Page 27 - Sonoma County Gazette April 2019
P. 27

    Are Antidepressants Losing Favor?
With the approval of Prozac in 1987, a new era of treatment for depression was ushered in. Previously, there had been other medications, like the
tricyclic antidepressants, but their side effects tended to limit their use. With the Serotonin Reuptake Inhibitors (SSRIs), patients were able to tolerate the treatment better and seemed to get good results, so doctors began prescribing them liberally. Over time, the conditions for which they were used expanded to include panic, anxiety, eating disorders, mood changes related to menses, and many others.
The numbers of people taking these medications continues to rise.
From 1999 to 2012 the percentage of Americans on antidepressants increased from 6.8% to 13%. Now nearly 25 million American adults are taking these meds for at least 2 years.
 Research shows variable results for these medications. They do perform somewhat better than placebo, especially in cases where the depression is more severe, but “their overall effect is mild to moderate” improvement. Therapy
is about as good as medication, with both together performing slightly better than either by themself. The medication often takes 6 weeks to produce improvement, and approximately 50% of people do not respond adequately
to the first medication they try. The prescriber will then switch, and another 30% may respond to that one. There is a significant portion of the depressed population that are considered “treatment resistant,” meaning the medications don’t work for them.
  Why is the Need Increasing?
Despite the fact that approximately 1⁄6 of the population are on these medications, we don’t seem to be a happier or more resilient culture these days. Overdoses and suicides have risen to the top for cause of death in young people, and these are often described as “deaths of despair.” Rates
of anxiety and depression in the general population continue to increase. What the heck is going on? Many people have theories, from nutritional deficiencies, to the stress of modern life, to screen time leading to isolation, but clearly the medications are not curing anything.
How About Getting Off of Them?
Side effects can be problematic, especially sexual problems that can
be upsetting for many people. Drowsiness and weight gain also affect approximately 10% of people using these meds. Most concerning has been suggestions of increased suicide risk, especially in adolescents, but that has generally been disproven at this point.
 Once people start them, we are recognizing that they may have difficulties getting off. The medical world has been slow to acknowledge this issue, but new research is confirming what many people have been saying for years. In a recent NY Times article, new research is leading to recommendations to slowly wean over months or even years, because some people were experiencing significant symptoms of anxiety, insomnia, even “brain zaps” if they weaned too quickly.
Other Approaches
Psychotherapy clearly has an important role in helping people with depression. There can be a dizzying array of therapeutic approaches, and none has shown a clear benefit over others, except in specific circumstances. Cost and time commitment can be a factor here.
 ECT, or electo-shock therapy is still being performed, and is considered safer than when used in the past, but is usually only indicated when there is severe depression unresponsive to medication.
Conclusions
Depression is increasing in our culture at a concerning rate. The medical attempts to deal with it have severe limitations. New treatments are starting to emerge, but none of these really get at the underlying causes. These bigger questions really need to be looked at by our philosophical, spiritual, and political leaders.
4/19 - www.sonomacountygazette.com - 27
An old anesthetic that gained favor as a street drug due to its psychedelic effects has recently become utilized for depression. Ketamine has been used off-label for depression in an IV form in special clinics for the past few years with some promising results, especially since it can lead to improvement very quickly. The FDA recently approved a nasal form called Esketamine that will be administered in a doctor’s office or hospital twice a week for four weeks. Because of side effects including hallucinations and disorientation after taking the drug, they would need to be monitored for a few hours and be driven home.













































































   25   26   27   28   29