Is there a need for new drugs?

Exercise is the most effective prescription, and untreated depression frequently resolves in less time than drugs take to kick in.

Fascinating quote: “[T]he drug may lower signs of depression in mice by targeting immune cells and tamping down on inflammation in the brain that may be interfering with important brain connections.”

I’ve found for myself that depression rears its ugly head when I’m under chronic stress, especially when I’m not eating an anti-inflammatory diet.

I just wanted to point out three quick things: exercise helps a lot with depression, SAM-e was as effective as Prozac in a big Harvard study, and the length of untreated depression is often less than 1 month.

Exercise for depression

There is plenty of research showing that exercise is an effective treatment for depression. Keep in mind it works better as a preventative than as a treatment, since depressed people often can’t motivate to exercise.

Of course, enough sleep probably helps here too. My number one depression trigger is insufficient sleep, and it probably has to do with cortisol levels.

SAM-e for depression

The supplement SAM-e functions as a methionine donor in the brain. Research including a Harvard study have shown it to be as effective as SSRIs but to also work in conjunction to them.

Of course, a “works for everyone” new drug would be a blockbuster pharmaceutic hit, but there are already effective supplements on the market too, including SAM-e, methylated B vitamins, St. John’s Wort, and saffron extract.

The length of untreated depression

Some recent research argues that antidepressants do more harm than good, and there is no reason to think a new drug would work otherwise.

The basic argument is that your body is smarter than you are and will regain homeostasis after a few weeks on any antidepressant medication:

“The more antidepressants perturb monoamine levels in the brain, the more the brain appears to push back, which increases the risk of relapse when the drug is discontinued. This positive relationship also strongly suggests that patients who get better without the use of antidepressants (i.e., when serotonin and norepinephrine levels are not perturbed) will have a lower risk of relapse. […] Antidepressants increase the brain’s susceptibility to future episodes of depression (Andrews et al., 2011) — Free full text available online at Pubmed

(Subjectively, I felt this to be exactly the case after two weeks on Cymbalta — after a great week I was back to baseline after week two.)

The researchers in that article argue that antidepressants have a clinically insignificant effect on anything except severe depression:

“The estimated 3-month risk of relapse for patients who had remitted while on placebo was only 21.4%, while the risk after antidepressant discontinuation generally increased with the monoaminergic perturbational effect of the class: 43.3% (SSRI), 47.7% (SNRI), 55.2% (TCA), 61.8% (fluoxetine), and 75.1% (MAOI).” — ibid

In other words, taking a placebo means a depressed person has half the chance of having their depression relapse compared to taking a medication.

So maybe the medications just turn depression into a chronic condition (that appears to require continued treatment and thus generates additional profits). That was my experience, as I talk about next.

My story

After having repeated episodes of severe-but-not-lingering depression (that were associated with occupational burnout), my physician put me on the SSRI Lexapro. I stopped being depressed, but I also stopped being motivated to. I also felt like I had memory loss and simply did not remember the passing of time as I used to. After a few months, I switched to Cymbalta, a SNRI, that worked great for a week but then left me with no improvements in mood or motivation. I spent most of the next year with a tremor, having panic attacks most days, and with persistent suicidality. My depression remained severe the entire time I was on the drug, but it lifted within two weeks of coming off it.

Of course, a correct diagnosis probably would have helped — I likely had depressed mood due to working overly long hours secondary to attention deficit. Antidepressants made me work slower and have additional difficulty concentrating. So, curing my undiagnosed burnout, treating my undiagnosed ADD, or fixing my undiagnosed failing relationship would have all helped — it’s just that my doctor only recommended depression drugs.

Presently I have no depression symptoms at all now that I’m getting enough sleep; not working a high-stress, low-reward job; avoiding sugar; performing meaningful work; and exercising twice a day.

In my case, using SAM-e was hugely helpful for my depression, but at the end of the day nothing was going to reduce my depression while my job and closest relationships were all being strained by my depression. In a real sense I had to discard those, focus on myself, and then re-engage with work and relationships once I re-emerged in a healthy place.

I’m still taking methyl B vitamins because I find they improve my alertness, but I’m sure the next time I experience depressed mood I’ll look at sleep, exercise, diet, and SAM-e before I suffer another year of having uncontrollable symptoms including shaking and panic attacks like I had on Lexapro and Cymbalta.

Of course, I’m not recommending anyone go off their medications, but the following quote has helped me to become more emotionally mature and choose what I want out of life:

Depression is the reward we get for being 'good’. —Marshall Rosenberg in NonViolent Communication (p. 49)

Thanks for reading, and best of luck to anyone going through the process of improving their own mental health.