Keri had been struggling with depression since her childhood, when her parents split up. She felt that her adverse childhood combined with a family history of struggles with depression nearly sealed her fate.
"I was often caught in a negative thought loop: Was I doing well at work? Is the economy going to crash? before she knew it, my mind would spiral out of control, sinking deeper into her own negative thought pattern."
Over time, these tendencies affected her sense of well being and self worth. She had tried many remedies over the years to overcome this depression from natural therapies to pharmaceutical interventions, but nothing seemed to work.
Depression, without a doubt, is a complex, multifactorial illness. In today's world, depression is increasingly pervasive and touches all aspects of modern life. This illness can be so deep rooted that it often requires an equally complex and thorough treatment plan.
Today, one in five American adults experience mental illness. Almost 7 percent of American adults live with major depression, and that number continues to grow every year. In fact, depression is now the leading cause of disability worldwide, affecting more than 300 million people of all ages. The World Health Organization (WHO) has determined that depression is ranked 4th on the global 'burden of disease' list. Rates of depression continue to increase and the WHO predicts that it will be the 2nd most common global burden of disease by 2020.
Over the next several weeks, I will be blogging extensively on the topic and will provide many ways to overcome the burden of depression. What I seek to do in this series of articles is not to provide a "silver bullet" cure, but rather to provide a wide array of strategies, that when used together, can help manage, mitigate, and even overcome the symptoms of depression.
The Problem With Antidepressant Medications
The most common pharmaceutical treatment for depression includes a class of drugs called SSRIs. Common drugs in this class include Prozac, Zoloft, Paxil, and Lexapro. While these medications can be effective in a certain percentage of the population suffering from severe depression, SSRIs continue to be "under the gun" as its effectiveness continues to be critically challenged.
For example, clinical trials testing the efficacy of drugs are generally funded by the drug companies trying to validate their use. However, drug companies can choose whether or not to publish the results of these trials. Guess which trials the drug companies tend to leave unpublished? In the world of antidepressants, 37 out of 38 positive trials were published, while only 3 of 36 negative studies were published. Previously, the published research seemed to indicate that 97% of studies support the use of SSRI's. However, the reality, when considering both the published and unpublished studies, demonstrated that SSRIs performed better than a placebo in only half of all studies. It should be noted that the unpublished studies became available during the discovery process in pending lawsuits against the pharmaceutical companies.
This type of selective publishing drastically misrepresents the benefits of these medications. Sadly, more than one in eight Americans above the age of 12 now report taking an antidepressant. Moreover, according to the latest statistics, 17.3 million American adults and 3.2 million adolescents suffered at least one major depressive episode in 2017. Moreover, evidence shows that 6 week trials have a higher success rate than longer, 8 week trials. The longer the study, the more poorly the study participants taking medication fared, suggesting that longer term use of antidepressants may be ineffective.
As we see above, the efficacy of these medications have been called into question in recent years. Taken as a whole, the evidence (here and here) seems to suggest that SSRIs only have a place in cases of severe depression and are not effective for those suffering from mild or moderate depression.
Moreover, in many instances, the side effects of these medications often outweigh any benefits. One of the more severe side effects of SSRIs includes suicide ideation, especially when used in adolescents. This issue became such a concern that the FDA mandated that all SSRIs include a "black box warning" to alert consumers of this danger. The black box warning is the pharmaceutical equivalent of the surgeon general's warning found on cigarette packs.
Sadly, SSRIstories.com has archived over 6000 reports associating SSRIs with suicide and other violent behavior. Moreover, when suicide rates skyrocketed among Iraq and Afghanistan veterans, SSRIs were thought to have played a role. SSRIs are commonly prescribed for veterans suffering from Post Traumatic Stress Disorders (PTSD). Other known side effects of SSRIs include decreased libido, sexual dysfunction, increased risk of type 2 diabetes, and possibly an increased risk for dementia.
Prozac, one of the most commonly prescribed antidepressants was first approved in 1987. Over the next 10 years, over 35,000 complaints were filed after those taking the medication suffered from a wide array of side effects ranging from birth defects to suicide and serotonin syndrome, a condition that leads to agitation, confusion, and high blood pressure.
One 2017 meta analysis of 131 placebo controlled trials concluded that "SSRIs significantly increase the risk of both serious and non-serious adverse events. The potential small beneficial effects seem to be outweighed by harmful effects.”
SSRI stands for selective serotonin re-uptake inhibitor. Serotonin plays numerous different functions in the human body including regulating mood, social behavior, appetite, digestion, sleep, memory, and sexual desire. It is often referred to as the happy neurotransmitter because of the role it plays in happiness and wellbeing. SSRI medications seek to make more serotonin available in the brain to exert its positive effects.
However, the reality is that serotonin is only one of the dozens of chemicals in the body that mediate happiness and wellbeing. There are numerous pathways involved which we have not even begin to understand. Modulating the natural processing of serotonin may throw other neurotransmitters off balance and thus lead to unwanted side effects.
To attempt to modulate mood by altering levels of this one neurotransmitter in the brain alone may be short sighted especially because serotonin works throughout the entire body. In fact, 90% of the serotonin in the body is produced by bacteria in the gut. (hint: perhaps a better strategy would be to optimize the health of our gut bacteria).
A Word of Caution
It should be noted that antidepressant medications can be useful and certainly has its place in the medical profession. If you are currently taking antidepressant medication and feel that the benefits outweigh the downsides, my goal is certainly not to discourage you from taking SSRIs.
If you or someone you know is considering stopping your antidepressant medication, I strongly urge you not to do so without the supervision of a medical professional. Withdrawal from these medications can be severe and even dangerous. In coming weeks, I will share natural strategies to help manage, mitigate and even overcome the symptoms of depression. These strategies can be helpful as a pre-emptive strategy for those who are considering starting an antidepressant or even for those who are currently taking antidepressants and are considering weaning off of them.
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Dr. Ram Cheruvu, Pharm.D.
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