Posts tagged ‘antidepressants’

July 21, 2011

antidepressants lead to more depression?

Patients who use anti-depressants are much more likely to suffer relapses of major depression than those who use no medication at all, according to new research. In an article that is likely to ignite new controversy in the hotly debated field of depression and medication, an evolutionary psychologist concludes that patients who have used anti-depressant medications can be nearly twice as susceptible to future episodes of major depression. (read the story in ScienceDaily)

Below is the abstract for the research which was published in Frontiers in Psychology:

Some evolutionary researchers have argued that current diagnostic criteria for major depressive disorder (MDD) may not accurately distinguish true instances of disorder from a normal, adaptive stress response. According to disorder advocates, neurochemicals like the monoamine neurotransmitters (serotonin, norepinephrine, and dopamine) are dysregulated in major depression. Monoamines are normally under homeostatic control, so the monoamine disorder hypothesis implies a breakdown in homeostatic mechanisms. In contrast, adaptationist hypotheses propose that homeostatic mechanisms are properly functioning in most patients meeting current criteria for MDD. If the homeostatic mechanisms regulating monoamines are functioning properly in these patients, then oppositional tolerance should develop with prolonged antidepressant medication (ADM) therapy. Oppositional tolerance refers to the forces that develop when a homeostatic mechanism has been subject to prolonged pharmacological perturbation that attempt to bring the system back to equilibrium. When pharmacological intervention is discontinued, the oppositional forces cause monoamine levels to overshoot their equilibrium levels. Since depressive symptoms are under monoaminergic control, this overshoot should cause a resurgence of depressive symptoms that is proportional to the perturbational effect of the ADM. We test this prediction by conducting a meta-analysis of ADM discontinuation studies. We find that the risk of relapse after ADM discontinuation is positively associated with the degree to which ADMs enhance serotonin and norepinephrine in prefrontal cortex, after controlling for covariates. The results are consistent with oppositional tolerance, and provide no evidence of malfunction in the monoaminergic regulatory mechanisms in patients meeting current diagnostic criteria for MDD. We discuss the evolutionary and clinical implications of our findings.

Michael C. Neale, Charles O. Gardner, Lisa J. Halberstadt, Susan G. Kornstein, Paul W. Andrews. Blue Again: Perturbational Effects of Antidepressants Suggest Monoaminergic Homeostasis in Major Depression. Frontiers in Psychology, 2011; 2 DOI: 10.3389/fpsyg.2011.00159

July 28, 2010

in place of antidepressants

A new article by Dr. Christiane Northup in looks at “The Limits of Antidepressants: (and) Exploring the Alternatives.” She starts out by reciting recent research that showed that the benefits of antidepressants have been greatly overstated. For instance, in January 2010, a study published in the Journal of the American Medical Association (JAMA)  evaluated another class of antidepressants, tricyclic antidepressants. Again, researchers determined that the typical patient, one with mild to moderate depression, gets the same amount of relief from a placebo as from an antidepressant. The New York Times reported that the co-author of the study, Robert J. DeRubeis, shared this important insight: “The message for patients with mild to moderate depression is ‘Look, medications are always an option, but there’s little evidence that they add to other efforts to shake depression–whether it’s exercise, seeing the doctor, reading about the disorder or going for psychotherapy.'”

The article goes on to talk about the benefits of fish oil, 5-HTP, exercise, and being honest with your feelings.

Once I got to reading this article, it becomes somewhat clear that ‘people taking antidepressants’ really refers to ‘people with mild to moderate depression,’ which she refers to as ‘the typical patient.’ Really, couldn’t we follow her suggested alternatives without leaving psychotropic medication? There’s often an assumption that if only we followed a certain regimen, we wouldn’t need to be taking any meds. Well, in many cases, I’m guessing that people have tried those other options before being prescribed antidepressants. We are not a bunch of lazy people who decided to pop some ‘happy pills’ in lieu of taking care of our bodies. From my experience, the antidepressants are what helped me start taking care of my body, because without it, I sometimes didn’t even bother taking showers or just waking up.

I realize the article wasn’t meant for those ‘severe’ cases, but it still tends to lump everyone in as if we can all just “get over it,” as Northup says.

Man, if I could just ‘get over it’ by simply taking fish oil and being honest with my feelings (again, I doubt not every depressive lies to him/herself), I think I would have taken that option a long time ago.

September 13, 2009

My lunchbox

lunch box
I keep my medication in a metal lunchbox. It’s a cute little way to store all the bottles, I think. I remember when my first prescription directed me to take one 100mg of Wellbutrin SR per day. Those days have clearly passed. In addition to other things, there’s 400mg of bupropion SR (generic wellbutrin) in my system each and everyday. There’s been times when I stopped taking the meds, but it hasn’t occurred to me to neglect this routine in a long time. I have been wondering recently, though, just exactly how much these meds are helping. What kind of difference would I notice if I just quit one day? Will there even be any?

I will take my evening dose, knowing that this would not be a good time to try to find out the answers to these questions. I’ve found out the answers the hard way before, but I guess I never learn.

August 3, 2009

Study: Americans get more antidepressants, less therapy had this article: Number of Americans taking antidepressants doubles. (It’s mainly a summary of a study that’s in the Archives of General Psychiatry.) There are a lot of interesting numbers documented in this piece:

  • By 2005, 10%, or 27 million Americans were taking antidepressants.
  • About 80% of the patients were treated by doctors other than psychiatrists.
  • Half of those taking antidepressants were not being treated for depression.
  • During the study(1995-2005), spending on direct-to-consumer antidepressant ads increased from $32 million to $122 million.

The most concerning data to me was that “among users of antidepressants, the percentage receiving psychotherapy fell from 31.5% to less than 20%.” I can’t tell from the article if this has happened because more people are using antidepressants for issues unrelated to depression, but the article does state that the main reason why people aren’t seeking therapy is because of insurance issues.  In any case, other research has suggested that therapy is an integral part of a long-term treatment plan (This article in NYTimes, for instance, is about the effectiveness of long-term therapy in bipolar depression).  It’s sad to think that many aren’t getting the treatment that they know they need because of issues related to cost.

January 10, 2009

Model Deviance

In Is It Me or My Meds?, Boston College Sociology professor David Karp asks his interviewees about their relationship with their psychotropic medication.  He found that, though some begin their medication career with a bit of trepidation, most “had become wedded to a biomedical version of mental illness.” In the concluding chapters, he becomes skeptical of the growing acceptance of biological psychiatry that has led to an overmedicated society. The skepticism toward embracing a totally medical model of mental illness is, to an extent, understandable.  Karp notes that his issues are with the “confluences of forces that lead doctors to routinely medicate for life distress.” Though my own conclusion of his assessment may not be correct, I got the impression that Professor Karp was a bit wary of wholly accepting the biological model of mood disorders.

Because this book focuses solely on the illness careers of those using pharmacological treatment, obviously it would not address ECT and its patients’ view of self. I’ve come to find that it’s the case in many of the books I’ve read. They all do not discuss beyond the typical illness career that involves wrestling with medication and having to spend time in a hospital. With only about 100,000 patients per year that undergo ECT in the US, I haven’t been able to read up to see a group study of if there’s any personal emotional (or model) transition from having a ‘typical’ illness career to adding ECT to his or her journey. I tend to think that self-identity kind of changes when ECT comes into play.  With just medication and therapy, I think I have some personal ‘luxury’ of accepting or denying ‘my illness as pathology.’  In the case of ECT treatments, I’m not sure that flexibility is available anymore.  It’s a clearly physical procedure, unlike the one I have experienced through the medication buffet. The thought process about ECT, at least for me, has been very different from how I’ve felt about medication. Anyway, the point is that how can one not embrace the medical model of illness and biological psychology when one has consented him/herself to a treatment that directly affects the brain chemistry? I don’t know if I have a choice. What will be interesting to see is if I hold the same self-identity oncethe treatments are underway.

The hospital’s finally settled on my physical exam date of Tuesday, 01.13. There better not be anything that would delay my procedure. Thank goodness the next two days will be occupied by watching copious amounts of football. My little-known love of NFL and certain sports commentators just might help sustain me through the weekend.

January 9, 2009

Finding a little spark

It sure took a while for me to pick a simple web-journal name that doesn’t sound so, well, depressing. I actually liked “the last option,” because that’s kind of what it is (Having trying 20+ different meds should count as having tried a lot of options). But I suppose the ECT is not just the last option but it could be the first time in a long time to actually feel alive, which by the way, I can’t really recall what it’s like to not want to die all the time.

So, I thought “a little spark” is appropriate in several ways, first of which is that it makes ECT sound kind of magical, rather than “you’re going to have a grand mal seizure and will experience some memory loss.” Second, a spark often starts something, like a sparkplug, or a spark that will give one a brilliant idea.  It’s that little spark that I guess I need in order to get a new life, and my little spark that’ll give me that life is actually going to come by means of a little spark (or at least 6 to 12 of them) in my head. Sounds a bit cutesy, and I’m not sure I quite believe what I’m writing. But just because I don’t believe it doesn’t mean I don’t want to believe it.

Btw, after I picked my little journal name, I found that there is a quote by Dante with that phrase: “From a little spark bursts a mighty flame.” And though I write in this tone in my personal, paper-form journal, this exercise in writing on the web feels ridiculously self-indulgent.

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