Are you one of the millions of people who feel flat, lethargic, depressed, anxious and/or irritable? Are you lacking in motivation, constantly worried, or find it hard to think?
If so, have you gone to your GP for help, and, after a short appointment, given an anti-depressant prescription as a solution to your woes? MOST PROBABLY! Anti-depressants are the third highest selling pharmaceutical drug world wide.
Your doctor most probably explained that your condition is due to a chemical imbalance in the brain and that the medication will correct this imbalance. Accordingly, with prescription in hand, you strongly believe that this will be the solution to your problems and that, after a short period of time, this imbalance will be corrected, enabling you to go back to some form of normalcy.
Unfortunately, after taking the drugs for some months, while you think you might be feeling slightly better, there are other new and concerning symptoms you are experiencing, such as weight gain, increased irritability, sexual dysfunction, loss of libido and even unexplained aggression. Despite still suffering from all your original symptoms and now a new crop of side-effect symptoms, you are too frightened to go off the medication as you feel that if you do, your condition will become worse. Does that sound like you?
So what’s really going on, and if the doctor is correct when he diagnoses a chemical imbalance, why has it not been corrected with the medication and why do you still feel horrible.
Good Question!!
Let’s look closely at whether the primary cause of depression is actually a chemical imbalance, as well as the effectiveness of anti-depressants in treating this condition.
An example of a chemical imbalance in the body can be seen in those patients suffering from diabetes type 1, where there is a deficiency of insulin causing a major dysregulation of blood sugar. The doctor prescribes insulin to normalize the body’s insulin and blood sugar levels. Sure enough, if this is done correctly, all the symptoms related to that deficiency disappear.
So that would mean that as the most popular medication to treat depression are serotonin reuptake inhibitor (SSRI) medication, which prolongs serotonin levels, then the main reason for depression must be a lack of serotonin. Or if benzodiazapenes like Valium, prescribed for anxiety, improve GABA (a calming neurotransmitter) then anxiety must be caused by a lack of GABA. And that is what we have all begun to believe.
But is it true?
In 2014, Blease wrote: “ … the popular conception of depression as wholly caused by biochemical imbalances is such a crude oversimplification of what is known about the causes of depression that it can be regarded as a deception: it renders other causal factors redundant and it promotes the false claim that there is consensus in the scientific community about all the relevant biochemical causes of depression”.
In fact, in 2009, the authors of a meta-analysis, examining the clinical records of 14,000 depressed patients, found that there was no link between depression and low serotonin, nor any link between changes in serotonin levels as a result of stressful life events. Rather they found a significant association between the number of stressful events and depression (Risch, et al., 2009). Furthermore, Kirsch (2014) found that from examining many studies using antidepressants, that It didn’t matter what drugs were used, or for that matter, whether they increased serotonin (SSRIs), decreased it (SSREs -Serotonin Reuptake Enhancers), or had no effect on serotonin at all, the effect on depression was the same. He determined that what all these drugs had in common was that they all produce side effects. Accordingly, as the subjects in these studies were made aware that they might experience such symptoms, they believed they were taking the test drug rather than the placebo, when such new adverse symptoms presented themselves during the duration of the study. So these studies weren’t in actual fact blind trials. Once the subjects felt they knew which medication they were given, their perception changed and became biased, leading to false positive results, similar to that seen when taking placebos (pills that produce positive effects independent of their chemical composition). Jacobsen et al, (2017) supported the findings of Kirsch et al, and concluded that as antidepressants are no more effective than placebos, the serious and non-serious adverse events associated with these medications appears to outweigh any potentially small beneficial effects.
Unfortunately, despite this lack of evidence for the “chemical imbalance’ theory, doctors still prescribe antidepressant medication liberally. In Australia, in 2011, there were 1.7 million people (7.8% of the Australian population) who had filled at least one PBS subsidised prescription for these medications, and of these nearly one-quarter (24.6%) had 11–13 scripts (Australian Bureau of Statistics, 2016). What is even more startling is that Australian use of anti-depressants has doubled over the last decade, with Iceland being the only country with a higher rate of the use of these drugs (Herald Sun, 2017). This is thought to be a result of the pressure that doctors are under and over-prescribing. Yet, despite this increased frequency in prescribing, very few patients are informed that, to date, (1) the causes of depression are not fully understood; (2) there are still no studies that have proven that depression is due to any chemical imbalance in the brain; (3) there can be many causes and these are likely to be complex; (4) there is lack of scientific consensus as to how anti-depressants work; and, (5) there has been no established scientific understanding of what constitutes an optimal brain state and a normal mix of brain chemicals, and how to assess it.
Just treating depression with SSRIs is extremely concerning as it ignores any underlying conditions that might be causing the depression, and discounts the effectiveness of non-pharmaceutical treatments, such as diet and lifestyle. In fact, rather than being a brain disorder, depression is thought to be an important indicator that there is some form of underlying health issue somewhere in the body (similar to a fever), such as blood sugar imbalances, hypothyroidism, low progesterone, vitamin deficiencies, e.g. vitamin B12, essential fatty acids, magnesium or zinc, as well as heavy metal toxicity and lack of exercise, to name a few. Disruption of the microbiome (our healthy bacteria) from overuse of antibiotics, the pill, and/or an unhealthy diet, can also affect mood, as these bacteria are known to regulate neurotransmitters in the brain. Mood disorders can also occur as a result of conditions that affect the production of energy, and those that produce inflammation. In fact, there have been many studies which have shown an undeniable link between gut dysfunction and the brain.
In regards to the inflammatory conditions, inflammatory mediators preferentially steal the amino acid, Tryptophan, from producing serotonin and melatonin, in favour of the production of niacin, an important B vitamin needed for energy production. Consequently, not only will there be reduced production of the neurotransmitters, but, in the process of niacin formation, a metabolite, quinolinic acid, is produced, which is highly toxic to nerve cells in the brain. While the patient’s serotonin levels might improve initially with medication, the underlying inflammation and the production of a potent neurotoxin might not be addressed, causing the inflammatory disorders to progress, and the depression to worsen.
Furthermore, prescribing doctors usually fail to explain that antidepressant medication is known to be highly addictive and considered among the most difficult drugs available to stop. In fact, it may take months or even years to reduce or even totally discontinue these drugs in the right way. Also, there have been known cases of people who have committed murders as a result of uncontrolled aggression caused by psychotic medication.
And if that is not enough, what is really alarming is that despite antidepressants, especially SSRIs, being originally intended for adults, they are being increasingly prescribed for children and adolescents for the treatment of depression, anxiety, and other mental disorders. Why is this alarming? Aren’t these drugs a welcome help for these children who are increasingly experiencing mood disorders and increased suicide risk? Unfortunately, there is a strong association of SSRIs with psychiatric adverse events in this age group, such as irritability, agitation, aggression, insomnia, hostility, restlessness, somatic manifestations of anxiety, panic attacks, impulsivity, disinhibition, emotional liability, social withdrawal, akathisia (an extreme form of restlessness), odd behaviour, hypomania/mania, and paranoia or other psychotic symptoms. Particularly worrisome is the association of SSRIs with the increased risk of suicide (Sharma et al., 2016). Yes, you heard correctly! The conditions that these drugs are supposed to treat in children, are what they can cause, and as early as the first few weeks after drug initiation. Indeed, antidepressants double the frequency of suicide in this age group. Don’t take my word for it. This has been known for some time, so much so that the UK and US regulatory bodies published a warning that these drugs may pose a risk of suicidality, violence, aggression, mania, and other abnormal behavioral changes (Amitai et al., 2015). And, from 1999-2013, concurrent with the huge 117% increase in the use of prescription drugs for psychiatric conditions, was a 240% increase in death rates from these medications.
As stated above, although the mechanisms for antidepressants are still not fully understood, they do sometimes help in more severe cases. So this blog is not about totally discounting the effectiveness of these drugs. And it is not my place to advise my patients to stop taking their medication. This is something that can only be done by their prescribing doctor. My concern is more with the fact that by quickly prescribing these drugs we could be ignoring the underlying health issues that might actually be responsible for the mood disorder.
I wonder if the increase in depression and anxiety is as a result of the unhealthy lives that most children and adults live, with limited exercise and an over abundance of processed, high sugar, foods? Or perhaps it has more to do with their social and family environment. Indeed, physical activity alone can treat mild to moderate depression symptoms (Hallgren et al, 2015; McCurdy et al, 2017). Could addressing these issues and investigating other deeper health issues be a more sensible way to treat the condition? If we just give medication, and don’t address the underlying factors, the individual’s health issues or their social environment will not improve, and nor will their depression, causing them to take antidepressants for life, battling side effects and addictions.
If you, or your loved ones, are suffering from depression or anxiety and are looking for a different way to address these conditions, please do not hesitate to contact me. Also, if you have still not read my other blogs, please click here. Furthermore, I have a facebook page that not only shares some of my blogs and videos but provides valuable health information. If you gain insight from some of the contributions, don’t forget to click on the “Like” button. do not hesitate to contact me. And if you have still not read my other blogs, and would like to, please click here.
Also, please leave a comment below, as I, and others reading this blog, would love to know your experience with depression and what has worked for you.
References:
ABC News (2017). OECD snapshot ranks Australia second in world in anti-depressant prescriptions. Retrieved from: http://www.abc.net.au/news/2013-11-22/australia-second-in-world-in-anti-depressant-prescriptions/5110084
Amitai, M, A., Weizman, A., & Apter, A. (2015). SSRI-induced activation syndrome in children and adolescents—what is next?. Current Treatment Options in Psychiatry, 2(1), 28-37.
Australian Bureau of Statistics (2016). Patterns of Use of Mental Health Services and Prescription Medications, 2011.
Retrieved from: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject4329.0.00.003~2011~Main%20Features~Antidepressants~10008
Blease, C. (2014). The duty to be Well-informed: The case of depression. Journal of medical ethics, 40(4), 225-229.
Kirsch, I. (2015). Antidepressants and the placebo effect. Zeitschrift für Psychologie (222), 128-134
Hallgren M, Kraepelien M, Öjehagen A, (2015). Physical exercise and internet-based cognitive-behavioural therapy in the treatment of depression: randomised controlled trial. Br J Psychiatry, 207(3), 227-234. doi:1192/bjp.bp.114.160101
Jakobsen, J. C., Katakam, K. K., Schou, A., Hellmuth, S. G., Stallknecht, S. E., Leth-Møller, K., … & Krogh, J. (2017). Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and Trial Sequential Analysis. BMC psychiatry, 17(1), 58.
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McCurdy AP, Boulé NG, Sivak A, Davenport MH (2017). Effects of exercise on mild-to-moderate depressive symptoms in the postpartum period: a meta-analysis. Obstet Gynecol,129(6):1087-1097. doi:1097/AOG.0000000000002053.
Risch, N., Herrell, R., Lehner, T., Liang, K. Y., Eaves, L., Hoh, J., … & Merikangas, K. R. (2009). Interaction between the serotonin transporter gene (5-HTTLPR), stressful life events, and risk of depression: a meta-analysis. Jama, 301(23), 2462-2471
Sharma, T., Guski, L. S., Freund, N., & Gøtzsche, P. C. (2016). Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. bmj, 352, i65.