In 1952, the world’s first antidepressant medication was discovered by the process called serendipity (an accidental finding of a “gift”). Patients diagnosed with tuberculosis and who also took a new TB medication called, iproniazid, became less anxious and agitated, and began to sleep better. Since 1952, there has been an explosion of new AD’s, as well as a broadening of their use for problems besides depression.
Today’s column, using a question and answer format, will attempt to tackle the most commonly asked questions about AD’s, and will focus on the most severe type of depression, called a Major Depressive Disorder. However, you will first need the following mini-lecture.
To organize a discussion of MDD, I have divided the symptoms of MDD into three clusters:
1. Body — Physiological. Sleep is broken by insomnia or early morning awakening. Weight loss or gain. Fatigue, muscle pain, loss of motivation and sexual desire.
2. Feelings — Affective. Profound sadness, loss of interest in normal activities, cries easily.
3. Thinking — Cognitive. Thoughts are negative, pessimistic and self-blaming. Concentration and decision making are lost. Worthlessness, hopelessness and a belief one is a failure or a bad person.
First Question: 10 years ago, patients diagnosed with MDD were often treated with a medication only approach. Today’s treatments are broad-based. What caused this change?
Answer — When neuroscientists proved that the brain was constantly making new brain cells (a process called neurogenesis), they began to identify those conditions which produced maximum neurogenesis. These findings have revolutionized the treatment of MDD. 21st century treatments reflect the fact that AD’s are not curative agents. That is, medication only treatments lack the power to cure all of the debilitating effects of MDD. Here is one way of thinking about AD’s : When an arm is broken, a cast is wrapped around the injury. The cast holds bones in alignment and protects the injury. AD’s act like this cast. They stabilize the biological aspects of MDD by restoring sleep, appetite and energy levels. Once this happens, the correction of cognitive distortion (highly negative beliefs about oneself) can be achieved. This sets the stage for the final phase of treatment: rebuilding, restoring and reclaiming all aspects of one’s life.
Question #2: What specific aspects are we talking about?
Answer — MDD treatments are now similar to the way chronic diseases such as diabetes are treated. A broad treatment program is applied, and just like a new suit tailor-made for a specific person, these ingredients are included: Exercise and physical fitness, weight reduction, nutrition education, skills to reduce stress, and the strengthening of family, friends and spiritual connections.
Question #3: Why do patients who have been diagnosed with an anxiety disorder take AD’s?
Answer — While it is true that AD’s were originally marketed only for MDD, it has been proven they are excellent for anxiety, obsessive-compulsive disorder and many other conditions as well.
Question #4: Are AD’s addictive? Answer — No
Question #5: If they are not addictive, why do many patients who stop using them have withdrawals?
Answer — Serotonin Discontinuation Syndrome occurs in up to 60% of patients who abruptly stop taking the class of AD’s using serotonin. SDS occurs within 48 hours of stopping the AD. Common symptoms include flu-like chills, nausea, vomiting, dizziness and sleep disturbances. For most patients, SDS problems resolve within four weeks.
In summary, we live in an age where advances in the treatment of MDD now rival, in effectiveness, the treatments for other chronic diseases such as diabetes, high blood pressure and cardiac disease. Unfortunately, only one third of depression sufferers seek treatment. What is keeping the majority of people who suffer from MDD from seeking care? I believe it is the part of the MDD which distorts and bends one’s own thoughts against themselves: “I am not worthy of good health.”
The content of this article is for educational purposes only, not treatment. The characters in this story are not real. Names and details have been changed to protect confidentiality.
References: “A Primer of Drug Action,” R. Julien, 2009
Dr. Richard Elghammer contributes his column each week to the Journal Review.
