By Kimberly Blend, MS, ARNP-BC –
In 2011, American Pharmacists filled 264 million prescriptions for antidepressants, up more than 25 million since 2007. How did these drugs get so popular?
The first antidepressants tricyclic and monoamine oxidase inhibitors (MOAIs) were discovered by happenstance in the 1950’s, when doctors were looking for drugs to treat schizophrenia and tuberculosis. Doctors noted they lifted patient’s moods. MAOIs can cause serious and sometimes fatal reactions in users who eat foods containing the amino acid tyramine, like aged cheese and pepperoni. And tricyclics are referred to as dirty drugs, binding to several receptors in the body and as a result causing unpleasant side effects, like dry mouth, blurry vision, drowsiness and weight gain. Even modest overdose of tricyclics can be lethal, so the only MD’s comfortable prescribing them were psychiatrists, who closely monitored patients.
The picture changed in 1988 when Prozac hit the market. As an SSRI it is selective to serotonin reuptake receptors thus making it a cleaner drug. But it does have side effects and the longer it’s on the market, the more those have become apparent. Over time, Prozac and it siblings, Paxil, Zoloft, Celexa, Lexapro; have become known as safe antidepressants, and that perception has opened the door for doctors to prescribe them widely, not just for depression but also for a variety of other conditions, i.e. migraines, symptoms of menopause, and PMS.
You might think taking antidepressants for a persistent low mood is a no brainer, and the FDA has approved their use for that purpose, but don’t assume these drugs will effectively relieve depression. A review of 30 years of data in the Journal of the American Medical Associate (JAMA) found that SSRI’s, the most frequently prescribed antidepressants, don’t work much better than placebo for people whose depression is simply mild to moderate. “They’re only truly effective for people with very serious depression” says Irving Kirsch, PhD, associate director of the program in placebo studies at Harvard Medical School.
Why does it matter whether antidepressants are effective drugs or just placebos, as long as they do the job of lifting mood? Three reasons: (1) the drugs cause side effects that can significantly affect, peoples’ lives. (2) Primary care physicians write four out of every five scripts for antidepressants — which is a problem, because PCP’s tend to be less familiar than psychiatric specialists with the approved and effective uses of antidepressants. That is not a slam on primary care doctors. Most simply haven’t been trained in the nuanced pharmacology of the drugs, nor do they have the time to keep up with the constantly changing literature. (3) There are other safe and effective options for treating mild to moderate depression, including psychotherapy and neurotransmitter testing and amino acid therapy.
To confuse the issue of mood even further depressive behavior and anxiety have been associated with stress and systemic inflammation for over a decade. Depressed and anxious persons display elevations in blood levels of inflammatory cytokines and lower levels of anti-inflammatory cytokines. Another consistent finding in the literature is that levels of cortisol hormone are often elevated in depressed individuals. Glucocorticoid receptor sensitivity is diminished in the brains of individuals with depression along with changes in the brain regions called the hippocampus and fluctuations in the levels of the protein BDNF and chemical messenger glutamate.
So what does all this scientific mumbo jumbo mean….
What many clinicians have found when looking a bit outside the “psychopharmacology box” is that disturbances in the functioning of the HPA axis and desensitization of the glucocorticoid receptor can result in dysregulation of cortisol, norepinephrine, epinephrine, dopamine and serotonin production. The production of these hormones from the adrenal glands and neurotransmitters is essential to overall health and wellbeing.
The evidential support from the current literature suggests that urinary neurotransmitter and salivary cortisol testing have an important role in clinical practice as representative biomarkers of HPA axis activity. There is growing evidence that the central pathways that alter HPA axis activity are important in the interpretation of these biomarkers.
By understanding the mechanisms for treatment and the factors leading to changes in urinary neurotransmitters and salivary hormone imbalance, health care practitioners can benefit from these tools to assist in making more informed therapeutic decisions and monitoring treatment regimens with enhanced patient care.
While patients can give you a long list of symptoms, they can’t tell you about the underlying imbalances causing those symptoms. Many patient symptoms, such as fatigue, sudden weight gain, anxiousness, sleep difficulties and depression can have strikingly different underlying causes. While one sleep-deprived patient may have low serotonin, another may have high glutamate.
Today’s complex and recurring conditions often require an approach that views nervous, endocrine and immune functions as an integrated system. Once we have the personalized, integrated information from a patients lab results, we can better address underlying imbalances. The result is quicker and increased care effectiveness and decreased care expenses.
Kimberly Blend, MS, ARNP-BC
Kim is the Mental Health Director at The Blend Institute. She is a graduate of the University of Vermont with a Bachelor of Science degree in Human Nutrition and an Associate of Science degree in Nursing. She has also earned a Master of Science in Nursing degree with a specialization in psychiatry from the University of South Florida. Kim is a national board certified nurse practitioner.
After several years of teaching at a collegiate level, she turned her focus to Integrative Psychiatry. Over the last 10 years, Kim’s focus in her private practice work combines her nutrition background with her traditional psychiatric treatment practices, including psychotherapy and psychiatric medication management. She works to view patient symptom presentation from a biochemical and psychological perspective. Kim’s expertise in biochemical diagnosis allows her to provide patients with targeted, natural treatment options as well as pharmaceutical options.
Kim is a national speaker on the topic of neurotransmitter testing and amino acid therapy and often travels teaching other clinicians on the utility of neurotransmitter testing and the efficacy of amino acid therapies.
In 2010, Kim and her husband, Dr. Timothy Blend, MD, founded The Blend Institute. The Institute is a unique, collaborative medical practice and wellness center in that it offers the expertise and services needed to assist individuals in reaching total health, including both the mind and body. Institute professionals are dedicated to helping patients achieve and maintain optimal physical and mental health.
If you’re sick and tired of feeling sick and tired, call The Blend Institute at 941-722-5600 or visit us online at www.blendinstitute.com.