Depression Support Group
Depression is a real and debilitating condition that is often misunderstood by family and friends. Its meaning can range from a prolonged period of sadness to an actual mental illness with specific symptoms. Find and share experiences with others who are going through the same struggles.
I came across this board while surfing the Daily Strength list of sites. It seems as if there are a few misconceptions about meds used to treat depression.
I have a five year degree in Pharmacology and Medicinal Chemistry, so I know about meds. I want to try to give everyone the true facts about treatment of depression with pharmaceuticals. BTW, I am a respected poster on a few boards, so I am not a nut case. ha ha
I have read some of the comments here and some of you definitely need to be on some meds to help you cope with your depression and anxiety. Counseling and talking to a psychologist is fine, but there is a point at which just talking does not help.
Most depressive states are caused by a chemical imbalance of the brain, so meds are needed to restore the normal balance. There are three main chemicals in the brain called neurotransmitters and they are responsible for the transmission of nerve impulses to the brain tissue. Think of them as chemical messengers that carry the impulses back and forth along the nerve synapses.
These three neurotransmitters in the brain area that control our mood are seritonin, norepinephrine, and dopamine. Seritonin is by far the one that gets out of balance in most cases and is the most important, but the other two can play a role in depression.
In clinical depression, there is not enough free seritonin available to carry the nerve impluses in the brain area. The brain tissue releases seritonin to transmit nerve signals and when it is done the free seritonin is soaked back into the tissue. But in depression the shortage of free seritonin does not allow the nerve impulses ("the messages") to go from nerve cell to nerve cell properly. As a result this shortage of seritonin causes mood changes resulting in depression.
The goal in therapy with antidepressants is to increase that amount of free seritonin in the brain area so that the nerves messages can be transmitted properly. The modern antidepressants, the SSRIs, do exactly that and ease the depression.
SSRIs are Selective Seritonin Reuptake Inhibitors and here is how they work. The brain tissue itself releases the seritonin to help with nerve transmissions and when the job is done the seritonin is soaked back into the brain tissue; the seritonin is no longer "free" seritonin in that it is trapped in the tissue.
The SSRIs inhibit this reuptake by blocking the seritonin when it tries to go back into the brain tissue after it has completed it job. Thus the seritonin can not get back into the tissue and it stays out there as free seritonin. This allows more seritonin available to conduct nerve impulses.
The SSRIs are selective in that they only block the reuptake of seritonin and do not affect dopamine or norephinephrine.
Years ago the only antidepressants used were called the tricyclic antidepressants. This included amitriptyline (Elavil). They were not very effective and had some bothersome side effects such as dry mouth and sedation.
Now we have the SSRIs as antidepressants and they work much better. Prozac was the first one introduced and now we have Zoloft, Celexa, Lexapro and others to choose from. These are very effective and usually by trial and error with both the product and the dosage, most all depressed people can be helped.
There are a couple of common mistakes that people sometimes make when taking these SSRIs. First, they give up on them and don't take them long enough. Antidepressants are not quick acting. If you take one today, you will not all of a sudden feel better tomorrow. The full antidepressant effect is not seen in the SSRIs until anywhere from two to four weeks. So don't give up on them.
Another problem is that the SSRIs can be troublesome if a person want to get themselves off the drug. Any withdrawal must be done very gradually and the dose must be slowly reduced over at least a month's time.
If a person tries to get off the drug too quickly, the results will not be life threatening, but they will be bothersome (dizziness, nausea, flu like symptoms), so it is imperative to slowly withdraw if a person want to stop taking them. A quick withdrawal causes the brain to "rebel" as it is used to having enough seritonin to work properly. In a withdrawal, the brain has to adapt to the smaller amount of free seritonin, which cause these untoward side effects.
I have read some of the comments here and it is obvious that some posters here need to be on some antidepressant meds. When a person can no longer function in life, wants to stay in bed all the time, cannot sleep and has early morning awakening, cries, or contemplates suicide, it is time to find some help in the form of meds.
If some here are on meds and they are not helping, the med needs to be changed or the dosage adjusted. There are very few true depression cases where there is not a med out there to at least help and enable a person to live a decent life.
I am a humanitarian. It bothers me to see people suffering when there are drugs out there that could help.
I also see so much misinformation regarding SSRIs and other meds that it bothers me. This info I have given you here is straight from the horses's mouth so to speak.
Hope this helps everyone to understand depression better.
rewdiazepam
I have a five year degree in Pharmacology and Medicinal Chemistry, so I know about meds. I want to try to give everyone the true facts about treatment of depression with pharmaceuticals. BTW, I am a respected poster on a few boards, so I am not a nut case. ha ha
I have read some of the comments here and some of you definitely need to be on some meds to help you cope with your depression and anxiety. Counseling and talking to a psychologist is fine, but there is a point at which just talking does not help.
Most depressive states are caused by a chemical imbalance of the brain, so meds are needed to restore the normal balance. There are three main chemicals in the brain called neurotransmitters and they are responsible for the transmission of nerve impulses to the brain tissue. Think of them as chemical messengers that carry the impulses back and forth along the nerve synapses.
These three neurotransmitters in the brain area that control our mood are seritonin, norepinephrine, and dopamine. Seritonin is by far the one that gets out of balance in most cases and is the most important, but the other two can play a role in depression.
In clinical depression, there is not enough free seritonin available to carry the nerve impluses in the brain area. The brain tissue releases seritonin to transmit nerve signals and when it is done the free seritonin is soaked back into the tissue. But in depression the shortage of free seritonin does not allow the nerve impulses ("the messages") to go from nerve cell to nerve cell properly. As a result this shortage of seritonin causes mood changes resulting in depression.
The goal in therapy with antidepressants is to increase that amount of free seritonin in the brain area so that the nerves messages can be transmitted properly. The modern antidepressants, the SSRIs, do exactly that and ease the depression.
SSRIs are Selective Seritonin Reuptake Inhibitors and here is how they work. The brain tissue itself releases the seritonin to help with nerve transmissions and when the job is done the seritonin is soaked back into the brain tissue; the seritonin is no longer "free" seritonin in that it is trapped in the tissue.
The SSRIs inhibit this reuptake by blocking the seritonin when it tries to go back into the brain tissue after it has completed it job. Thus the seritonin can not get back into the tissue and it stays out there as free seritonin. This allows more seritonin available to conduct nerve impulses.
The SSRIs are selective in that they only block the reuptake of seritonin and do not affect dopamine or norephinephrine.
Years ago the only antidepressants used were called the tricyclic antidepressants. This included amitriptyline (Elavil). They were not very effective and had some bothersome side effects such as dry mouth and sedation.
Now we have the SSRIs as antidepressants and they work much better. Prozac was the first one introduced and now we have Zoloft, Celexa, Lexapro and others to choose from. These are very effective and usually by trial and error with both the product and the dosage, most all depressed people can be helped.
There are a couple of common mistakes that people sometimes make when taking these SSRIs. First, they give up on them and don't take them long enough. Antidepressants are not quick acting. If you take one today, you will not all of a sudden feel better tomorrow. The full antidepressant effect is not seen in the SSRIs until anywhere from two to four weeks. So don't give up on them.
Another problem is that the SSRIs can be troublesome if a person want to get themselves off the drug. Any withdrawal must be done very gradually and the dose must be slowly reduced over at least a month's time.
If a person tries to get off the drug too quickly, the results will not be life threatening, but they will be bothersome (dizziness, nausea, flu like symptoms), so it is imperative to slowly withdraw if a person want to stop taking them. A quick withdrawal causes the brain to "rebel" as it is used to having enough seritonin to work properly. In a withdrawal, the brain has to adapt to the smaller amount of free seritonin, which cause these untoward side effects.
I have read some of the comments here and it is obvious that some posters here need to be on some antidepressant meds. When a person can no longer function in life, wants to stay in bed all the time, cannot sleep and has early morning awakening, cries, or contemplates suicide, it is time to find some help in the form of meds.
If some here are on meds and they are not helping, the med needs to be changed or the dosage adjusted. There are very few true depression cases where there is not a med out there to at least help and enable a person to live a decent life.
I am a humanitarian. It bothers me to see people suffering when there are drugs out there that could help.
I also see so much misinformation regarding SSRIs and other meds that it bothers me. This info I have given you here is straight from the horses's mouth so to speak.
Hope this helps everyone to understand depression better.
rewdiazepam
Therefore, by the drug companies own admission, in every one of their drug labels, the mechanism of action that you buy into is a hypothesis, not a proven theory
My opinion is that the "chemical imbalance" theory of depression is nonsense. We know little more about how neurotransmitters influence mood than we did 50 years ago. We cannot see what happens at the synaptic gap; wild speculation now masquerades as "evidence-based" treatment.
SSRIs and SNRIs are among the most dangerous drugs ever approved by the FDA. The fact that they are still used in clinical practice, despite thousands of studies demonstrating their lack of efficacy, despite hundreds of bulletin boards documenting the misery and suffering these drugs have caused, is a complete mystery to me.
They frequently cause suicidal ideation, homicidal ideation, pervasive sexual dysfunction that lasts for decades or can be permanent, withdrawal symptoms worse than benzodiazepenes and heroin, and irreversible tardive dyskienisia.
I have seen all of these side effects with my own eyes. I am a rookie, and I've only treated about 100 clients as a psychotherapist. But of the 60 who used neuroleptics developed after about 1982, only two or three seemed to derive any benefit from them, and at least half developed side effects far worse than the symptoms the drugs were prescribed for.
I feel some of advice you are giving here is quite dangerous. SSRIs actually do begin working almost immediately; often the first few weeks are the period when people have strong suicidal urges, or develop arousal disorders or other sexual dysfunction. I suggest exactly the opposite: When side effects are present, a physician should be consulted immediately, and the drug should be discontinued as quickly as possible, though yes, it often should be tapered if at all possible.
It is not obvious that anyone should be on antidepressant meds. I feel most of these drugs should be banned by the FDA.
These are just my observations made anecdotally. This is no substitute for the advice of a medical professional.
I would not trust any medical professional I have not known for at least 10 or 15 years.
First of all, there is no doctor who will tell you that anyone knows the cause of depression. The neurotransmitter thing is just theory. You can google from mayo clinic on down and you will read over and over again that DOCTORS SIMPLY DO NOT KNOW THE EXACT CAUSE OF DEPRESSION AND ALOT OF OTHER MENTAL ILNESSES FOR THAT MATTER.
That said, not all depression responds to drugs. Though I can see how your having a degree in Pharmacaology, would sway you in this way. But it simply is not the truth.
That said, it seems that some people are helped by drugs, but I have seen drugs prescribed for many people who should not be on them. The best example I can think of is depression due to grief, loneliness, etc. In other words, reactive or situational depression.
There is a lot of evidence that people with mild depression respond just as well to cardiovascular exercise.
I agree with you completely and I would like to add that anti-psychotics used in the treatment of Schizophrenia and Bipolar Disorder are not, in fact, anti-psychotics at all.
They are also highly damaging and very dangerous drugs.
seeblue
Interesting name diazepam = valum.
Anyway, I challenge you to post a reputable source (hospital or governemental = NIH) that states that we know the cause of depression and that that cause is an imbalance in neurotransmitters.
Thank you
From medine plus, brought to you by the National Library of Medicine.
Read the first few sentences.
I only put this information out there. You can do what you want to with it.
This is what pharmacologists and physicians are taught in med school. I guess if you don't agree with it, then all the pharmacologists and Ph.D.s in the field are wrong.
@Seeblue,
Yes, I read the link you gave me and I agree 100%. I said several times that we are not certain what causes depression. I used the example the we have never seen a nerve synapse and cannot really measure seritonin levels.
So, yeah, I agree.
So I am not sure why you are challenging me on the exact cause of depression, as I have already stated, it is all theory.
Pharmacology is the study of how drugs affect the human body, how the drugs cause the effect they do. We use a
text, "Goodman and Gilman: The Pharmalogical Basis of Therapeutics."
All of pharmacology is theory.
Here is the reason that most pharmacologists believe that many forms---not all forms---of depression are caused by a chemical imbalance in the brain area of seritonin or one of the other neurotransmitters: in many depressed patients, when they are administered a drug which increases the amount of available seritonin in the brain area, in many cases the depression is alleviated. In the absence of no other factors, what would a reasonable person make as a logical deduction? A logical person, and most pharmacologists agree, the depression was relieved by the drug, since there were no other factors present and the antidepressant was the only drug used in the controlled studies.
Now I don't know what you think, but that is enough evidence to me to teach that some forms of depression are caused by an imbalance in brain chemistry, and according to the controlled studies, the chemicals out of balance are the neurotransmitters.
@Seeblue,
I don't quite understand your skepticism. For example, do you think that a 15mg dose of Morphine Sulfate will alleviate pain and produce analgesia? I think you would surely agree that it does. Why do you think that? Because it has worked in clinical trials, just as seritonin reuptake inhibitors have worked in clinical trials in depression. The only logical explanation is that the drug is killing the pain. Also you might have seen someone with extreme pain whose discomfort was alleviated by the morphine sulfate, just as many physicians have seen that many depressed patients are relieved by SSRI. At some point, you have to use some common sense.
No, we can not see the receptors on the cells, and no, while we do know the molecular structure of morphine sulfate, we can not actually see anything. I suppose it is only theory, but trust me, there are no pharmacologists that refuse to believe the morphine sulfate is a potent analgesic.
Do you understand how clinical trials are done?
It seems everyone here already has their mind made up on the topic of depression, so there is really no need to discuss it any further. I know what the studies say and that is what I teach. Should I teach something else?
So if you are severely depressed, you can refuse SSRIs or any other med. That is your choice. If you are severely depressed you can go ride your bicycle and do lots of cardio and hope that works.
I have taken the time to put the info out there. You either think it has some credibility or you think it is hogwash.
rewdiazepam
Just because we are not throwing around our degrees here, does not mean we don't have them and, more importantly, that many are not quite well-read on these issues.
You may be a humanitarian, but you are a Pharmacologist first and that has to bias you in favor of drugs.
I do not wish to debate with you. I believe it is a good thing that people on this board are intelligent, well-read, and some of us, are even educated ; .... have a great day.
"Most depressive states are caused by a chemical imbalance of the brain, so meds are needed to restore the normal balance. There are three main chemicals in the brain called neurotransmitters and they are responsible for the transmission of nerve impulses to the brain tissue. Think of them as chemical messengers that carry the impulses back and forth along the nerve synapses."
READ THE FIRST SENTENCE AGAIN, IF YOU WILL. IT IS INDISPUTABLE.
The first thing would be to get a thorough physical examination. There are a number of diseased states that cause depression.
>
I did not know that you, a Psychopharmacloogist, speaking on an online forum, could diagnose and decide who needs psychotropic medication. This can only properly be done by an M.D., and truly, one who is a Psychiatrist as well.
So, you come off, as
1. Innaccurate in your statement re causation and Pompous.
2. You are diagnosing and "virtually" prescribing medication.
3. You are using your education (not that great by the way) anyway as many many people now have advanced degrees just to survive in our economy) to tell us we are wrong and misinformed. You can NOT know that.
Gee (to use the vernacular), I wish we had an edit function on this board.
Thanks. You've proven my exact point. And the fact that these drugs are "approved by the FDA", a GOVERNMENT agency, makes me even more afraid to use them! Just because the FDA approves these drugs does not mean that they are SAFE, it just means that they have passed FDA guidelines...and all these pharmaceutical companies make damn sure in their ads that consumers are well aware of the side-effects, which take up half the time in a :30 commercial and read like a grocery list!
Lithium was going to be the drug of choice once my psychologist was about to introduce me to a psychiatrist (who prescribes drugs to treat depression). It was at that point that I realized if I don't want to be on drugs, I better find a natural path.
And I'm not big on antibiotics either. Like Chemotherapy to treat cancer, antibiotics destroy healthy intestinal flora as well as negative intestinal bacteria. With no intestinal flora to properly digest food, antibiotics induce diarrhea. But, you're right, for vast infections, they are the only choice. I prefer to ingest probiotics through food.
I think we're in agreement that drugs should be used as a last resort to treat any physical or mental ailment, only when all natural options have been explored, and have failed.
Yes, anyone with a heart condition will eventually have to get on Lipitor if they don't want do die. Or pop an aspirin every day, which has the positive result of thinning the blood so the heart can more easily pump it, with the negative side-effect of aggravating a bleeding ulcer or other bleeding problem. It's all about weighing the obstacles in this thing called life and health.
It's good to have both a Pharmacologist and nutrition/exercise-minded people on here. It's given what I said, provided this thread with a balanced perspective!