Americans are sad.
I mean, it’s really no secret, though everyone tries to pretend it is. Today, over 16 million Americans have been diagnosed with major depression and, of every 9 people, one is most likely taking a prescription antidepressant, an increase of over 500% in the last 3 decades[1,2]. Mood disorders, like depression, are the third most common cause of hospitalization, and depression is more than twice as likely to affect women than men[3,4]. And while everyone has heard of it, and most everyone knows someone who’s been affected, many people don’t truly understand depression.
What is Depression?
According to the National Institute of Mental Health, depression is a common, serious mood disorder. Its symptoms can affect the way you think, feel, and handle daily activities. While depression causes the same, noticeable symptoms, some forms may develop under unique circumstances or cause symptoms that are slightly different. These types of depression include persistent depressive disorder (dysthymia), which consists of a depressed mood lasting for two years or more, postpartum depression, which may be experienced after a woman gives birth, psychotic depression, which occurs when severe depression is accompanied by psychosis, and seasonal affective disorder, where the depression is triggered by the winter months[5].
The most common symptoms of depression, which persist for longer than two weeks, include:
- Persistent sad, anxious, or “empty” mood
- Irritability
- Loss of interest or pleasure in hobbies and activities
- Fatigue
- Appetite and/or weight changes
- Thoughts of suicide or death
Causes
For most cases, the cause or “trigger” of depression is unknown, though researchers are beginning to find clues that may help prevent the disorder.
Not Getting Enough Sleep
Sleep is absolutely vital to survival. Loss of sleep for just one night can lead to immediate, but reversible, mood changes, and chronic sleep deprivation can cause brain fog, weight gain, diabetes, lowered sex drive, infertility, heart disease, and mental illness[6]. And, to those who have suffered from depression, it comes as no shock to know that chronic insomnia is a commonly reported symptom that comes with depression. To researchers, there’s an interesting relationship between sleep deprivation and mood disorders, like depression. While it is widely recognized as a symptom, emerging research is also pointing to the loss of sleep as a potential cause for the onset. Several studies have found chronic insomnia to increase the risk of depression diagnosis, and alterations in sleep patterns have been associated with depression for over 30 years[7].
High Sugar Consumption
Up to 25% of the American diet is pure sugar, and while we have long known the health effects this toxic substance can cause, many people don’t understand the toll it can have on mental health. High sugar intake has been associated with decreased brain growth factor levels and increased inflammatory markers, both of which have been known to lead to depressed mood, changes in hormone levels, and depression diagnosis[8]. In those who consumed the highest amount of sugar per day, their overall long-term risk of being diagnosed with depression was increased by over 20%.
Hormone Imbalance
One possible explanation for the gap between rates of depression among men and women may have to do with the delicate hormone balance, which differs greatly between the sexes. Estrogen and progesterone, two hormones vital to the female body, have been known to affect the areas in the brain responsible for mood and mood regulation, and a “window of vulnerability” has been scientifically identified during periods of hormone instability[9]. In fact, environmental factors – like hormonal birth control – that impact the hormonal balance have also been known to increase the risk of depression[10].
Medications Available for Depression
Medication is often one of the first lines of defense when it comes to depression. These prescriptions, commonly referred to as antidepressants, chemically affect the way your body perceives emotion, balancing mood and improving sleep. Each drug is specifically intended to chemically alter the brain, with many different categories and types of these drugs available.
SSRIs: Selective Serotonin Reuptake Inhibitors (SSRIs) are some of the most common medications prescribed for depression. These typically include the household names that people recognize: Zoloft, Lexapro, Paxil, Luvox, and Celexa. Serotonin is one of the endorphins responsible for happiness, and SSRIs work by blocking the reabsorption of serotonin, making more available to you.
SNRIs: Serotonin and Norepinephrine Reputake Inhibitors (SNRIs) are not as commonly prescribed as SSRIs, but many people still recognize their names. These drugs include: Pristiq, Cymbalta, Fetzima, Ixel, and Effexor. SNRIs work very similarly to SSRIs, but instead of just blocking serotonin reuptake, it also blocks the reabsorption of norepinephrine.
Tricyclic Antidepressants (TCAs): These drugs are typically only prescribed where SSRI-therapy has failed. Because TCAs are less commonly prescribed, the drug names are not as well known, but they include: Elavil, Vivactil, Surmontil, Tofranil, and Anafranil. TCAs help boost levels of serotonin and norepinephrine, while also blocking acetylcholine, in an effort to bring balance to the brain.
Norepinephrine and Dopamine Reuptake Inhibitor: Norepinephrine and dopamine reuptake inhibitor (NDRI) drugs are made up by only one: Wellbutrin. It is commonly used when treating patients with Major Depressive Disorder (MDD), and works by blocking the reabsorption of norepinephrine and dopamine.
How Do These Medications Impact the Body?
Most people receive an explanation as to how the drugs are going to impact their symptoms, but many do not understand the side effects they may experience, that are completely separate from their depression. The most commonly reported side effects are stomach upset, weight gain, decreased sexual desire, vision problems, and anxiety. But really, those symptoms are just the tip of the iceberg.
Antidepressants and the Brain
It was once believed that antidepressants had no detrimental impact on the brain, but new findings are revealing that these drugs may lead to cognitive impairment after all. Within 8 weeks of treatment with SSRIs, patients showed statistically significant memory loss, and while these results are still being discussed, other trials have come to similar conclusions[11]. Because of a noticeable, almost instant occurrence of cognitive impairment (ranging from mild to severe delirium) that became obvious in the elderly following treatment with TCA antidepressants, it became more common for SSRI drug therapy to be attempted first[12]. It was assumed that these drugs would be less likely to have an impact on cognition, but unfortunately recent studies are not very comforting. In 2016, it was found that in populations under 65 who take antidepressant medications (including SSRIs) may be at an increased risk of developing Alzheimer’s Disease and/or dementia[13].
And, though some people do find that antidepressant medications ease their symptoms of depression, sadly that comes at a cost for many. When starting these drugs, not only do you run the risk of them not actually working, but they can also impact the brain so severely that they lead to the development of a new condition altogether. Treatment with antidepressants, particularly SSRIs, for depression has a documented risk of causing bipolar disorder and even mania[14]. In 2001 alone, when those taking antidepressants was still much lower, an estimated 860,000 admissions to a psychiatric hospital was due to SSRI-induced mania or psychosis[15]. Long-term treatment with antidepressants has also been associated with treatment-resistant depression, worsening depression, lowered motivation, emotional blunting, and drug-induced indifference[16,17].
Antidepressants and the Heart
In the US, heart disease is the number one killer of all Americans, and an estimated 610,000 die of heart disease in our country alone every single year[18]. Several factors contribute to the development of heart disease, including pre-existing conditions (like obesity and diabetes), diet, and alcohol intake and, while most people are aware of these risk factors, many know nothing about the impact of pharmaceutical drugs on their heart. And, unfortunately, antidepressant medications have been shown to have the ability to impact the heart. Another reason, besides the possibility of cognitive impact, that TCA drugs are used less frequently today is because of their high rates of heart-related side effects[19]. And, although their use has lessened, TCA antidepressants are still prescribed every single day, despite the fact that cardiovascular adverse reactions have been reported in patients with no prior history of heart disease. In the beginning, it was assumed that these drugs could only cause heart-related side effects at high, or overdose level, concentrations. But, as more research emerges, we are beginning to realize that even therapeutic doses have the ability to cause catastrophic effects. Therapeutic doses of TCAs, SSRIs, and SNRIs have been linked with abnormally low blood pressure and irregular heart rate, and blood pressure monitoring is recommended for those taking these drugs[20].
Antidepressants and Breast Cancer
According to the American Cancer Society, over 300,000 American women will be diagnosed with breast cancer this year[21]. It is the second most common cancer to affect women, and one of the deadliest. Certain life choices, like birth control, deodorant, and alcohol use, have been shown to increase the risk of breast cancer – and emerging research is putting antidepressants into a very dangerous category. These medications, especially SSRIs but also TCAs, definitively increase the risk of breast and ovarian cancers, and for those who are diagnosed, the likelihood of being killed by the disease in increased by nearly 30%[22,23]. And, while some studies exist that attempt to disprove this connection, it was been discovered that these researchers have financial ties that “can affect the research process” and “may result in the publication of incomplete or inaccurate results.”
Antidepressants and Suicide
The worst outcome of depression is suicide, and this is something that everyone wants to avoid. It is hoped that antidepressants will alleviate the symptoms of depression and reduce the risk of suicide, but that is not the case for many unfortunate people. 14 years ago, in 2004, the FDA issued a black-box warning, which is the strictest labeled warning for prescription drugs, on antidepressants because of their association with an increased risk of suicidal thinking, feeling, and behavior in young people[24]. A study conducted in 2016 concluded that doctors should consider alternative treatments of depression when it comes to children and teenagers. This recommendation is based on the study of over 18,000 patients which found that both SSRIs and SNRIs doubled the risk of aggression and suicide[25]. Other studies have found the increased risks of suicide to be highest in SSRI medications, with the first month of use being the most dangerous – carrying a five-fold higher risk of completed suicide[26,27].
Antidepressants while Pregnant and Breastfeeding
Antidepressants are one of the most common, most controversial medications prescribed to pregnant and lactating women. Between 1998 and 2005, approximately 1 in every 20 women reported using an antidepressant during their pregnancy, and we all know rates have increased since then[28]. Currently, most antidepressants are grouped by the FDA into Pregnancy Categories C and D – meaning that no controlled studies exist, and those that do show risk to the fetus[29]. These risks range from birth defects, heart defects, respiratory distress, and seizures, to constant crying, jitteriness, irritability, and increased risk of death. Nearly all of these drugs are also excreted into breastmilk, and there is potential for serious adverse reactions in nursing infants.
Certain drugs, and their impacts on developing humans, have been deeply examined and the results are concerning, to say the least. In pregnancy, SSRIs and SNRIs, have documented correlation with heart defects, bone defects and craniosynostosis, TCAs have been linked with eye, ear, face, neck, and digestive defects, and Effexor has been associated with respiratory defects[30]. Another area of risk when it comes to antidepressants and pregnancy is the baby suffering withdrawal syndrome after birth. In 2004, the FDA issued a class labeling change for both SSRIs and SNRIs because of evidence that third trimester exposure could be associated with signs and symptoms of withdrawal. These symptoms included respiratory distress, seizures, difficulty feeding, vomiting, and constant crying, just to name a few[31].
In lactating women, the drugs that seem to be the most problematic are Prozac and Celexa. These antidepressants, as well as Effexor, are identified in the highest concentrations of excreted breast milk[32]. Research examining the potential adverse effects antidepressant use may have on breastfeeding infants is extremely limited, but some small case studies do exist. When it comes to Prozac and Celexa, adverse reactions like excessive crying and uneasy sleep, have been reported[33,34].
Alternative Treatments for Depression
While many people are under the presumption that pharmaceuticals are the only solution in treating depression, that couldn’t be further from the truth. Alternative, effective, and safe options do exist, and though they may not be well-known, they deserve to be considered.
Herbal Options
St. John’s Wort is one of the most commonly known names in the world of herbal antidepressants. Studies into St. John’s Wort have determined it equally as effective as SSRIs, with mild side effects, like nausea and fatigue, remaining exceptionally rare[35,36]. Valerian is another well-known herb that is often used to alleviate symptoms of depression. Valerian is impressively helpful in treating insomnia, and aids in falling asleep, staying asleep, and maintaining a healthy sleep wake cycle[37]. Valerian helps normalize levels of serotonin in the brain, and reduces symptoms of depression[38]. It is recommended that valerian be combined with St. John’s Wort for faster, more successful treatment[38].
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Supplements
While depression is often thought of as chemically- or emotionally-rooted, recent studies are revealing the key role in the onset, severity, and duration of depression. It has been found that those with depression tend to have lower levels of folate, iron, and zinc than health controls[39]. It is for this reason that Vitamin D supplements and phototherapy have been used so successfully in treating those with Seasonal Affective Disorder[40,41]. Supplementation with Omega-3 Fatty Acids has been found to relieve symptoms of depression, including for those with a Major Depressive Disorder diagnosis[42]. Because nutritional deficiencies can cause the onset of depression, it only seems reasonable to believe that curing these deficiencies would relieve symptoms. Some research into that idea has recently been done with folate, and the results give hope. Folate supplements can be taken to help improve mood, regulate levels of serotonin in the brain, and may boost other forms of depression treatment[43,44].
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Conclusion
Depression is a serious, life-intruding condition that often warrants some type of intervention. Pharmaceuticals, while can mask some unwanted symptoms, are often dangerous, and can even cause an entirely new set of symptoms. Properly being informed of the potential side effects, and alternative options is a necessary component of healthcare. Be well.
Until next time,
Savannah