Oasis Magazine Articles

Depression Suppression

By Amina A. Young, RPh



Although mental health awareness campaigns run in the month of October, most of us can agree that February is the most depressing month. This month has little to offer: bad movies, postholiday weight gain, broken New Year’s resolutions and being plain broke from the holidays. For most of us, such occasional mood changes are normal and temporary. Unfortunately, this cannot be said of the 350 million suffering from clinical depression.

Clinical depression is not a simple condition. Women are twice as likely to be affected and it is estimated that over 800,000 people per year commit suicide from depression. In 2009, a Cairo University psychiatry professor claimed that 1.2 million Egyptians suffer from depression. This is possibly an understatement due to a lack of resources for diagnosing, and the overall stigma mental health disorders may hold in certain cultures. It has many different types and severities (mild, moderate, severe). Likewise, sufferers can experience a number of symptoms that determine the type of depression experienced. More information can be found in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM5) also known as the holy bible of mental disorders.

People are treated for depression so they can lead a productive life and be able to function in school, work and other social settings. Treatment helps eliminate or at least decrease negative symptoms, and decrease the number of times depressive episodes occur in one's lifetime. It is also used to prevent self harm and decrease the risk of suicide. Depression is the result of a chemical imbalance in the brain. Some of the chemicals involved (also known as neurotransmitters) include serotonin (5HTP), dopamine (DA) and norepinephrine (NE). Medications are used to help correct this balance.
 

Medications:

Selective Serotonin Reuptake Inhibitors (SSRIs): This is the first, and most popular group of medications. It is also usually the group of drugs most patients try first and the most prescribed for depression. It works by making sure serotonin (5HTP) stays in the brain longer and it has a long history of safety and efficacy. A major complaint is sexual dysfunction. Examples are citalopram, escitalopram, paroxetine, fluoxetine, sertraline. 

Serotonin Norepinephrine Reuptake Inhibitors (SNRI): These drugs work by ensuring both serotonin and norepinephrine are in the brain longer. These drugs are usually given after an SSRI has been tried and didn’t work. Earlier it was thought they worked better than SSRIs but when compared, the difference was small and hard to measure. Examples are venlafaxine, desvenlafaxine, duloxetine.

Tricyclic and Tetracyclic Antidepressants (TCAS and TeCAs ): These are reserved for when SNRIs and SSRIs don't work. Usually they are avoided in elderly since it can cause dizziness, and constipation which harder to manage in older individuals. Even though they work well, their side effects are not as tolerable to most. Examples are amitriptyline, nortriptyline, mirtazapine.

Monoamine Oxidase Inhibitors (MAOI): This group of drugs has been around a very long time. Rarely used unless the 3 previously mentioned groups do not work. People taking drugs in this group need to be closely monitored. There are also a number of food restrictions when taking these drugs. Examples are phenelzine, tranylcypromine, moclobemide.

 

Other:

Bupropion: Works on both dopamine and norepinephrine. Not usually considered a first choice but great as an “add on” to existing medication to maximize treatment. Also, it is given to those if they are trying to quit smoking or weight loss is recommended.

Trazodone : This drug is unrelated to the other groups but works by increasing serotonin. It is not commonly prescribed because it causes excessive drowsiness. This is sometimes added to those already on an antidepressant to help them sleep at night.

Vortioxetine : This is the newest drug on the market. Like trazodone, it shares no similarities with other medications but also works on increasing serotonin. It seems to be a good option when SSRI/SNRI are not working. New studies indicate this drug may soon be a suitable first choice. There also may be fewer side effects associated with this option. Only time will tell how it performs, as more studies are in progress.

 

Natural products:

St. John’s Wort: Probably the most famous and studied plant for depression. There are studies that show it works, and others that show it doesn’t. When combining the evidence it can be concluded that it does help with depression for mild to moderate cases. It works similar to prescription medication. The downside is that this product has a lot of drug interactions.

SAMe (S-adenodyl L-methionine): Through a very complicated mechanism, this molecule increases the neurotransmitters and chemicals in the brain such as dopamine, norepinephrine and serotonin. Unfortunately, good formulations are expensive comparable to prescription medication.

Inositol : Formerly called a Vitamin B8, but now downgraded to a sugar alcohol that is not essential to humans since we can self produce it. Benefits have been seen at high doses, however, larger scale studies are needed to confirm this.

Vitamins and Essential Fatty Acids: Specifically Folic acid, Vitamin B12, Vitamin D, Vitamin E and Vitamin C have been focused on. Poor nutrition is sometimes a theory thrown around for causing depression. Good nutrition gives positive benefits to overall health, so studying vitamins is important. Unfortunately, lots of conflicting data is reported. Essential fatty acids from fish oils such as EPA and DHA are important for our brains and nervous system. Countries that eat more fish seemed to have lower rates of depression. When looking at the studies, certain groups seemed to benefit when taking fish oils for depression, where as other groups showed no improvement.

Hormones : DHEA (dehydroepiandrosterone) is a hormone made in our bodies, but is also commercially available. The way it is thought to work is unclear, but it was found those with depression seemed to have low levels of DHEA, especially as we get older. The studies were done on a very small number of people and larger studies are needed with better controls to confirm if it really works. Safety is also a concern here, where evidence is needed that taking this hormone at higher doses won't increase the risk of certain cancers.

Neurotransmitter Precursors : These are molecules required to make the neurotransmitters or chemicals that we make naturally anyways. By ingesting the ingredients needed to make these molecules, the idea is it may increase levels in the brain. A few examples include L-tryptophan, 5HTP, phenylalanine. Some of these studies show these molecules work, other show they do not. More information and properly controlled studies are needed.

Others: Other agents claiming to help with depression include damiana, lavender, yohimbe, turmeric, ginkgo, saffron and glutamine. Writing about each one would make a very long article! However, saffron is worth mentioning since it is showing some very exciting results. But this became quickly less exciting when the only country taking time to evaluate this is Iran. Because of saffron’s potential, hopefully other studies will follow.

 

Therapies:

Electroconvulsive Therapy (ECT): This is still considered controversial by some, but has been around a long time. It is usually only offered for severe cases needing quick results, or where everything else has been tried and deemed unsuccessful. It has an unusually high success rate but factors limit its use, such as needing to do multiple sessions per week for several weeks, cost of treatment and strange temporary effects like amnesia and confusion.

Psychotherapy (including cognitive, behavioural and interpersonal): This is a very important part of treatment and invaluable when combined with medication. Therapy can be individual, group or family therapy if needed. This helps with problem solving and coping techniques through exercises that help change how one thinks. Therapy is usually customized based on the specific goals you are trying to reach.

Lifestyle Considerations: Coping with depression is more than just taking medication and some therapy. Doing your best to create better sleeping habits, adding some physical activity and healthy eating all contribute to one's overall wellbeing. Also minimizing caffeine and alcohol consumption is ideal. Lean on family and friends for support, and know there are lots of options not mentioned so talk to a professional and don't be afraid to do your own research. If you hear about a medication your coworker is on that is working great, remember this doesn't mean it will work for you. Take time for yourself, to read, meditate and perhaps relieve stress with an adult coloring book. If you have young children (and boarding school and summer camp is not an option) schedule some time apart since studies show a few hours a week of childcare / any assistance can be beneficial.

Disclaimer: Always consult a primary care practitioner before initiating or discontinuing treatment.





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