1 in 10 on antidepressants

[GracieRuth]

http://abcnews.go.com/Health/Wellness/10-americans-antidepressants-therapist/story?id=14763251

I find this statistic disturbing. Don't get me wrong--I know first hand how very real depression can be, and how deadly. Antidepressants have probably made the difference between life and death for me. But 10% of the population being so depressed we need antidpressants? It makes me want to look for things wrong with the culture itself.

I do not have a simplisitc notion of mental health. I'm very aware that a LOT of different variables come in to play, that it's nature AND nurture interacting, plus throw in a little random factor. Some people are definitely biologically predisposed to depression, sure. But having that predisposition does NOT fatalistically mean a person will suffer depression (otherwise identical twins would have identical problems). Enter the realm environment, which includes everything from epigenetics to toxins in drinking water to being raised by a coke snorting prostitute who knows as much about mothering as she does about calculus.

Basically, the bells and whistles going off in my head are saying, "Hey we've spent several decades learning the biology of depression. Great. Now we need to learn other important factors, because a 10% rate is way , way, way too high." There is also a question in my head, "Is everyone on antidepressants actually depressed?" Sometimes they are perscribed for other reasons, like OCD. And there is always the problem with "Here is the trendy diagnosis, and here take these pills."

Things I would like scientists to research for their impact on depression:

1. The effect of electric light usage at night has already been shown to be a major factor in bipolar mood swings. How much has the switch to late night activity played in the rise of general depression?

2. In a certain sense, anything you put into your mouth is a drug. Everything from orange peels to potatos has a certain psychobiological effect. Is there a diet more likely to cause depression, or more importantly, is there a diet more likely to help prevent depression?

3. I don't want to go back to the days of blaming parents for everything from autism to schizophrenia. However, it IS true that early childhood experiences can make a permanent impact on gene expression. To offer a simplistic example, rat babies that get licked a lot by their moms have larger brains and lower stress reactions as adults. Are there certain parenting styles that can raise the odds of depression, or which can help guard against it? Are biological parents more likely to parent better (in a statistically significant sense) than day care providers? When is a divorce better for the kids, and when is staying together better for the kids, and does either situation impact vulnerability to depression? Are children raised without fathers more prone to depression? To what extent does a solid extended family play a role?

4. Are there other life experiences that play a significant role in vulnerability to depression? For example, are kids who are bullied fragile to begin with, does the bullying make them more fragile, or both?

5. Are there chemical substances in our food, water, or environment which increase vulnerability to depression?

I'm sure if I think more, I could add to the list.

Penny for your thoughts?

 

[turquoise]

But 10% of the population being so depressed we need antidpressants? It makes me want to look for things wrong with the culture itself.

There are two books I might recommend on this subject, the primary one being Anatomy of an Epidemic, and the other being Mad in America (both by the same author). As you'll see in the first article, the number of people on disability for some type of mental illness has doubled since about 1987. The explanation I would argue for is that psychopharmacology is big business, and that drug companies, doctors and psychologists tend to promote labeling as much of the population as possible with some kind of illness as a way of expanding their potential market. Furthermore there's incentive by drug companies and psychiatrists to push chemical and medical solutions, as that is where their profit comes from. In simpler terms, they like to tell people that they're sick and then push drugs on them for money, rather than look at other causes of the problem.

From the above linked articles:

... the antipsychotics, benzodiazepines and antidepressants were discovered as side effects during research for antihistamines (specifically promethazine), gram negative antibiotics (specifically mephenesin) and the anti-tuberculosis agents isoniazid and iproniazid respectively. The psychiatric mechanisms of action of these drugs were not known at the time and these were initially called major tranquilizers (now typical antipsychotics) due to their induction of "euphoric quietiude," minor tranquilizers (now benzodiazepines) and psychic energizers (now antidepressants) due to patients "dancing in the wards."[6] These compounds were developed during a period of growth for the pharmaceutical industry bolstered by the 1951 Durham-Humphrey Amendment giving physicians monopolistic prescribing rights thus aligning the interests of physicians and pharmaceutical companies.

It was not until many years later, after the mechanisms of these drugs were determined that the serotonergic hypothesis of depression and dopaminergic hypothesis of schizophrenia were developed to fall in line with the drug's mechanisms. According to Whitaker's analysis of the primary literature lower levels of serotonin and higher levels of dopmine have proved to be true in patients WITH prior exposure to antidepressants or antipsychotics (ie as homeostatic mechanisms) but NOT in patients without prior exposure.

So far there is no clear and convincing evidence that monoamine deficiency accounts for depression; that is, there is no 'real' monoamine deficit.

 

[Barnabas]

My guess would be that since anti-depressants have become more readily available and that widespread recognition that depression is indeed a real problem has made people more apt to actually seek out anti-depressants. Then you combine on top of that people who are just having a bad day and want a pill that can end that for them and what you get is a steadily increasing number of people on anti-depressants.

 

[Peppermint]

I think there is a lot of stumbling in dark and guessing in the psychiatric work. The causes aren't identified by taking an empirical approach to the neural physiology in many cases, but with the help of self report and descriptive indicators. I have read a text about the misuse of anti depressants, but I can't find it anymore. The gist was that the very often touted catch all "chemical imbalances" aren't the real cause of depressive symptoms, but rather a decline in brain cells. Anti depressants, while coincidentally helpful with mitigating the issue (apparently some of them had influence of the proliferation of the cells) don't really address the core cause. In some ways they are the best we have right now. That said, electro convulsive therapy is still approved for treatmen of very difficult cases.

2) Depression and anxiety disorders are far more prevalent in the industrialized world, a fact often noted by the Dalai Lama. The implication being that such things are largely environmental or a result of lifestyle rather than due to 'chemical imbalances'.

Environmental influences are a contributing factor that can cause damage to the brain due to neouroplasticity in youth, and the effect stress hormones have on the neural tissue.

Studies have shown that children exposed to serious psychological trauma during childhood are at risk of suffering increased psychiatric disorders, including depression, anger, hostility, drug abuse, suicidal ideation, loneliness and even psychosis as adults. Using modern brain imaging, the physical damage to these children's brain development can be seen as clearly as a bone fracture on an X-ray. Early-childhood sexual abuse, physical abuse and witnessing domestic violence undermine the normal wiring of brain circuits, especially those circuits connecting the left and right sides of the brain through a massive bundle of connections called the corpus callosum. Impairment in integrating information between right and left hemispheres is associated with increased risk of craving, drug abuse and dependence, and a weakened ability to make moral judgments. (See my post "Of Two Minds on Morality" for new research on the corpus callosum and the ability to make moral judgments.)


A series of studies by a group of psychiatrists and brain imaging scientists lead by Martin Teicher, of Harvard Medical School, shows that even hostile words in the form of verbal abuse can cause these brain changes and enduring psychiatric risks for young adults. In a study published in 2006, the researchers showed that parental verbal abuse was more strongly associated with these detrimental effects on brain development than was parental physical abuse. In a new study published in the July issue of the American Journal of Psychiatry, they report that exposure to verbal abuse from peers is associated with elevated psychiatric symptoms and corpus callosum abnormalities. The main causes are stress hormones, changes in inhibitory neurotransmitters, and environmental experience affecting the formation of myelin electrical insulation on nerve fibers. The most sensitive period for verbal abuse from peers in impairing brain development was exposure during the middle school years. Why? Because this is the period of life when these connections are developing in the human brain, and wiring of the human brain is greatly influenced by environmental experience.

We are exposed to a lot of stress in our everyday lives and chronic stress leads to depression.


Then, there are also probably people who badger their doctors for an easy fix to their problems even if maybe they don't have legit depression.

 

[this is only temporary]

This article: http://www.experiencelifemag.com/issues/may-2011/life-wisdom/a-path-out-of-depression.php
has an interesting, and (in my opinion) a very useful take on depression.

To paraphrase, it suggests:
1. Feed Your Brain (get omega 3s, other nutrients we don't get enough of these days, typically)
2. Don't Think