chronic depression – part ii

What’s behind this explosion of Depression and mood-enhancing drugs?  We’ll get to what’s causing much of the Depression tomorrow.  As for what’s causing the explosion of Antidepressant Medications?  It’s a no-brainer.   Just follow the money!  Instead of educating people about the best ways to deal with underlying issues (both physical and psychological) it is far too easy (and profitable) for doctors to give their patients drugs —- put them on SSRI’s.  Of the three hundred plus billion dollars spent on medications in America each year, Antidepressants come in as the number one or two moneymaker depending on whose research you look at.  But are they effective?

One of the biggest studies on the therapeutic effects of SSRI’s was done by a group of Medical Doctors, Psychiatrists and Psychologists working through the University of Pennsylvania, and published in a 2009 issue of JAMA — Journal of the American Medical Association.  The interesting thing is that their work was not a single study, but a meta-analysis of several major studies on the effectiveness of SSRI’s.  Their conclusions?  “There is little evidence that they [SSRI’s] have a specific pharmacological effect relative to placebo for patients with less severe depression….    The magnitude of benefit of antidepressant medication compared with placebo….. may be minimal or nonexistent, on average, in patients with mild or moderate symptoms.”  Whoa!  In other words, we are loading entire segments of our population up on expensive drugs that do not even work well, yet have a whole array of potentially serious side effects?  Sure we are!  That’s how it works in a system that even most doctors will admit is run by Big Pharma.   This is why EVIDENCE-BASED MEDICINE is such a pipe-dream!

With most drugs used to change the way you feel (alcohol, heroin, prescription pain meds, meth, cocaine, etc,), the amount of drug that created yesterday’s “high”, will not get you high tomorrow.  And the cycle continues unabated until people are consuming mass quantities of these substances just to feel a buzz.  Years ago, when Rush Limbaugh became addicted to prescription pain medications after a failed back surgery, he had worked his way up to as many as 30 Oxycontins per day.  Alcohol works the same way.  The more one drinks, the more it takes to get drunk.  A similar thing happens with SSRI’s and your body’s own Serotonin.  How does the body respond to the inhibited reuptake of Serotonin in the Synaptic Cleft?  Follow along.

Body systems tend to run on feedback loops.  These are like the thermostat that we set to keep our house at a certain temperature.  When the inside temperature falls outside the range we have set, the furnace or air conditioner (depending on the season) automatically kicks on and regulates the temp back to its set point — and then it shuts off.   When the body perceives it has an overabundance of Serotonin, it will slow down the gut’s Serotonin production.  SSRI’s are designed keep Serotonin in the Synapse by inhibiting its reuptake. But for many people, the body (rightly) perceives this as an excess of Serotonin.  For many people who stop taking SSRI’s, this is not a huge problem.   They may struggle for a few weeks (this is the period where people get the SSRI Discontinuation Syndrome mentioned above), but eventually their Serotonin production goes back to normal (whatever “normal” is).  However, for a significant number of people, the feedback mechanism fails, Serotonin production remains diminished, and they end up with a potentially ugly array of long-term problems —- problems that can be both physically and / or psychologically devastating.

Besides diminishing Serotonin production, the body will respond to these perceived increases in Serotonin levels another way as well.  It will down-regulate Serotonin sensitivity.  In other words, when there is an excess of Serotonin at the Serotonin Receptors in the Synaptic Cleft, the brain will recognize this and automatically raise the threshold (decrease the sensitivity) of these receptors.   The resulting desensitization to Serotonin causes “masked” or “robotic” patients (these are the actual medical terms used to describe these people) who are now physiologically unable to feel extreme joy or happiness.  Because the body is no longer reacting normally to Serotonin, these intensely good feelings are blunted.  Or worse yet; they become impossible.  This helps us understand some of the more common sexual side effects of SSRI’s.