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I want to preface this by saying that each persons response is highly individual, but on the basis that antidepressants don't thoroughly treat, nor cure depression - let's talk about it.
Depression costs more than 9 billion dollers per year, more than that now considering the state of the world. Officially, the WHO has projected it to be the leading cause of disability by 2030, and I feel that we are well and truely on that path still. I want to show you why these drugs don't have lasting change, and what else you could do.
Pill State
Anti-depressants were discovered by accident. Yep, that's a fact you can look up. There have been multiple variations of the same drug developed since it was invented, but honestly, since the 80's nothing much as changed in the way of therapy for depressed people. This is including therapies such as talk therapy and magneto-therapy (electroconvulsion therapy).
In the 1950's (around 70 years ago) a drug with the action of inhibiting (stopping) monoamine-oxidase (an enzyme) was first testing on Tuberculosis patients to treat their TB. Iproniazid, the drug in question, caused such elation in those patients that the doctors working the study thought to use it for other conditions. This triggered scientists to look at other drugs that may do the same thing - enter imipramine, the first drug in the tricyclic antidepressant family. "The clinical introduction of fluoxetine, a selective serotonin reuptake inhibitor, in the late 1980s, once again revolutionized therapy for depression, opening the way for new families of antidepressants." However, all these antidepressant work via similar mechanisms. They prevent the reuptake of certain neurotransmitters (serotonin, norepinephrine or dopamine) to improve mood, also known as a the 'happy hormone'. If you see the image below, (MAO is monoamine oxidase) you can see where these drugs are doing their thing.
The main point for me explaining this, is to then tell you that there is no evidence that [all] depressed people have low neurotransmitters. The drug was discovered by accident, depressed people could use some elation, they worked the theory back to explain how the drug worked without ever fully understanding how depression worked. In fact, we still don't fully understand how depression works because the brain is just so damn complex.
33% of depressed people find that their medications become ineffective, not to mention the side effects, no matter which one. Symptoms like low mood, anhedonia (apathy) and low energy start to creep back in slowly. Health practitioners (including me) will often rule out anything that's interacting with the medication - such as alcohol, pregnancy, sudden weight gain, or other medications - before suggesting a medication review. They don't have any good research to say why these medications stop working, because they don't understand. The body is smart, and constantly adapting, so you could theorise that it has learned to work around the medications, or that their mechanism of action (like in the photo) is not treating the cause of the issue.
While these medications have trials suggesting their effectiveness, increasing happy hormones is likely to improve low mood for anyone, but it doesn't address the cause of the depression, nor is it a good long-term solution. These are not meant to be long-term medications, but once you stop - symptoms return for the majority. Safe to say they don't offer a holistic or lasting solution. Even, Penn and Tracy (2012) states "fundamentally current medications may be hitting the ‘wrong’ (or at least an upstream and indirect) target, hindering efficacy."
The Alternatives
The theory most naturopaths run by, is either consistent with higher levels of inflammation, damage to the gut microbiome or the neuroendocrine theory, which implicates hormonal abnormalities in depression due to hyperactivity of the hypothalamic–pituitary axis (HPA) meaning there is insufficient feedback suppression of corticotrophin-releasing factor (CRF) and glucocorticoids (to improve BDNF). I don't want to get too deep into the specifics but, working holistically is absolutely essential to treating depression. Mindset training has also shown some benefit for changing the pathways in the brain.
What else could contribute?
enviroment (exposure to toxins, heavy metals, relationships)
gut health (more LPS producting bacteria)
Inflammatory conditions (endometriosis, arthritis.... anything ending in 'itis')
medications
dysfunction in the HPA
nutritional deficiencies
trauma
Most, if not all, of these are variable measures, meaning we can change or remove them, effectively removing the causation. This is work that I do with clients all the time. See my services.
What could help?
Saffron - this little stem of sunshine has been used to centuries but some of the latest data shows "8 weeks of saffron supplementation resulted in significant improvements in depression scores", especially with PMDD (pms depression). Keep an eye out for our new product related to this. You can also read more in this blog on saffron here.
St John's Wort - a well known treatment for depression, with similar score improvement to the above medications. Although, I caution it's use as there's a lot of interactions - one of the few herbs that causes hormonal contraception to be ineffective (as well as blood thinners).
Lemon Balm - used for both anxiety and depression, especially in the acute sense. This herb makes a great tea, you can grow it at home easily too.
Lavender - in combination with lemon balm, a common and traditional mix in some Asian countries. This pairing was comparable to fluoxetine (developed in the 80's) in improving depression scores.
You can try these herbs as a tea, but I would recommend speaking to a herbalist or naturopath (such as myself) if you are already on medication to avoid serotonin overload. There is many more on this list to support mood stabilisation, but let's leave it at a few for now.
Overall, medication have their place in acutely managing moderate to severe depression (to reduce risk to life), but have absolutely no impact on the cause of depression. You should by no means reduce or stop your medication without guidance from a GP. Holistic healthcare can help identify the cause/triggers to help heal the depression from the root of tree, so to speak. If you have any questions, feel free to email me - mickayla@rosemarynaturopathy.com.au
Genetic side note: polymorphisms associated with favourable antidepressant response, e.g. a functional polymorphism: 5HTTLPR, of the 5HT transporter gene (5HTT) has a short and long allele. The long allele has been associated with better response to SSRIs, whereas the short allele with poorer response. Genetic testing is something we can order for you if you were concerned about genetic inheritance or predisposition to disease.