A lot of recent research has suggested that an overactive inflammatory response in the body is connected to depression and that anti-inflammatory medication seems to help. Read the Story
Anti-Inflammatory Drug Proves Effective for Treating Severe Depression
How Stress and Depression Can Shrink the Brain
Major Depression or chronic stress can cause the loss of brain volume, a condition that contributes to both emotional and cognitive impairment. Read the Story
Tripping the Switches On Brain Growth to Treat Depression
A recent study shows that antidepressants can produce positive effects on brain structure depending on their ability to raise the levels of growth factor in the brain. Read the Story
Foods That Can Help Counter Depression
You are what you eat. Find out what foods fight depression. Read the Story
The Charlie Rose Show: Depression
From The Charlie Rose Show on PBS, an excellent and thoughtful one hour exploration of what depression is and how we can treat it. It’s well worth the 60 minutes. Watch the Show
How Lawyers Can Choose the Right Treatment for Depression
Dr. Irving Kirsch, a professor at The University of Hull, has caused a stir lately with a body of research suggesting that SSRIs, the most common class of antidepressant, are no better than placebos. (Here is a 60-Minutes story about his findings.) Of course, for every SSRI skeptic there are any number of evangelists who swear by the drugs.
Personally, I’m undecided. I’ve seen SSRIs aggravate depression by muting happy emotions and adding unpleasant side-effects, while offering no measurable antidepressant effect. But I have also seen them help. In rare cases, they have been a godsend.
For anyone considering antidepressants, I would humbly suggest that the question, do antidepressants work, is the wrong question. The more relevant and pragmatic question is this: might antidepressants be helpful in my particular case?
The SSRI debate is useful in general, but it is mostly irrelevant to individual cases. It’s a bit like debating the effectiveness of transmission replacements for cars. Sometimes a new transmission fixes a car, sometimes it doesn’t. It depends on the problem.
If I found a mechanic who insisted on rebuilding every transmission (or who reflexively opposed it) I would find a new mechanic, pronto. I wouldn’t settle for one who failed to define the problem before tearing into my car. Yet that is often what is expected of patients who seek treatment for depression. Describe your symptoms – quickly! – and don’t question my treatment.
It seems to me that our central nervous systems should get at least as much respect as our cars. Of the many times that I have witnessed the failure of an antidepressant, there has been a corresponding misapplication of the drug. The correlation is difficult to ignore.
But don’t take my word for it. There is compelling research suggesting that antidepressants are routinely misused in Western countries. In a rather conservative study, Jureidini and Tonkin (2006) found that many prescriptions (one third or more, depending on the measure and the population) fell outside clinical indications, were given in excessive doses, or were prescribed for far longer than they should have been.
According to another study, only about one-third of patients experience relief after taking an antidepressant for a sufficient period of time (Cascade, Kalali, and Blier, 2007). That’s an exceptionally low number, and I suspect that has more to do with poor diagnosis than the effectiveness of the medication.
Antidepressants may be the first and best option in cases of severe depression. But in mild or moderate cases – which are the vast majority – behavioral interventions work better. Addressing the problems that lie behind depression is often more effective and longer lasting than medication (Dobson et al. 2008).
(Ironically, Jureidini and Tonkin also found that antidepressants are under-prescribed among the seriously depressed who could most benefit from them. They noted that fewer than 25 percent of US, Canadian, and European patients meeting criteria for major depression receive proper medication management.)
Antidepressants appear to be helpful in severe cases but they are probably useless and potentially harmful when they are incorrectly prescribed in less severe cases. I believe that anyone considering SSRIs should first answer these four questions, with the help of a qualified clinician:
- How severe is the depression? There are a number of depression inventories to help answer this question. If the symptoms are in the mild to moderate range, SSRIs are probably an inappropriate intervention.
- Is the depression most likely a result of circumstances or lifestyle choices that will remain unaffected by medication? If so, pills may blunt moods but they won’t fix the problem.
- Have physical problems been ruled out? Depression can be secondary to thyroid problems, low testosterone levels, nutritional deficiencies, sleep difficulties, and other physical problems. SSRIs fix none of these.
- Have healthier interventions failed? Making tough decisions about exercise, diet, sleep, alcohol use, and other lifestyle choices should be the first order of business in cases of mild to moderate depression. Physical exercise alone is as effective as any antidepressant in most cases (it is the benign cure-all that SSRIs wish they could be), and cognitive behavioral therapy is an excellent response to circumstances or lifestyle choices that contribute to depression.
SSRIs should only be taken with considerable deliberation and a solid understanding of the problem at hand. Despite their benign image, they are the furthest thing from harmless happy pills. They come with side effects, and there is evidence that they can have serious, long-term effects on the central nervous system. If SSRI’s are the right answer for you, then by all means, use them. But please take the time to properly define the problem first.
I realize that it is an investment of time and money, and I know that depression deprives a person of gung-ho initiative. It might be simpler to skip the process and take the pills, but we only get one brain each. Taking time to define the problem could prevent years of wasted effort and needless suffering.
Dr. Shawn Smith is a psychologist in Denver and the author of The User’s Guide to the Human Mind: Why Our Brains Make Us Unhappy, Anxious, and Neurotic and What We Can Do about It.
New Depression Therapy is Still Developing
Lots of law students and lawyers have mixed results with medication to treat their depression — even worse, some of these medications don’t work at all or have too many side effects. Find out about this new treatment which uses magnets to treat depression. Read the Story
Inability to Experience Pleasure During Major Depression Could Lead to Novel Treatment
Stanford Medical School has discovered the brain pathway responsible for adnedonia – the inability to experience pleasure – during major depression. Read the Story
Risk for Depression and Chronic Inflammation Increased by Childhood Adversity
From Medical News Today, a great piece about the powerful connection between a difficult childhood, depression and inflammation in the body. Read the Story
Obesity, Depression Found to Be Root Causes of Daytime Sleepiness
Three studies conclude that obesity and depression are the two main culprits that make us excessively sleepy when awake. Read the Story
Built by Staple Creative