Doctor’s Notes
By Joseph Feuerstein, MD
Integrative Approaches to Depression H
ave you noticed that depression is everywhere? You can read about it on posters and billboards and in magazines and hear about it on any number of television commercials.
Cynics would say that the current depression epidemic is being engineered by the pharmaceutical industry in an effort to sell more of their ware.
Whether that is true or not, depression is a serious problem in
the US. According to the National Institute of Mental Health, Ameri- can adults have an almost 17% risk of developing depression during their lifetime.
In this article I review the evidence for the western and alter-
native approaches to the treatment of depression and will let you decide for yourselves what works and what doesn’t. Anti-depressant medications and Cognitive Behavioral Therapy are two of the mainstays of the western approach to depression. The most common medications on the market are the Selective Serotonin Uptake Inhibi- tors (SSRIs), like Celexa, Lexapro and Prozac, the Select Noradren- ergic Uptake Inhibitors (SNRIs), like Wellbutrin, and the drugs that are to varying degrees, a combination of both types of medicine, like Effexor and Pristiq. How do these drugs work? They increase levels of Serotonin (the
chemical in the brain that makes you happy) and another stimulating neurotransmitter in the brain called Noradrenaline. The drugs can have lots of side effects, including dry mouth, nausea, poor sleep, agitation, and even sexual side effects.
Do they work? The answer is a little more complicated than just a simple yes or
no. Let’s look the evidence. In the red corner we have the often quoted mantra, based on the clinical studies, that “anti-depressants help about three-quarters of the people who take them.” But wait, we have a spoiler in the works! On January 6, 2010,
an article was published in the Journal of the American Medical As- sociation which analyzed the results of more than 700 patients in 6 studies. The article concluded that for patients with mild to moderate depression, there was almost no significant difference in improve- ment whether the patient took a real anti-depressant, or took a sugar (placebo) pill! Is this because anti-depressants don’t actually help to moderate depression?
Another possibility is the significant placebo response that was seen in all the trials. The placebo response is where the expectation that a pill (even a fake sugary one) will make you better, is enough to make you actually feel better! Is it your medicine or your mind making you feel better? It is difficult to tell and the issue was hotly debated in the scientific world. The authors also found that in patients with severe depression,
there was a substantial benefit in taking the medication instead of taking the sugar pill. In my own practice, I tend to use natural remedies for patients with mild and moderate depression and will refer anyone with se- vere depression to a psychiatrist for medication.
40 Natural Nutmeg June 2012
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