably not doing themselves a favour. There will clearly be a number of people who definitely need to continue these agents and remain in close contact with their treating doctor but my conversations with patients have led me to believe this is a minor part of the group. Most people appear to start for some acute reason and then never stop. There appear to be multiple papers suggesting that many of the anti-inflammation tactics used to assist endometriosis patients also decrease the need for SSRIs and in many cases work better than the drugs. It is becoming increasingly clear that endometriosis is more than simply some endometrial cells outside the uterus but is in fact a chronic systemic inflammatory condition. As such I have been advising patients that they approach holistic lifestyle measures to decrease inflammation such as exercise, fasting, avoidance of processed foods, cold showers, mindfulness acupuncture and the like.
A recent editorial in the esteemed Economist highlights these issues and I intend to discuss the benefits of stopping with more of my patients in the future.
