What you need to know about antidepressants
Marisa Branscombe explores the rise of antidepressants and investigates alternative treatments for depression.
Society seems to be more dependent on drugs as the panacea for all problems. This is the case so often these days, that they are the first port of call for health professionals who don't have time to explore alternative remedies for patients. Antidepressants and mood altering drugs are being prescribed left, right and centre to adults and children throughout Australia. But are these the answer for everyone, or are they only beneficial to those who are in a severe state? Would natural remedies be more appropriate for some sufferers?
Antidepressants: History and types
Researchers began developing a number of synthetic drugs for the treatment of depression way back in the 1950s - and they took off in a big way! At the time they were seen as a breakthrough and almost a rarity, but now a large variety of antidepressant medication is available.
Distinguished by how they affect the balance and function of certain neurotransmitters in the brain, these medications fall into four principle categories:
Progress for developing new and improved antidepressant medication since these various drugs were discovered has been limited. Today's treatments remain sub-optimal, with less than half of the patients treated going into complete remission.
Tricyclic drugs – these dominated the market for 20 years but are much less common now due to their negative side effects.
Selective serotonin reuptake inhibitors (SSRIs) – these work to make more serotonin available and hence elevate mood. Current SSRIs include Prozac, Luvox, Paxil, Zoloft and Celexa. Prozac was the first of these discovered (1974) and a plethora of writing on the science, clinical use and ethics of neuropharmacology almost immediately followed.
Monoamine oxidase inhibitors (MAOIs) – these work to reduce the quantity of the enzyme MAO within the synapses. The use of these types of antidepressants leads to higher levels of adrenaline and dopamine. Current products available include Nardil and Parnate.
Noradrenaline reuptake inhibitor drugs (NARIs) – these affect neurotransmitter activity but do not fit into any of the above categories. Drugs on the market include Wellbutrin, Desyrel, Effexor and Serzone.
The case for antidepressants
When doctors are dealing with patients who are suffering with symptoms of depression or ‘the blues', their first reaction is often to prescribe antidepressants. Why so? Because antidepressants have helped many people live happier lives and statistics show they are effective in reducing depressive symptoms in between 50 per cent and 80 per cent of people.
In fact, researchers from Oxford University, who looked at 31 studies covering 4,400 people, found that there were benefits for those severely depressed to take antidepressants and also in taking them for a longer time period than usual. The usual prescription is six months and these researchers say that extending this to one or two years is beneficial in the more extreme cases. They also found it could substantially reduce the risk of relapse into depressive illness.
The most common side effects include:
Constipation or diarrhoea
Impaired sexual function
Mood flattening and lack of emotion
Another study by the Department of Psychology at the University of Hull is far from convinced antidepressants are the answer, indicating they work no better than a placebo for most patients. Unpublished trials were included in their analysis for the first time ever, and the results showed that pharmaceutical companies had merely cherry-picked the best results of trials to make their drugs appear more effective. This is supported by research recently published in the New England Journal of Medicine.
Aside from this, antidepressants come with a myriad of side effects, many of them which are quite dangerous.
More specifically, SSRIs may additionally cause insomnia, headaches, tremors, excessive sweating and patients can suffer long term withdrawal effects when they cease taking the medication. MAOIs usage may lead to dangerous elevation in blood pressure when mixed with decongestants, antihistamines or foods containing tyramine (red wine and cheese).
Natural mood lifters
Many people prone to depression have found they can control their moods very well with natural supplements. Key mood enhancing herbs and nutrients are St. John's wort, lemon balm, red clover, kava, gingko, phenylalanine, tyrosine, omega-3 fats (EPA and DHA), B vitamins, vitamin C, zinc, L-tryptophan and 5-HTP.
If we look at St. John's wort as an example, its side effects are not nearly as severe or frequent. It is an herb taken by thousands of people across the world every day and in the Europe is prescribed five times as often as Prozac. A study conducted in 1996 among 1,700 people showed that a dose of 300 mg per day of St. John's wort helped those with mild to moderate depression.
Unlike many antidepressants, it can be mixed with alcohol, is not addictive, can easily be stopped and restarted, enhances sleep at night time and alertness during the day. It does not inhibit sex drive and no one has ever died while taking the supplement, unlike the reported deaths of 30 people for every one million people prescribed with antidepressants.
Like synthetic drugs, these too have their cautions. Some people may have adverse skin reactions when taking herbs such as these, but cases are rare. They may also interact with other medications, so it is important to seek medical advice.
Rowena Daw from mental health charity Mind indicates a ‘one size fits all' approach is certainly not the answer when dealing with mental health issues such as depression. "People's experience of mental health is as individual as they are themselves, and issues surrounding side effects, preferences and choices must be taken into account", she says. Antidepressant drugs vary in their side effects and what works for one person may not work for another. To ensure treatment is effective, patients need to be involved in the decision-making surrounding treatment.
Guidance from the Royal College of Psychiatrists states, "Antidepressants don't necessarily treat the cause of depression or take it away completely." However, the current recommendation for those already on the medication is to continue taking them for six months after they feel better, because of the high reported chance of relapse.
Overall, it seems there is a role for medications as well as for herbs in the treatment of depression and other psychiatric issues. There are situations where one treatment is called for and other situations where a combination works best. Many doctors will try natural supplements before recommending antidepressant drugs due to the downsides. However, patient progress should be tracked closely and regularly to ensure a safe mental state is maintained.