antidepressant

How to Tell When It’s Time to Start an Antidepressant

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You don’t have to wait until things get “bad enough” to feel better.

do i need antidepressants

As a recovering perfectionist, I love a good set of rules. There is no greater high than following them exactly. I’ve always been the people-pleasing “delight to have in class,” but my report card days are long gone and the real world doesn’t come with a detailed manual. If it did, I would request a section called: “How to know it’s time to start an antidepressant.”

Until last year, anxiety was (and sometimes still is) my cocaptain. Years of therapy helped me understand that it’s only my brain’s way of trying to protect me. But no matter how much self-awareness I gained, or how impressed I left my therapist (see: delight to have in class), intrusive thoughts still broke through. I struggled to go places alone and constantly braced myself for panic attacks, yet medication didn’t feel like an option for me. Because I wasn’t hyperventilating into a paper bag (some call it “high-functioning”), I had convinced myself I could self-help-yoga-breathwork my way through it.

Then my cat died.

In the three years leading up to that, my husband and I experienced five losses in our family. Grief and I were well acquainted. But my two-year-old cat’s sudden death was the final straw. Therapy could no longer keep me afloat. A friend begged me to see a doctor and to ask about medication. I feared a pill would change me, steal my creativity, or become a crutch.

A year into taking an antidepressant, I can confidently say that’s not the case.

“Following a traumatic event, many people experience acute stress,” Ludmila De Faria, MD, associate program director for psychiatry residency at the University of Florida and chair of the American Psychiatric Association’s committee on women’s mental health, tells SELF. For me, that stress was heaped atop lingering grief and my everyday worries. Together, they wore a ditch into my brain where anxiety thrived.

Experts call this rumination, likened to “a wheel stuck in a rut,” Kathryn Hirst, MD, a psychiatrist at Lightfully Behavioral Health in Encinitas, California, tells SELF. Imagine a car trapped in the mud: With every attempt to accelerate, the tires spin, causing it to sink deeper and deeper. “When anxiety is really bad, the rut is too deep to get out of without help,” Dr. Hirst explains. For a lot of people, medication can shallow the rut, she says, and when it’s taken alongside therapy, “the two might make it so the rut isn’t even there.”

In retrospect, it’s clear I needed help. So to illuminate the warning signs for others, I asked experts when you should consider starting antidepressants, and how to have that conversation with your doctor.

The lingering stigma of SSRIs

Selective serotonin reuptake inhibitors, or SSRIs—drugs like Prozac, Zoloft, and Lexapro—are a “relatively new-ish” class of medications used to treat different types of anxiety, depression, and PTSD. Put simply, they work by increasing serotonin levels in your brain, Dr. De Faria explains. This is crucial because anxiety and depression, two conditions that commonly occur together, can develop when your body doesn’t have enough of this feel-good neurotransmitter.

SSRIs succeeded tricyclic antidepressants (TCAs), which Dr. De Faria describes as “old, clunky” medications that often came with “so many” side effects, like constipation, dry mouth, and urinary retention, among others. As a result, a lot of people dreaded taking them, she says.

Although SSRIs have far fewer side effects than TCAs, and there’s plenty of data to support their efficacy, there’s a persistent stigma that looms around them. One driving force behind that: “There’s still a lot of shame around depression and anxiety—people feel as though they should be able to ‘tough it out’ and get through it on their own,” Dr. Hirst says. “This makes it hard to ask for help, and even harder to accept taking medication.”

Put another way: Mental health conditions are societally “othered,” even though they’re common, Michelle Forcier, MD, MPH, a clinician with FOLX Health and associate professor of pediatrics at the Warren Alpert Medical School of Brown University in Providence, Rhode Island, tells SELF. In fact, as of 2018, 13% of adults in the United States used antidepressants—and depression rates have soared since then, which some researchers largely attribute to the pandemic and its ripple effects.

A lot of folks also don’t understand how depression and anxiety develop in the first place, Dr. De Faria notes. “People still think of psychiatric conditions as a character flaw or a personality issue. And that’s not what it is,” she explains. “It’s very much biological.”

When should you consider starting an SSRI?

From the depths of my ditch, it was hard to see the red flags. “We do have a blind spot for our own functioning,” Dr. De Faria says. I was shocked to learn that you can be diagnosed with depression, and therefore qualify for medication, when symptoms last for just two weeks, according to the DSM-5, the authoritative guide to diagnosing mental health conditions. The criteria for an anxiety disorder differs slightly—symptoms, depending on their nature and how many there are, must persist between two weeks and six months.

In general, the major signs to watch for include persistent worrying or sadness, insomnia, restlessness, a significant change in your appetite, difficulty focusing, a loss of interest in things that once brought joy (like your hobbies), and thoughts of death or suicide.

Dr. De Faria says you shouldn’t wait to bring these symptoms up to your doctor. In fact, if you have any combination of them for “more than seven days in a two-week period, that deserves a conversation.”

If you’re still unsure, Dr. Hirst recommends asking yourself the following questions:

According to Eric Lenze, MD, head of the department of psychiatry at Washington University’s School of Medicine in St. Louis, there’s even a version of the questionnaire providers use to guide diagnoses, called the PHQ-9, online. If you take it, and your total score is 10 or higher, he recommends talking to a doctor about SSRIs, as well as your therapy options. (Gentle reminder: That score doesn’t replace an official diagnosis from a health care provider.)

If you decide to seek help and your provider agrees that antidepressants and/or therapy make sense for you, know that you don’t have to take SSRIs forever once you start them. “I see many patients who are able to take medication—and ideally, engage in therapy—feel better, and then taper off medication [under the guidance of their doctor] after they’ve been doing well for several months or a year,” Dr. Hirst says.

Dr. De Faria agrees and makes a good point: “Would we be having this conversation if you had pneumonia and needed an antibiotic?”

How to talk to your provider about starting an antidepressant

When I decided to pursue medication, I sought out a practice that specialized in anxiety and ultimately saw a psychiatric nurse practitioner, who treated me. Even a psychologist or therapist, unless they have certain credentials (typically MD or DO—and, in some states, PhD or PsyD), can’t prescribe medication.

Primary care doctors are actually the most common prescribers of antidepressants in the United States, Dr. Hirst says. “It’s as simple as telling your provider that you are depressed or anxious, and you want to know if medication could be helpful,” she explains.

Put another way, Dr. De Faria says it’s worth asking directly: “Can we assess my symptoms to see if there’s a need for further treatment?” And when talking about your symptoms, Dr. Forcier says it’s important to highlight those that especially worry you, how often they occur, and how they affect your daily life. (Note: You should be screened for bipolar disorder before you start SSRIs, as they may worsen symptoms of the condition for some people. And be sure to discuss any potential thoughts of self-harm with your doctor before starting any new medications.)

Most people notice the impacts of an antidepressant—good and bad—after about four weeks, Dr. Lenze says. The biggest potential side effects to be aware of include a lower sex drive, weight fluctuations, and sleep problems. If the dose of your prescription needs to be tweaked, don’t be discouraged—the process often takes some trial and error. “We know that the majority of patients can get well with treatment, so don’t settle for a medication that doesn’t work or only works a little,” Dr. Lenze urges. “Dose increases and medication changes are often necessary to get well.”

Again, experts strongly recommend taking medication and going to therapy for the best results if you’re dealing with severe mental health symptoms. “They work better together in many cases,” Dr. Forcier says. Both SSRIs and therapy are designed to correct the biological causes of anxiety and depression; therapy also teaches you how your symptoms show up in everyday life, and how to respond to them productively. Of course, whether you try one or the other or both is an extremely personal decision.

For me, when I had both at play, it was like a critical switch—one that was snapped off and stuck in fight or flight for years—was repaired with a spare part and, finally, slipped into neutral. I still have bad days and will always be joined by anxiety in some way. The little blue pill I take simply demotes it from cocaptain to backseat driver, where its voice is a lot quieter.

If you are struggling and need someone to talk to, you can get support by calling the Suicide & Crisis Lifeline at 988 or by texting HOME to 741-741, the Crisis Text Line. If you’re outside the United States, here is a list of international suicide helplines.

Antidepressant Use in Pregnancy

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A new mouse study investigated the impact of SSRIs on brain development.

  • A new mouse study found antidepressant use during pregnancy may influence brain development in utero.
  • Most antidepressants are safe to use during pregnancy, according to experts. Depending on the severity of mental illness, withholding medication can lead to more severe health risks.
  • Other treatments for depression include cognitive behavioral therapy, interpersonal psychotherapy, support groups, mindfulness, yoga, and exercise.

A new mouse study found taking antidepressants during pregnancy may affect brain development in utero and be a risk factor for developing mental health disorders later in life.

The findings were published February 16 inNature Communications.Trusted Source

Researchers examined the impact of a chemical called fluoxetine on mice.

Fluoxetine elevates the amount of serotonin in the brain and is typically used in selective serotonin reuptake inhibitors (SSRI) medications such as Prozac and Sarafem which are used to help treat depression and perinatal depression. The researchers looked at how serotonin influences prefrontal cortex development in a fetus – specifically, the effect of deficiency and surplus of serotonin on brain development in mice.

Results showed that serotonin not only impacts overall brain function but also impacts how individual connections between neurons change and adapt. This, in turn, affects the way the brain learns.

“This is certainly a fascinating scientific study on postnatal development in the mouse brain but how it applies to the human brain still remains a question,” said Dr. Michael Cackovic, maternal-fetal medicine physician at Bridgeport Hospital.

Cackovic wasn’t involved in the study.

Most brain development in humans occurs in the first two years of life and 90% before kindergarten so it would make sense that giving “pups” this medication early in life could potentially cause a problem, Cackovic explained.

SSRIs can transmit from parent to child in utero

Researchers looked at the effects of serotonin on the part of a developing brain called prefrontal cortex when it is exposed to fluoxetine.

Fluoxetine goes into the placenta but also into breast milk.

“All known SSRI medications readily pass through the placenta and enter the fetal circulation,” said Dr. Jay Gingrich, professor of developmental psychology at Columbia University Vagelos College of Physicians and Surgeons. “There are several studies that have examined the health and mental health outcomes of children exposed to SSRIs in utero. Because serotonin receptors and pathways are highly conserved through evolution (across distant species), there has been a presumption that findings in rodents may likely be relevant to human brain development.”

Gingrich continued: “This has been difficult to prove unequivocally, but several studies have found increased rates of depression, anxiety, and adjustment disorders in SSRI-exposed children as they age into adolescence. Other studies have found increased rates of autism, but most of those studies have not controlled for maternal mental health and several studies failed to find a similar linkage.”

The risk of exposure through breast milk is expected to be far lower than through placental passage and should not dissuade mothers from breastfeeding or resuming SSRI use during this period, he added.

These findings do not mean that people who wish to become pregnant should stop taking SSRIs immediately, according to experts.

“There is a tremendous amount of data that supports use of an SSRI during pregnancy when it is taken to help the person achieve remission or maintain remission of their depression and/or anxiety,” said Dr. Katherine Campbell, associate professor of obstetrics, reproductive sciences at Yale School of Medicine.

Campbell, who did not work on the study, did clarify that infants can have symptoms if their parent is on SSRIs while pregnant.

“When babies are born to parents who are on fluoxetine (or other SSRI), the baby can have withdrawal symptoms that can start after birth,” Campbell said. “Withdrawal symptoms can include irritability, jitteriness, and fast breathing. There are newer SSRIs on the market that cross the placenta and cross into breast milk in lower concentrations.”

Is it safe to take antidepressants during pregnancy?

While there may be risks in taking SSRIs while pregnant, there are also risks of experiencing mental health disorders. Experts point out that untreated mental illness has significant and well-established consequences to maternal and infant health.

For example, untreated depressionTrusted Source in pregnancy is associated with preterm birth, low birth weight and stillbirthTrusted Source.

“Antidepressants, and selective serotonin reuptake inhibitors (SSRIs) specifically, are the most studied class of medications in pregnancy and the clinical consensus based on the extensive literature (in human studies), is that they are generally safe to use in pregnancy and in lactation when medically indicated (with the exception of paroxetine, which is usually not prescribed or used in pregnancy due to equivocal evidence on possible minor cardiac malformations),” said Dr. Ariadna Forray, associate professor of psychiatry at Yale School of Medicine and Director at the Center for Wellbeing of Women and Mothers, Psychiatry; Yale Medical Director, ACCESS Mental Health for Moms.

Forray was not involved in the study.

“The irony is that both untreated maternal depression and the use of antidepressants both increase the risk for anxiety and depressive disorders in the offspring in later life,” Gingrich said. “This conundrum is what has made it so difficult to discern whether SSRI use in pregnancy is a net positive to the child or whether we are exacerbating what trends were expected based on maternal history.”

Experts say if you are pregnant and taking SSRIs you can speak with your physician about whether or not it would make sense to stop taking the medication.

In many clinical scenarios, it is problematic to withhold medication treatment during pregnancy because of the severity of the mother’s symptoms.

“We have been working in this area for 20 years in attempt to provide a clearer risk-benefit profile to clinicians and their patients to help inform better decisions. This work is ongoing,” Gingrich added.

Other options to treat depression

There are various non-pharmacological interventions to help treat depression symptoms that people can explore after talking to their psychiatrist and physician if they want to avoid SSRIs.

“Evidence-based interventions include cognitive behavioral therapy and interpersonal psychotherapy,” said Forray. “Things like support groups, mindfulness, yoga and exercise can also be helpful additions to evidence-based treatments.”

In addition, “there are several effective psychotherapies for depression during pregnancy and in the post-partum period (IPT, CBT) and there are new non-SSRI medications specifically indicated for post-partum depression (e.g., Zurzuvae or zuranolone),” Gingrich explained. “The US needs to improve the availability and reimbursement of such non-pharmacologic therapies for patients in need. These are often barriers to obtaining appropriate psychotherapy for the expecting mother.”

Takeaway

According to a new mouse study, antidepressant use during pregnancy may affect brain development in utero. However, further research is needed.

The clinical consensus is that most antidepressants are safe to use during pregnancy, according to experts. It is important to note that withholding medication can pose greater health risks for the pregnant person and child.

Aside from medication, there are other ways to help treat symptoms of depression. These include cognitive behavioral therapy, interpersonal psychotherapy, support groups, mindfulness, yoga, and exercise.

How Antidepressant Use During Pregnancy Shapes Fetal Brain Development.

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A study from the University of Colorado Anschutz Medical Campus reveals that the use of antidepressants during pregnancy, specifically fluoxetine, can affect fetal brain development, particularly in the prefrontal cortex, and increase the risk of mental health disorders in children. Credit: SciTechDaily.com

First study to provide evidence of the direct impact of serotonin on the development of prefrontal cortex.

A new study published today (February 16) in Nature Communications provides direct evidence that antidepressant use during pregnancy can impact a child’s brain development and contribute to the risk of mental health disorders later in life.

The study, led by researchers at the University of Colorado Anschutz Medical Campus, focused on the effect of fluoxetine, commonly used in medications such as Prozac and Sarafem for treating depression and perinatal depression, on a developing prefrontal cortex.

Serotonin’s Role in Brain Development

Since fluoxetine works by increasing the levels of serotonin in the brain, the researchers looked at the impact serotonin has on prefrontal cortex development in a fetus.

“While it is known that serotonin plays a role in the brain development, the mechanisms responsible for this influence, specifically in the prefrontal cortex, have been unclear. The prefrontal cortex, the most evolved brain region, plays a central role in highest-order cognition, which is why we focused our study on finding the answer from this brain area,” said lead author Won Chan Oh, PhD, assistant professor in the Department of Pharmacology at CU Anschutz.

Oh and his student, Roberto Ogelman, a neuroscience PhD candidate, found serotonin directly influences nascent and immature excitatory synaptic connections in the prefrontal cortex, which if disrupted or dysregulated during early development can contribute to various mental health disorders.

Experimental Findings and Future Directions

“Our research uncovers the specific processes at the synaptic level that explain how serotonin contributes to the development of this important brain region during early-life fluoxetine exposure,” adds Oh. “We are the first to provide experimental evidence of the direct impact of serotonin on the developing prefrontal cortex when fluoxetine is taken during pregnancy, because fluoxetine not only crosses the placenta but also passes into breast milk.”

To study the effect, the researchers looked at the impact of deficiency and surplus of serotonin on brain development in mice. They discovered that serotonin is not just involved in overall brain function but also has a specific role in influencing how individual connections between neurons change and adapt, contributing to the brain’s ability to learn and adjust.

“Understanding this correlation has the potential to help with early intervention and the development of new therapeutics for neurodevelopmental disorders involving serotonin dysregulation,” said Oh.

The researchers say healthcare professionals should be involved in decision-making around individualized care for pregnant women, including discussing the benefits and side effects of antidepressants and possible non-pharmacological interventions for postpartum depression.

The researchers plan to continue studying the impact of fluoxetine, next examining its impact on a developing teenage brain.

Amplitude-determined seizure-threshold, electric field modeling, and electroconvulsive therapy antidepressant and cognitive outcomes

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Abstract

Electroconvulsive therapy (ECT) pulse amplitude, which dictates the induced electric field (E-field) magnitude in the brain, is presently fixed at 800 or 900 milliamperes (mA) without clinical or scientific rationale. We have previously demonstrated that increased E-field strength improves ECT’s antidepressant effect but worsens cognitive outcomes. Amplitude-determined seizure titration may reduce the E-field variability relative to fixed amplitude ECT. In this investigation, we assessed the relationships among amplitude-determined seizure-threshold (STa), E-field magnitude, and clinical outcomes in older adults (age range 50 to 80 years) with depression. Subjects received brain imaging, depression assessment, and neuropsychological assessment pre-, mid-, and post-ECT. STa was determined during the first treatment with a Soterix Medical 4×1 High Definition ECT Multi-channel Stimulation Interface (Investigation Device Exemption: G200123). Subsequent treatments were completed with right unilateral electrode placement (RUL) and 800 mA. We calculated Ebrain defined as the 90th percentile of E-field magnitude in the whole brain for RUL electrode placement. Twenty-nine subjects were included in the final analyses. Ebrain per unit electrode current, Ebrain/I, was associated with STa. STa was associated with antidepressant outcomes at the mid-ECT assessment and bitemporal electrode placement switch. Ebrain/I was associated with changes in category fluency with a large effect size. The relationship between STa and Ebrain/I extends work from preclinical models and provides a validation step for ECT E-field modeling. ECT with individualized amplitude based on E-field modeling or STa has the potential to enhance neuroscience-based ECT parameter selection and improve clinical outcomes.

Discussion

This investigation used a unique design with amplitude-determined seizure titration at the first treatment followed by fixed 800 mA for subsequent treatments. Pulse number (20 Hz frequency and 8 s pulse train duration) was held constant at 160 pulse pairs for the STa titration and the 800 mA treatments. Both STa and Ebrain/I had a wide range, which challenges the long-standing use of fixed amplitude ECT. STa increased with age, which is consistent with the observations made by Liberson when “brief stimulus therapy” was first experimented in the 1940s [49]. The relationship between STa and Ebrain/I extends work from preclinical models [15, 16] and provides a validation step for ECT E-field modeling. Despite their relationship, STa and Ebrain/I had different relationships with antidepressant and cognitive outcomes. The antidepressant and cognitive outcomes in relation to STa may be understood as a ratio between STa and subsequent 800 mA treatments (800 mA/STa) (Fig. 1B). Lower ratios (e.g., 800 mA/686 mA) may be inadequate to achieve the necessary “suprathreshold” dosing for antidepressant response. Higher STa (and hence lower 800 mA/STa ratio) was associated with the BT switch at V2 as determined by <25% change from baseline depression severity. Higher Ebrain/I was associated with worse cognitive outcomes as measured by longitudinal change in category fluency. Ebrain/I at the mid-point of the distribution (0.15 V/m/mA) differentiated cognitive impairment with 800 mA amplitude. STa and treatment number interaction was related to right hippocampal volume change, and right hippocampal volume change was associated with antidepressant outcomes (bitemporal switch and RUL response). In the following sections, we provide context for these findings, strengths and limitations of this approach, and potential implications for the practice of ECT dosing.

Antidepressant outcomes

Our antidepressant results demonstrated improved efficacy with “suprathreshold” treatments. In current clinical practice, suprathreshold treatments are defined in the context of pulse number (i.e., pulse train duration and frequency). The minimum number of pulses for a fixed amplitude and pulse width determines the seizure threshold. The suprathreshold multiplier (typically six-times seizure threshold for RUL ECT) determines the individualized pulse number necessary for antidepressant efficacy [50]. In contrast, the suprathreshold specifier can also be applied to the stimulus current amplitude. Our findings indicate that for ECT with 800 mA fixed amplitude to be effective, the inflection point for STa is approximately 330 mA, corresponding to fixed amplitude/STa ratio of 800 mA/330 mA or ~2.5. Higher STa (>330 mA) is associated with inadequate antidepressant response with subsequent treatments completed at 800 mA resulting in a protocol-determined switch to BT electrode placement. When the STa is greater than 330 mA, increased amplitude (>800 mA) may improve antidepressant efficacy. Alternatively, an electrode placement switch from RUL to bitemporal may also provide the necessary suprathreshold dose for antidepressant efficacy in the context of high STa.

Previous research with E-field strength and antidepressant outcomes has been mixed [14, 17, 51]. In this current study sample, Ebrain/I was unrelated to antidepressant outcomes. We also did not replicate the previously identified relationship between right hippocampal E-field strength (Ehippo/I) and right hippocampal volume change [14]. Differences between these two investigations include the focus on RUL (previous investigation included RUL and BT) and 800 mA (previous investigation included 600 and 700 mA). Despite not demonstrating the Ebrain/I and hippocampal volume relationship, right hippocampal volume change was associated with antidepressant outcome including response criteria and bitemporal electrode placement switch. Larger investigations are necessary to disentangle the effect of Ebrain/I from ECT treatment number and other parameters (i.e., pulse width, stimulation time) on hippocampal volume change and to explore potential moderating effects of structural and functional changes between Ebrain/I and antidepressant outcomes. In contrast, STa may capture additional information such as cortical excitability not included in Ebrain/I that strengthens the relationships to antidepressant outcomes [52] or age-related changes in conductivity (i.e., white matter disease) not presently included in E-field modeling approaches [53].

Cognitive outcomes

The DKEFS Category and Letter Fluency tests were sensitive to RUL-mediated changes in cognitive performance. Higher Ebrain/I was associated with worse category fluency performance. In contrast, STa was unrelated with cognitive outcomes. The strong association between Ebrain/I and cognitive outcomes replicates our previous work and adds support for the role of Ebrain/I in ECT dosing [14, 54]. In this sample, an Ebrain/I of 0.15 V/m/mA was the maximal associated with stable cognitive performance with traditional fixed amplitude 800 mA dosing. When Ebrain/I is greater than 0.15 V/m/mA (120 V/m at 800 mA), decreased amplitude (<800 mA) may reduce cognitive risk. The widespread right hemisphere associations between Ebrain/I and cognitive outcomes did not identify a specific anatomic “anti-target” amenable to changes in electric field geometry to improve the focality of treatment to prevent cognitive impairment. In contrast, an individualized stimulus amplitude determined prior to treatment initiation has the potential to improve cognitive outcomes.

Source: Nature

Running Versus Antidepressants: Which is More Effective for Mental Health?

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A study, the first of its kind, has delved into comparing the effects of antidepressants and running exercises in treating anxiety and depression. It yielded some interesting results.

Running to fight depression

Study Details

Participants in the study were 141 patients who were diagnosed with either depression, anxiety, or both. They were given a choice: take SSRI antidepressants or engage in group-based running therapy, both lasting for 16 weeks. 

Perhaps surprisingly to some, a majority (96 participants) chose running over medication (45 participants).

While 82% of the participants in the antidepressant group adhered to their medication intake, only 52% of the running group managed to stick to the exercise regimen. This is noteworthy considering the initial preference for exercise over medication.

By the end of the trial, roughly 44% of participants from both groups experienced improvements in their anxiety and depression levels. 

However, those who chose running also displayed better physical health indicators such as weight loss, reduced waist circumference, improved blood pressure, and heart functionality. On the contrary, those on antidepressants witnessed a slight dip in these physical health markers.

Professor Penninx’s Take

The study was presented by Professor Brenda Penninx from Vrije University, Amsterdam, at the European College of Neuropsychopharmacology’s (ECNP) conference in Barcelona.

Penninx stated that the team intended to observe how either therapy affects overall health, not just mental well-being. She further noted that despite the evident benefits of exercise, it might be challenging for some to maintain the regimen. Encouragement and adequate supervision, as was provided during the study, seem essential for successful adherence.

She also stressed that while antidepressants are safe and often effective, they might not be the best fit for everyone. The study suggests that we need to consider exercise therapy more seriously as a potential treatment method.

It’s also essential to recognize the possible side effects of antidepressant treatments. Especially in patients with heart issues, it’s crucial to consider the physical health implications of these medications.

Expert Commentary

Dr. Eric Ruhe from Amsterdam University Medical Centres highlighted the importance of the findings and added a word of caution. He said that while the study’s results are intriguing, the fact that patients chose their preferred treatment might introduce some bias in the comparison. 

It’s essential to note that the participants in the antidepressant group were, on average, more depressed, potentially affecting their likelihood of adhering to exercise.

Ruhe also stressed the difference in adherence rates, suggesting it’s often harder for individuals to change lifestyle habits compared to just taking a pill. This insight has broader implications for healthcare, emphasizing the importance of finding effective ways to encourage and sustain healthy behaviours.

In summary, while both running and antidepressants offer benefits for mental health, it is essential to consider the broader picture. Taking into account the physical benefits, personal preferences, and potential side effects will ensure that each patient receives the most appropriate and effective care.

Why Ketamine Is a Speedster Antidepressant.

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https://neurosciencenews.com/ketamine-antidepressant-speed-neurogenesis-20716/

Single Dose Of Antidepressant Lexapro Can Change Brain’s Wiring In Just 3 Hours

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shutterstock_118491940
A single dose of Lexapro, a commonly prescribed SSRI antidepressant, quickly produces dramatic changes in the architecture of the human brain. 

One out of every 10 Americans takes an antidepressant, according to the National Health and Nutrition Examination Survey, while one in every four women in their 40s and 50s do so. Now, a new study finds a single dose of a commonly prescribed SSRI (serotonin reuptake inhibitor) quickly produces dramatic changes in the architecture of the human brain. Specifically, brain scans taken of volunteers before and after one dose show a reduction of connectivity throughout the brain, with an increase of connectivity in two separate regions — all in just three hours.

What are SSRIs?

Worldwide, SSRIs are among the most widely prescribed form of antidepressants, often used to treat depression, anxiety disorders, panic attacks, and personality disorders. Classified as third-generation antidepressants, they are known for having fewer side effects than older pills and work by increasing levels of serotonin, a brain chemical naturally produced by your body. While serotonin serves many roles within your brain, chiefly it balances mood.

For the current study, 22 medication-free participants let their minds wander for about 15 minutes while their brains were scanned with an fMRI, a technology capable of measuring oxygenation of blood flow. Meanwhile, the researchers analyzed the three-dimensional images of each participant’s brain and measured the number of connections between small blocks of neurons known as voxels. After giving each volunteer a single dose of Lexapro (escitalopram), the researchers carefully observed the changes in those connections.

Immediately, the researchers felt surprised to discover the speed with which one dose of the SSRI performed. Within a matter of hours, it had reduced the level of intrinsic connectivity in most parts of the brain, while increasing connectivity within two regions: the cerebellum and thalamus. The cerebellum is responsible for, among other tasks, controling motor skills and balance, while the thalamus regulates consciousness, sleep, and alertness.

“We were not expecting the SSRI to have such a prominent effect on such a short timescale or for the resulting signal to encompass the entire brain,” said Dr. Julia Sacher of the Max Planck Institute for Human Cognitive and Brain Sciences and an author of the study. Sacher believes better understanding of the differences in individual response to SSRIs “could help to better predict who will benefit from this kind of antidepressant versus some other form of therapy.”

Introduced in 2002, Lexapro is approved for the treatment of major depressive disorder and generalized anxiety disorder. Though headaches, nausea, and insomnia are among its most common side effects, the Food and Drug Administration also warns of suicidal thoughts and tendencies brought on by the drug.

Ayahuasca: This Amazonian Brew May Be the Most Powerful Antidepressant Ever Discovered

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WIKI-Ayahuasca_

 

Recent studies show that this Amazonian healing elixir has the power to alleviate feelings of depression in just a few hours, with lasting positive changes.

After centuries of being labeled as primitive, traditional medicines are slowly making a comeback, especially in academia. The more research that’s conducted on traditional remedies, the more scientists must bow to the wisdom of our ancestors, as well as contemporary indigenous healers who are carrying these traditions forward. One of the most powerful traditional remedies isayahuasca.

Ayahuasca is a psychoactive healing elixir from the Amazon rainforest, a bitter tea consumed during healing ceremonies by native peoples of Peru, Brazil, Columbia and Ecuador. Ayahuasca is the only combinatory vision-inducing agent in the world. Like a tea, ayahuasca is made by brewing a combination of bark from the Banisteriopsis caapi vine (aka “the vine of the soul”) and leaves from Psychotria viridus (aka chakruna).

Shamans describe it as a sacred plant medicine that “opens a portal to the spirit world.” Portal or not, the healing properties of ayahuasca are undeniable. There are thousands of anecdotal reports of people having been healed from physical and mental disorders by taking ayahuasca—including some for whom death seemed near. The cases of post-ayahuasca cancer remission are too numerous to ignore, and the psychological benefits seem equally impressive. However, quality clinical studies are scarce.[i]

In a 2015 study led by neuroscientists at the University of São Paulo, Brazil, even one dose of ayahuasca was found to have powerful and immediate antidepressant effects. The study involved six volunteers with depression that was unresponsive to at least one antidepressant drug. The volunteers were administered the tea, then monitored in a quiet room and evaluated with standard clinical questionnaires to track their depression symptoms. The treatment was well tolerated, except for half of the participants vomiting (a common side effect). The psychedelic effects of ayahuasca wear off in about five hours.

Statistically significant improvements in depression symptoms were seen in just two to three hours, which is particularly notable when you consider conventional antidepressants typically take weeks to work. Even more impressive was that the benefits were sustained over the next 21 days. Further trials are underway, including a randomized, double blind, placebo-controlled study about ayahuasca’s benefits for depression, involving 80 patients.

The way Ayahuasca[ii] promotes psychedelic insights has long perplexed Western scientists. Ayahuasca is said to “help put into order the body, mind and spirit with the past, present and future.”[iii] During healing ceremonies, ayahuasca users commonly report emotionally charged visions, memories, and revelations about themselves and their lives, personalities and behaviors. The visions are not random—they typically center on emotionally charged and traumatic experiences, providing users the opportunity to re-experience those events in a more insightful way. Shamans say the elixir will give you whatever answers you seek.

Ayahuasca’s psychoactive properties are generally believed to be related to its serotonergiceffects. Psychotria viridis is rich in DMT (N,N Dimethyl Tryptamine), the most potent vision-inducing agent known to man.  DMT is not only found in hundreds of plants around the world but is alsomanufactured by your own body. But thanks to the enzyme MAO (monoamine oxidase), you aren’t tripped out all day, every day. The other ingredient in ayahuasca, Banisteriopsis caapi, contains a group of compounds called harmala alkaloids, which are MAO inhibitors (MAOI). These allow the DMT to stimulate unbridled activity in your brain by preventing the breakdown of serotonin and other neurotransmitters.

Imaging studies reveal that ayahuasca hyperactivates frontal brain regions, specifically the medial frontal and anterior cingulate cortices responsible for somatic awareness and emotion. Ayahuasca triggers a large release of glutamate, which causes neural firing all along the frontal cortex. The elixir also activates parahippocampal areas involved in processing memory and emotion, including the amygdala. The insula is also activated, which is where feeling states are generated and is thought to act as a bridge between our emotional impulses and decision-making capacity. This may be what allows subjects to “travel” through their past experiences with an awareness of thoughts, emotions and memories that are difficult to access in ordinary mental states.

Your brain’s neocortex is also involved in anticipatory and planning behavior and abstract reasoning, so its activation may help explain the complex and meaningful cognitive experiences that take place during and after the consumption of ayahuasca.

Ayahuasca impacts dysfunctional cognitive-behavioral patterns. Powerful or traumatic events create imprints on the brain that are reinforced every time we encounter a similar situation. Repeated events reinforce these pathways, building up something like “emotional scar tissue,” which can lead to dysfunctional emotional responses and problematic behaviors throughout one’s lifetime. Ayahuasca appears to help users override these entrenched neurological patterns, allowing new connections to be made. Users report emerging with fresh perspectives on past experiences, which may explain many of ayahuasca’s healing benefits for depression, anxiety and PTSD, substance abuse and other problems. An interesting video about Ayahuasca research is available here.

Longer-term studies show ayahuasca positively impacts mood, reasoning and decision-making with minimal adverse effects. Ayahuasca has been shown to be non-addictive when used long-term by healthy individuals in supportive settings. There is no evidence of neurotoxicity—ritualized long-term users even scored better on certain cognitive tests than control groups.

Due to the intensity of the visions, ayahuasca should not be taken alone. Its therapeutic potential and safety are contingent upon how the experience is facilitated, monitored and integrated. However, with proper support, even a single dose of ayahuasca seems to offer potentially deep therapeutic benefits.

Antidepressant was misrepresented as safe for adolescents.

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A new study has found that a psychiatric drug claimed to be a safe and effective treatment for depression in adolescents is actually ineffective and associated with serious side effects.
The widely used antidepressant paroxetine is neither safe nor effective for adolescents with depression, concludes a reanalysis of an influential study originally published in 2001.

A University of Adelaide led study has found that a psychiatric drug claimed to be a safe and effective treatment for depression in adolescents is actually ineffective and associated with serious side effects.

Professor Jon Jureidini, from the University of Adelaide’s newly created Critical and Ethical Mental Health Research Group (CEMH) at the Robinson Research Institute, led a team of international researchers who re-examined Study 329, a randomised controlled trial which evaluated the efficacy and safety of paroxetine (Aropax, Paxil, Seroxat) compared with a placebo for adolescents diagnosed with major depression.

Study 329, which was funded by SmithKline Beecham (now GlaxoSmithKline), was reported in 2001 as having found that paroxetine was effective and safe for depression in adolescents. However, Professor Jureidini’s reanalysis showed no advantages associated with taking paroxetine and demonstrated worrying adverse effects.

“Although concerns had already been raised about Study 329, and the way it was reported, the data was not previously made available so researchers and clinicians weren’t able to identify all of the errors in the published report,” says Professor Jureidini.

“It wasn’t until the data was made available for re-examination that it became apparent that paroxetine was linked to serious adverse reactions, with 11 of the patients taking paroxetine engaging in suicidal or self-harming behaviours compared to only one person in the group of patients who took the placebo,” he says. “Our study also revealed that paroxetine was no more effective at relieving the symptoms of depression than a placebo.”

“This is highly concerning because prescribing this drug may have put young patients at unnecessary risk from a treatment that was supposed to help them,” he says.

Professor Jureidini says it is important that research data and protocols are accessible so they can be reviewed and scrutinised.

“In 2013, an international researcher consortium called for undisclosed outcomes of trials to be published and for misleading publications to be corrected. This initiative was called restoring invisible and abandoned trials (RIAT),” says Professor Jureidini.

“Study 329 was one of the trials identified as in need of restoration, and because the original funder was not interested in revisiting the trial, our research group took on the task.

“Our reanalysis of Study 329 came to very different conclusions to those in the original paper,” he says. “We also learnt a lot about incorrect reporting and the considerable fall out that can be associated with distorted data.”

“Regulatory research authorities should mandate that all data and protocols are accessible,” he says. “Although concerns about patient confidentiality and ‘commercial in confidence’ issues are important, the reanalysis of Study 329 illustrates the necessity of making primary trial data available to increase the rigour of evidence-based research,” he says.

Professor Jureidini’s study was published in the medical journal BMJ today.

CEMH is committed to undertaking and promoting critical and ethical appraisal of evidence, to help improve decision-making in mental health policy and practice.

 

Is America addicted to antidepressants?

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In a recent appearance on The Dr. Oz Show, Dr. Sue Varma discussed overuse of antidepressants, also referred to as the “new drug moms are hooked on,” and “mommy’s little helper” because of their growing prevalence for use by mothers and women in general. During the show, one mother stated that taking antidepressants has made her a more functional person and a better mom, while another said that antidepressants took away the highs and lows of life and turned her into a zombie. Neither woman underwent a psychiatric evaluation or comprehensive health screening to check for underlying causes prior to being prescribed antidepressants by their primary care physicians (PCPs).

Antidepressant

Antidepressants are currently the third most commonly prescribed drug in America, and women are two times more likely to take them than men. However, this trend is not limited to antidepressants. CBS News reported that women and the elderly are more likely to be prescribed medication during a doctor’s visit than any other population.

The concern is that 50% of all patients who are prescribed antidepressants do not have a mental illness and have never had an appropriate mental or physical health evaluation to determine the cause of their symptoms. Misdiagnosis and inadequate evaluation has contributed to a 400% increase in antidepressant prescriptions over the past 20 years. Even more alarming is that, out of 500 million prescriptions written each year, only 13% are prescribed by psychiatrists, leaving the majority (59%) to primary care doctors and other practitioners (18%).

Varma explained that the average mental health evaluation lasts at least 90 minutes with watchful monitoring should treatment ensue and that antidepressants should be considered a small portion in the toolkit for mental health. This same amount of care is not taken in the few minutes patients will have to discuss mental health during a visit to their primary care doctor. Very rarely do patients undergo the type of physical screening that would be needed to eliminate other possible causes of depression with their PCPs. Often, patients are experiencing symptoms of depression as a side effect of another health issue, and because doctors are hasty to prescribe antidepressants, the underlying cause may go unfound and continue to wreak havoc in the body. Hypothyroidism, chronic dehydration, copper toxicity, B12 deficiency and other nutritional deficiencies are just a few health issues that may cause symptoms of depression to manifest.

Do antidepressants provide a plausible solution?

Varma noted that antidepressants may be effective in some cases, but that exercise, social support, talk therapy and other methods are just as effective as, if not more than, medications in the treatment of mild to moderate depression. Furthermore, discussions about coping skills and other treatment approaches should be considered because antidepressants often lose their effectiveness over time in what has been coined the “poop out effect” or tachyphylaxis. This effect alludes to the fact that antidepressants do not provide a true solution to the problem they are meant to solve.

According to homeopathy advocate and author Dana Ullman, “meta-analysis of antidepressant medications found only modest benefits over placebo treatment in published research, but when unpublished trial data is included, the benefit falls below accepted criteria for clinical significance. … These researchers did find benefits from the use of antidepressants in the treatment of severe depression, but because the majority of people taking antidepressants today do not have ‘severe depression,’ it is prudent for many people with depression to talk to their doctors about safer and more effective alternatives.” The first step is to undergo an adequate evaluation to determine if you are dealing with depression or another health issue.

Learn more: http://www.naturalnews.com/049777_antidepressants_pharmaceutical_addiction_mental_illness.html#ixzz3amvAqXEN