Thanks for covering this, and I hope you cover alternative ways of treating depression, given its increasing prevalence and serious consequences. The "Speaking of Psychology" podcast recently had a good episode on TMS for treating depression (link below). There needs to be more research in this area, but since it can't be patented, very little money. Also, current protocols require trying other treatments first (i.e., drugs), and it's not always covered by insurance, and practitioners are scarce. It also takes a commitment of time on the part of the individual (as does counseling), and some people would prefer the magic bullet of a pill, at least if they're unaware of how ineffective and potentially risky they are.
I have not analysed too much about non-pharmaceutical treatments for depression treatments but I do think exercise, psychology and diet have a big role to play.
I couldn't see a way to add to my response (below), but I wanted to add that the reason I don't think that exercise and better diet, while helpful, are a panacea is that depression has existed since antiquity, long before people had highly refined diets and widespread insufficient exercise (link below). I believe depression is a combination of genetic pre-disposition and environmental triggers, like many diseases, although in some cases, it seems primarily genetic, and in others primarily environmentally triggered. As always, it's complicated. I also wanted to clarify what I said about depression and lack of motivation - it is NOT the person's fault! Unfortunately, too many people still think a depressed person should be able to "pull themselves up by their bootstraps!" Brain chemistry is involved, and we need to figure out better ways to address it. Yes, counseling and exercise can lead to changes in the brain, but the inherent motivational deficits are often obstacles to effective implementation of those 2 interventions. As for meds, people who are untreated or ineffectively treated will often self-medicate, which is often worse than prescribed Rx's. That's why we need more research into non-pharmaceutical ways (or better pharmaceutical ways) to impact the brain. Thanks for reading if you made it this far! :)
You are absolutely right that this problem has been ignored for year's and the false serotonin hypothesis has influenced peoples perception of the nature of depression. Of course this misunderstanding has been in the interests of big pharma. It's great that you push back. However what about the idea of withdrawing those addicted to SSRIs using a "long acting" compound like Fluoxetine. When I practiced some years ago I found this a successful strategy. People withdrew OK by continually halving the dose.
Thanks Keith, I couldn't offer prescribing advice (I'm a scientist) but when I contacted Gøtzsche about it he said "we generally recommend against changing drugs, e.g. because the patients are then exposed to two drugs at the same time, which could lead to problems."
In practice patients are often exposed to two drugs sometimes of the same class, sometimes different. I think this is a case of the perfect being the enemy of the good. Its true that some people find transferring from paroxetine (or similar) to fluoxetine a difficult process but, once stabilized, withdrawal is much easier.
My reading (sorry cannot find source) is that anti-depressants have some anxiolytic effect, which may explain their initial assistance to patients. Finding ways to ease and manage any return of anxiety in a person withdrawing from anti-depressants whilst not being prescribing addictive anxiolytics remans a challenge. I would like to see more definite research on the use of nutritional psychiatry measures to manage depression in people and maybe to alleviate some of the withdrawal of anti-depressants - problems with what the manufacturers and clinicians seem to call 'discontinuation syndrome'.
That's my understanding too - antidepressants have anxiolytic properties. I'm told the drugs have a significant 'numbing' effect, which some patients do not like. This comes down to informed consent - are people being told that 50% of people being prescribed the drug have difficulty coming off it & that withdrawal can be worse than their original depression? Yes, definitely need more studies nutritional psychiatry.
I agree, although these may not be enough for all depressed persons. As somebody who has treated depression in others, it's often a challenge to get people motivated to do what may be helpful for them, especially exercise, given that depression itself impairs motivation. (Even though I'm not impressed by the risk/benefit ratios of various neurotransmitter-changing drugs, I do think there's good evidence that a dopamine deficiency may be involved, which leads to anhedonia and overall reduced motivation - link below). I think it's critical we find more ways to get the brain to a state where it can more effectively engage in counseling and exercise. As for diet, the research in general is mostly epidemiological and of very poor quality, but everybody knows we need to eat less processed food. Again, motivation is a huge obstacle given that such foods are addictive. If only we could find a magical motivation pill! :)
Thanks for covering this, and I hope you cover alternative ways of treating depression, given its increasing prevalence and serious consequences. The "Speaking of Psychology" podcast recently had a good episode on TMS for treating depression (link below). There needs to be more research in this area, but since it can't be patented, very little money. Also, current protocols require trying other treatments first (i.e., drugs), and it's not always covered by insurance, and practitioners are scarce. It also takes a commitment of time on the part of the individual (as does counseling), and some people would prefer the magic bullet of a pill, at least if they're unaware of how ineffective and potentially risky they are.
https://www.apa.org/news/podcasts/speaking-of-psychology
I have not analysed too much about non-pharmaceutical treatments for depression treatments but I do think exercise, psychology and diet have a big role to play.
I couldn't see a way to add to my response (below), but I wanted to add that the reason I don't think that exercise and better diet, while helpful, are a panacea is that depression has existed since antiquity, long before people had highly refined diets and widespread insufficient exercise (link below). I believe depression is a combination of genetic pre-disposition and environmental triggers, like many diseases, although in some cases, it seems primarily genetic, and in others primarily environmentally triggered. As always, it's complicated. I also wanted to clarify what I said about depression and lack of motivation - it is NOT the person's fault! Unfortunately, too many people still think a depressed person should be able to "pull themselves up by their bootstraps!" Brain chemistry is involved, and we need to figure out better ways to address it. Yes, counseling and exercise can lead to changes in the brain, but the inherent motivational deficits are often obstacles to effective implementation of those 2 interventions. As for meds, people who are untreated or ineffectively treated will often self-medicate, which is often worse than prescribed Rx's. That's why we need more research into non-pharmaceutical ways (or better pharmaceutical ways) to impact the brain. Thanks for reading if you made it this far! :)
https://www.peertechzpublications.com/articles/ADA-6-145.php
What you describe is typical for the drug industry and doctors. Better for them if all these people just stay on their pills.
This is an important study! Thanks for this information as to how people should taper off SSRIs.
Thanks Deborah
You are absolutely right that this problem has been ignored for year's and the false serotonin hypothesis has influenced peoples perception of the nature of depression. Of course this misunderstanding has been in the interests of big pharma. It's great that you push back. However what about the idea of withdrawing those addicted to SSRIs using a "long acting" compound like Fluoxetine. When I practiced some years ago I found this a successful strategy. People withdrew OK by continually halving the dose.
Thanks Keith, I couldn't offer prescribing advice (I'm a scientist) but when I contacted Gøtzsche about it he said "we generally recommend against changing drugs, e.g. because the patients are then exposed to two drugs at the same time, which could lead to problems."
In practice patients are often exposed to two drugs sometimes of the same class, sometimes different. I think this is a case of the perfect being the enemy of the good. Its true that some people find transferring from paroxetine (or similar) to fluoxetine a difficult process but, once stabilized, withdrawal is much easier.
My reading (sorry cannot find source) is that anti-depressants have some anxiolytic effect, which may explain their initial assistance to patients. Finding ways to ease and manage any return of anxiety in a person withdrawing from anti-depressants whilst not being prescribing addictive anxiolytics remans a challenge. I would like to see more definite research on the use of nutritional psychiatry measures to manage depression in people and maybe to alleviate some of the withdrawal of anti-depressants - problems with what the manufacturers and clinicians seem to call 'discontinuation syndrome'.
That's my understanding too - antidepressants have anxiolytic properties. I'm told the drugs have a significant 'numbing' effect, which some patients do not like. This comes down to informed consent - are people being told that 50% of people being prescribed the drug have difficulty coming off it & that withdrawal can be worse than their original depression? Yes, definitely need more studies nutritional psychiatry.
I agree, although these may not be enough for all depressed persons. As somebody who has treated depression in others, it's often a challenge to get people motivated to do what may be helpful for them, especially exercise, given that depression itself impairs motivation. (Even though I'm not impressed by the risk/benefit ratios of various neurotransmitter-changing drugs, I do think there's good evidence that a dopamine deficiency may be involved, which leads to anhedonia and overall reduced motivation - link below). I think it's critical we find more ways to get the brain to a state where it can more effectively engage in counseling and exercise. As for diet, the research in general is mostly epidemiological and of very poor quality, but everybody knows we need to eat less processed food. Again, motivation is a huge obstacle given that such foods are addictive. If only we could find a magical motivation pill! :)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5716179/