Showing posts with label Antidepressant. Show all posts
Showing posts with label Antidepressant. Show all posts

Thursday, January 16, 2014

A Psychiatrist’s Perspective on Using Drugs

English: animal medication
 (Photo credit: Wikipedia)

By Kelly Brogan, MD
When I see new patients, I do not prescribe medication for them. Patients who come to me know that I plan to help them understand "why" they are experiencing "what" they are going through. 
Once I have tapered patients off of medication, we use alternatives if symptoms crop up again.
Knowing my basic orientation around the issue of psychiatric prescribing doesn't seem to stop some patients from asking for what they believe will be a quick fix in an antidepressant pill.  Where did they learn to make these treatment requests of providers?
Perhaps they are a reflection of the 49% of requests for drugs prompted by "direct-to-consumer" (DCA) advertising by pharmaceutical companies.1 Fully 7 out of 10 times, doctors prescribe based on these requests made by patients who learned from advertising that they have an "imbalance" that must be fixed with a pill.
In a 10-year period from 1999 to 2008, DCA tripled from 1.3 to 4.8 billion dollars devoted to educating patients about their need for psychiatric medication. The "mass provision" of SSRIs to the public is not a reflection of their well-understood mechanism, of their efficacy, or of their safety. In fact, it flies in the face of all three. 
As stated by Professor of Neuroscience, Elliot Valenstein:2 "What physicians and the public are reading about mental illness is by no means a neutral reflection of all the information that is available."

Reasoning Backwards: What Are We Treating?

If you were to ask the average person on the street what the biology of depression relates to, they would very likely parrot, "serotonin deficiency." This hypothesis, referred to as the monoamine hypothesis, grew out of observations of mood-related side effects in the treatment of tuberculosis patients with iproniazid,3 which has some inhibitory impact on the breakdown of monoamines.
From this accidental observation and double talk about reserpine's role in inducing and treating depressive states, a theory was born.  Six decades of subsequent studies in never-medicated depressed patients have been conflicting, confusing, and inconclusive, and a critical review of the hypothesis concludes:4
" … there is no direct evidence of serotonin or norepinephrine deficiency despite thousands of studies that have attempted to validate this notion."
Similarly conclusive is a New England Journal of Medicine review on Major Depression,5 which stated:
" … numerous studies of norepinephrine and serotonin metabolites in plasma, urine, and cerebrospinal fluid as well as postmortem studies of the brains of patients with depression, have yet to identify the purported deficiency reliably."
Even in the pursuit of this appealingly reductionist idea of a chemical deficiency, we are unable to measure central nervous system quantities, to account for the inner workings of 14 different types of serotonin receptors,
Also for the vast projections of serotonin trafficking neurons, and for the delicate interplay between the 100 some neurotransmitters that we know to be active in the brain. Dr. Daniel Carlat, author of Unhinged, writes:
"We have convinced ourselves that we have developed cures for mental illnesses…when in fact we know so little about the underlying neurobiology of their causes that our treatments are often a series of trials and errors."

How Do These Meds Work?

Even if we were to accept the premise that these medications are helpful, extrapolating a medical etiology from this observation would be the same as saying that shyness is a deficiency of alcohol, or migraine a deficiency of codeine.
And to my holistic and integrative colleagues who are very excited about tryptophan and 5HTP in medication-naïve patients, I will remind them that the only time that tryptophan depletion has correlated with low mood is in those patients previously treated with SSRIs.
We have been taught to associate serotonin with feeling good, but the fact is that high serotonin has been associated with feeling bad, including carcinoid syndrome, Alzheimer's, autism, and schizophrenia.
Low serotonin metabolite (5H1AA) is indicative of turnover of serotonin, and is the eventual result of increased serotonin in the synapse. This has been associated with suicide, violent crime, alcoholism, bulimia, and exhibitionism! Clearly, we are not dealing with a simple more is better, or even a "looking for the right balance" type of scenario.
Chasing this pattern and seeking to alter "levels" is like trying to connect a pile of scattered dots into a long straight line – you have to ignore the ones that don't fit.What about genetics? Wasn't I born with this defect?
Despite the continued efforts to identify "the gene," a false start in 2003,6 which suggested that those with a variant in the serotonin transporter were 3x more likely to be depressed, was later mowed over by a meta-analysis of 14,000 patients that denied this association.7  Dr. Insel, head of the NIMH, had this to say:
"Despite high expectations, neither genomics nor imaging has yet impacted the diagnosis or treatment of the 45 million Americans with serious or moderate mental illness each year."
Carlat goes on to say: "And where there is a scientific vacuum, drug companies are happy to insert a marketing message and call it science. As a result, psychiatry has become a proving ground for outrageous manipulations of science in the service of profit."

Pharma Weaves an Irresistible Tale

Eleven billion dollars are spent each year on antidepressant medications,8 pharmaceutical companies have 625 lobbyists,9 and they underwrite more than 70% of FDA trials. They court physicians,10 give them samples, tell patients to "ask their doctor," pay consultants to speak at scientific meetings, advertise in medical journals, fund medical education, and ghostwrite, cherry pick and redundantly submit data for publication.  Psychiatric studies funded by pharma are 4x more likely to be published if they are positive,11 and only 18% of psychiatrists are disclosing their conflicts of interests when they publish data. Their studies allow:
  • Placebo washout (getting rid of those who are likely to respond to placebo before the study to strengthen the perceived benefit)
  • Replacement of non-responders
  • Breaking blind by using inert placebos so that subjects know that they have received the treatment
  • Use of sedative medications concurrent to study medications
A now famous 2008 study in the New England Journal of Medicine12 by Turner et al sought to expose the extent of data manipulation. Through valiant efforts to uncover unpublished data, they determined that from 1987 to 2004, 12 antidepressants were approved based on 74 studies. 38 were positive, and 37 of these were published.  Thirty-six were negative (showing no benefit), and 3 of these were published as such while 11 were published with a positive spin (always read the data not the author's conclusion!), and 22 were unpublished.
Since two studies are required by the FDA for approval, you can see how these companies are tossing the coin repeatedly, until heads comes up, and hoping no one is looking when it's tails. Per Robert Whitaker, author of Anatomy of An Epidemic and Mad In America, references, these practices undermine the accuracy of data and deliver information that corrupts physician's delivery of care and endangers patients.
The costs of this manipulation of information is the loss of true informed consent – physicians cannot adequately share with patients the risks and benefits if the benefits are fabricated and the risks are not uncovered (by 5-6 week trials) or are unacknowledged.

Placebo Effect – Why They "Work"

Despite Pharma's efforts, the truth about these brain bombs is emerging. In 1998, Dr. Irving Kirsch, an expert on the placebo effect, published a meta-analysis13 of 3,000 patients who were treated with antidepressants, psychotherapy, placebo, or no treatment and found that 27% of the therapeutic response was attributable to the drug's action. 
This was followed up by a 2008 review,14 which invoked the Freedom of Information Act to obtain access to unpublished studies, finding that, when these were included, antidepressants outperformed placebo in only 20 of 46 trials (less than half!), and that the overall difference between drugs and placebos was 1.7 points on the 52 point Hamilton Scale.  This small increment is clinically insignificant, and likely accounted for my medication side effects strategically employed (sedation or activation).
He found that severely depressed patients were less placebo responsive, generally, potentially accounting for the impression of some increased benefit, such as that found by Fournier et al.15 When active placebos were used, the Cochrane database16 found that differences between drugs and placebos disappeared, given credence to the assertion that inert placebos inflate perceived drug effects.
In response to 2005 recommendations from the National Institute for Health and Clinical Excellence that SSRI medications be first line treatment recommendations for depression, Drs. Kirsch and Moncrieff pointed out17 that the NICE data, itself, demonstrates a 1 point difference on the 52 point Hamilton Scale between placebo and drug groups, and that it was not in more severely depressed patients that this was found.
The finding of tremendous placebo effect was also echoed in two different meta-analysis by Khan et al18 who found a 10% difference between placebo and antidepressant efficacy, and comparable suicide rates. The largest, non-industry funded study,19costing the public $35 million dollars, followed 4000 patients treated with Celexa (not blinded, so they knew what they were getting), and half of them improved at 8 weeks. Those that didn't were switched to Wellbutrin, Effexor, or Zoloft OR "augmented" with Buspar or Wellbutrin.
Guess what? It didn't matter what was done, because they remitted at the same unimpressive rate of 18-30% regardless. Only 3% of patients were in remission at 12 months.
So what if it's placebo effect? It's working at least some of the time, so who cares? Here's why I, and other concerned psychiatrists and practitioners, care: I first became aware of the habit forming nature of these medications when I tapered a patient off of Zoloft in anticipation of a pregnancy in the coming year, and she experienced about 6 months of protracted withdrawal that began at about two months after the last dose. This was nothing I was prepared, by my training, to deal with. 
What are these medications actually doing?!  The truth is, we have very little idea. We like to cling to simple explanations, but even the name of the various antidepressants, selective serotonin reuptake inhibitors and norepinephrine reuptake inhibitors is misleading.
They are far from selective.  An important analysis20 by the former director of the NIMH makes claimed that antidepressants "create perturbations in neurotransmitter functions" causing the body to compensate through a series of compensatory adaptations which occur after "chronic administration" leading to brains that function, after a few weeks, in a way that is "qualitatively as well as quantitatively different from the normal state."
Changes in beta-adrenergic receptor density, serotonin autoreceptor sensitivity, and serotonin turnover all struggle to compensate for the assault of the medication.
Andrews et al21 calls this "oppositional tolerance," and demonstrate through a careful meta-analysis of 46 studies demonstrating that patient's risk of relapse is directly proportionate to how "perturbing" the medication is, and is always higher than placebo (44.6% vs 24.7%). They challenge the notion that findings of decreased relapse on continued medication represent anything other than drug-induced response to discontinuation of a substance to which the body has developed tolerance. They go a step further to suggest:
"For instance, in naturalistic studies, unmedicated patients have much shorter episodes, and better long-term prospects, than medicated patients (Coryell et al., 1995; Goldberg et al., 1998; Posternak et al., 2006). Several of these studies have found that the average duration of an untreated episode of major depression is 12–13 weeks (Coryell et al., 1995; Posternak et al., 2006).
Since acute ADM management of major depression minimally requires several weeks to reduce symptoms, the duration of untreated episodes is much shorter than the recommended duration of ADM therapy. This suggests that ADM therapy may delay resolution of depressive episodes."
Harvard researchers22 also concluded that at least fifty percent of drug-withdrawn patients relapsed within 14 months. In fact:
"Long-term antidepressant use may be depressogenic . . . it is possible that antidepressant agents modify the hardwiring of neuronal synapses (which) not only render antidepressants ineffective but also induce a resident, refractory depressive state."23

Buyer Beware

Here we come to the little disclosed poor outcomes associated with long-term treatment. We won't focus on the risk of suicide and violence, bleeds, or even suppressed libido and sexual dysfunction, indifference (or "medication spell-binding" as Dr. Peter Breggin calls it), or weight gain and dysglycemia.  Let's just focus on what the data shows on how your ability to function, long-term, in the world with depression is significantly sabotaged by treating that first episode of depression with medication.
This was famously explored by Robert Whitaker, and can be summarized with the following studies, as a primer. Longitudinal studies demonstrate poor functional outcomes for those treated with 60% of patients still meeting diagnostic criteria at one year24 (despite transient improvement within the first 3 months). When baseline severity is controlled for, two prospective studies support a worse outcome in those prescribed medication:
One in which the never-medicated group experienced a 62% improvement by six months, whereas the drug-treated patients experienced only a 33% reduction in symptoms,25 and another WHO study of depressed patients in 15 cities which found that, at the end of one year, those who weren't exposed to psychotropic medications enjoyed much better "general health;" that their depressive symptoms were much milder;" and that they were less likely to still be "mentally ill."26
I'm not done yet. In a retrospective 10-year study27 in the Netherlands, 76% of those with unmedicated depression recovered without relapse relative to 50% of those treated. Unlike the mess of contradictory studies around short-term effects, there are no comparable studies that show a better outcome in those prescribed antidepressants long term.
Perhaps most concerning to a holistic physician is data28 that suggests that long-term antidepressant treatment actually compromises the known and evident benefits29 of exercise! Benefits of exercise treatment of depression were comparable to Zoloft and were diminished when combined with Zoloft where patients relapsed at higher rates than they did with exercise alone.

Selling Sickness

Whitaker helps us to remember: Prior to the widespread use of antidepressants, the National Institute of Mental Health told the public that people regularly recovered from a depressive episode, and often never experienced a second episode.30 Now we have skyrocketing rates of disability in the setting of skyrocketing prescriptions. Whitaker has compiled and analyzed data demonstrating that days of work lost are increased by medication treatment as is long-term disability (19% vs 9%),31 3-7 times the incidence of loss of "principal social role" and "incapacitation,"32 with treated illness, and that 85% of unmedicated patients recover in a year, with 67%33 doing so by 6 months – an enviable statistic.
What has happened here? Since its 1952 inception and notorious inclusion of homosexuality as a diagnosable syndrome, the Diagnostic and Statistical Manual has now ballooned to more than 300 diagnoses in its fifth edition, all arrived at through general consensus of a committee consisting of practitioners with conflicts of interest34 and pharmaceutical enmeshments. Allen Frances at Columbia states:
"Wholesale imperial medicalization of normality that will trivialize mental disorder and lead to a deluge of unneeded medication treatment – a bonanza for the pharmaceutical industry but at a huge cost to the new false positive patients caught in the excessively wide DSM-V net." 
We need to break the populace out of its spell, reject the serotonin meme, and start looking at depression (and anxiety, and bipolar, and schizophrenia, and OCD, etc) for what they are – disparate expressions of a body struggling to adapt to a stressor. We need to identify vulnerabilities, modifiable exposures, and support basic cellular function, detox, and immune response. This is personalized medicine, where these abstract labels become meaningless because they only address the "what" of the symptoms" in an impressionistic, non-specific manner.  One as helpful as saying the fever is the disease, and Tylenol the cure. Psychiatry's swan song has been sung…listen for its plaintive wail. 

About the Author

Dr. Brogan is boarded in Psychiatry/Psychosomatic Medicine/Reproductive Psychiatry and Integrative Holistic Medicine, and practices Functional Medicine, a root-cause approach to illness as a manifestation of multiple-interrelated systems.  After studying Cognitive Neuroscience at M.I.T., and receiving her M.D. from Cornell University, she completed her residency and fellowship at Bellevue/NYU.  She is one of the only physicians with perinatal psychiatric training who takes a holistic evidence-based approach in the care of patients with a focus on  environmental medicine and nutrition. She is also a mom of two, and an active supporter of women's birth experience, rights to birth empowerment, and limiting of unnecessary interventions which is a natural extension of her experience analyzing safety data and true informed consent around medical practice.  She is the Medical Director for Fearless Parent, and an advisory board member for and Pathways to Family Wellness. She practices in NYC and is on faculty at NYU/Bellevue. 
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Thursday, October 3, 2013

Violent Side Effects of Antidepressants

On the Threshold of Eternity
On the Threshold of Eternity (Photo credit: Wikipedia)
In light of a long list of mass shootings over the past several years, the causative role of psychiatric drugs in violent events will undoubtedly have to be evaluated and addressed at some point. Personally, I’d vote for sooner, rather than later.
Antidepressants in particular have a well-established history of causing violent side effects, including suicide and homicide.  In a recent Scientific American1article, the author states:
“Once again, antidepressants have been linked to an episode of horrific violence. The New York Times2 reports that Aaron Alexis, who allegedly shot 12 people to death at a Navy facility in Washington, DC, earlier this week, received a prescription for the antidepressant trazodone3 in August.”
The drug in question, trazodone, has been associated with:4
“New or worsening depression; thinking about harming or killing yourself, or planning or trying to do so; extreme worry; agitation; panic attacks; difficulty falling asleep or staying asleep; aggressive behavior; irritability; acting without thinking; severe restlessness; and frenzied abnormal excitement.”
The naval yard shooting is just the latest event to bring questions about prescription medications to the fore, but it bears noting that in this particular case no evidence has yet been released confirming that the shooter had the drug in his system at the time of the massacre.
Still, questions about the safety, or lack thereof, of antidepressants and other psychiatric drugs really need to be addressed regardless of whether they were instrumental in this particular case. Just last year, a Canadian judge ruled that a teenage boy murdered his friend because of the effects of Prozac.
When will such side effects be taken seriously? Just how many people have to kill themselves or others before a drug is considered too dangerous to be prescribed?
In a paper titled Antidepressants and Violence: Problems at the Interface of Medicine and Law,5 David Healy, a British professor of psychiatry at Cardiff University and an authority on side effects of psychiatric drugs, writes:
 “Legal systems are likely to continue to be faced with cases of violence associated with the use of psychotropic drugs, and it may fall to the courts to demand access to currently unavailable data. The problem is international and calls for an international response.”

Potential Side Effects of Antidepressants = Violence and Worsened Depression

In 2004, the US Food and Drug Administration (FDA) revised6 the labeling requirements for antidepressant medications (SSRI’s and others), warning that:
“Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders.
Anyone considering the use of [Insert established name] or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need.”
These labeling revisions were in large part driven by lawsuits, in which pharmaceutical companies were forced to reveal previously undisclosed drug data.

For example, a civil lawsuit filed in 20047 charged GlaxoSmithKline (GSK) with fraud, claiming the drug manufacturer hid results from studies on Paxil showing the drug did not work in adolescents and in some cases led to suicidal ideation. Rather than warning doctors of such potential side effects, GSK actually encouraged them to prescribe the drug to teens and children.
According to,8 GSK has agreed to pay out more than $1 billion to settle more than 800 different lawsuits related to Paxil—and that’s over and above the $3 billion it agreed to pay to settle the Department of Justice’s investigation into illegal marketing of Paxil and other drugs!
In an effort to gather the necessary data on adverse side effects, Healy and other healthcare experts have formed an organization called RxISK.9 It’s a free, independent website where patients, doctors, and pharmacists can report side effects and research prescription drugs of all kinds. I’d encourage you to bookmark it and refer to it when needed.

Antidepressants and ADHD Drugs Top List of Most Violence-Inducing Drugs

Please note that antidepressants are not the only type of drugs associated with violent, homicidal behavior, but they are among the most common suspects. A study10 by the Institute of Safe Medication Practices published in 2010 identified no less than 31 commonly-prescribed drugs that are disproportionately associated with cases of violent acts. Topping the list is the quit-smoking drug Chantix, followed by Prozac and Paxil, and drugs used to treat ADHD.
The data was collected from the FDA's Adverse Event Reporting System (VAERS), and it's well worth noting here that only an estimated one to 10 percent of all side effects are ever reported to VAERS, so the fact that more than 1,500 violent acts were actually reported as being linked to any given drug is pretty amazing. The vast majority of side effects, regardless of what they are, are typically blamed on something else and connections are brushed aside as "coincidental."
In all, five of the top 10 most violence-inducing drugs were found to be antidepressants:
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Fluvoxamine (Luvox)
  • Venlafaxine (Effexor)
  • Desvenlafaxine (Pristiq)
According to Professor Healy, a study by the Drug Safety Research Unit in Southampton showed that one in every 250 subjects taking Paxil or Prozac were involved in a violent episode. In a study group of 25,000 people, this included 31 assaults and one homicide. In 2011, a whopping 14 million prescriptions for Paxil and more than 25.5 million prescriptions for Prozac were written.11 This could potentially equate to some 158,000 drug-induced incidents of violence annually from these two drugs alone. As reported in the featured article:12
“Another study involving more than 9,000 subjects taking the antidepressant paroxetine (Paxil) for depression and other disorders showed that subjects experienced more than twice as many ‘hostility events’ as subjects taking a placebo.” ... Healy suspects that the main causal factor behind suicide and violence toward others is increased mental and/or physical agitation, which leads about five percent of subjects taking antidepressants to drop out of clinical trials, compared to only 0.5 percent of people on placebos.”
Another two in that top 10 list of violence-promoting drugs are commonly-prescribed ADHD medications (including Strattera). When you consider that antidepressants and ADHD drugs are among the most prescribed types of drugs13 in the US, the fact that so many of them are linked to increased rates of violence should be cause for pause. Besides an increased risk of violent episodes, ADHD drugs such as Ritalin, Vyvanse, Strattera, and Adderall (and their generic equivalents) are also responsible for nearly 23,000 emergency room visits annually, as of 2011 statistics. Over a mere six-year span, there’s been a 400 percent increase in ER visits due to side effects of these drugs.

Use Antipsychotic Medications with More Care, Psychiatrists Say

In related news,14 the American Psychiatric Association (APA) recently issued a statement urging doctors and patients to reconsider the practice of using anti-psychotic medications as the first line of treatment for:
  • Dementia in the elderly
  • Behavior problems in children, or
  • Insomnia in adults
The drugs in question include Risperdal, Zyprexa, Seroquel, and Abilify. APA’s recommendation with regards to anti-psychotic drug prescriptions is part of a larger campaign called Choosing Wisely,15 which covers a wide array of common medical practices that patients and doctors would do well to question, as they may cause more harm than good. Joel Yager, a psychiatry professor at the University of Colorado-Boulder, told USA Today:
“Doctors who overprescribe the medications are doing what they think might help, often without first trying safer or more effective alternatives.”

Key Factors to Overcoming Depression Without Drugs

It’s important to realize that your diet and general lifestyle are foundational factors that must be opitimized if you want to resolve your mental health issues, because your body and mind are so closely interrelated. Depression is indeed a very serious condition; however, it is not a “disease.” Rather, it’s a sign that your body and your life are out of balance.
Mounting and compelling research demonstrates just how interconnected your mental health is with your gastrointestinal health, for example. While many think of their brain as the organ in charge of their mental health, your gut may actually play a far more significant role. The drug treatments available today for depression are no better than they were 50 years ago. Clearly, we need a new approach, and diet is an obvious place to start.
Research tells us that the composition of your gut flora not only affects your physical health, but also has a significant impact on your brain function and mental state. Previous research has also shown that certain probiotics can even help alleviate anxiety16,17. The place to start is to return balance—to your body and your life. Fortunately, research confirms that there are safe and effective ways to address depression that do not involve unsafe drugs. These include:
  • Dramatically decrease your consumption of sugar (particularly fructose), grains, and processed foods. (In addition to being high in sugar and grains, processed foods also contain a variety of additives that can affect your brain function and mental state, especially MSG, and artificial sweeteners such as aspartame.)  There's a great book on this subject, The Sugar Blues, written by William Dufty more than 30 years ago, that delves into the topic of sugar and mental health in great detail.
  • Increase consumption of probiotic foods, such as fermented vegetables and kefir, to promote healthy gut flora. Mounting evidence tells us that having a healthy gut is profoundly important for both physical and mental health, and the latter can be severely impacted by an imbalance of intestinal bacteria.
  • Get adequate vitamin B12. Vitamin B12 deficiency can contribute to depression and affects one in four people.
  • Optimize your vitamin D levels, ideally through regular sun exposure. Vitamin D is very important for your mood. In one study, people with the lowest levels of vitamin D were found to be 11 times more prone to be depressed than those who had normal levels.18

    The best way to get vitamin D is through exposure to SUNSHINE, not swallowing a tablet. Remember, SAD (Seasonal Affective Disorder) is a type of depression that we know is related to sunshine deficiency, so it would make sense that the perfect way to optimize your vitamin D is through sun exposure, or a safe tanning bed if you don't have regular access to the sun.
  • Get plenty of animal-based omega-3 fats. Many people don't realize that their brain is 60 percent fat, but not just any fat. It is DHA, an animal based omega-3 fat which, along with EPA, is crucial for good brain function and mental health.19Unfortunately, most people don't get enough from diet alone. Make sure you take a high-quality omega-3 fat, such as krill oil.

    Dr. Stoll, a Harvard psychiatrist, was one of the early leaders in compiling the evidence supporting the use of animal based omega-3 fats for the treatment of depression. He wrote an excellent book that details his experience in this area called The Omega-3 Connection.
  • Evaluate your salt intake. Sodium deficiency actually creates symptoms that are very much like those of depression. Make sure you do NOT use processed salt (regular table salt), however. You'll want to use an all-natural, unprocessed salt like Himalayan salt, which contains more than 80 different micronutrients.
  • Get adequate daily exercise, which is one of the most effective strategies for preventing and overcoming depression. Studies on exercise as a treatment for depression have shown there is a strong correlation between improved mood and aerobic capacity. So there’s a growing acceptance that the mind-body connection is very real, and that maintaining good physical health can significantly lower your risk of developing depression in the first place.
  • Get adequate amounts of sleep. You can have the best diet and exercise program possible, but if you aren't sleeping well you can easily become depressed. Sleep and depression are so intimately linked that a sleep disorder is actually part of the definition of the symptom complex that gives the label depression.

What the Future May Hold

A recent article in The Guardian20 suggests psychiatric drugs may soon be rendered obsolete, in favor of neurotechnology. “No longer focused on developing pills, a huge research effort is now devoted to altering the function of specific neural circuits by physical intervention in the brain,” Vaughan Bell writes, noting that virtually all pharmaceutical companies have closed down or curtailed their research and development of new psychiatric drugs.
The latest “craze” in this field has instead been redirected toward the understanding—and manipulation—of neural networks, with the aim to modify behavior by stimulating specific brain circuits deep within your brain. Some of these procedures include the implanting of electrodes into the brain, for example. According to the article:
“Big money has already been committed. The Obama White House has promised $3 billion to develop technology to help identify brain circuits, while the National Institute of Mental Health has promised to move its seven-figure funding away from research into conditions such as schizophrenia and depression towards a system that looks at how brain networks contribute to difficulties that are shared across diagnoses. This project, given the unspectacular name Research Domain Criteria or the RdoC Project, is being cited as an eventual replacement for the diagnostic system used by current-day psychiatrists.”
One of the latest technologies in this area, called optogenetics, involves “injecting neurons with a benign virus that contains the genetic information for light-sensitive proteins.” As a result of this injection, your brain cells become light-sensitive, allowing them to be remotely controlled via flashes of light sent through fiber optic cables implanted into your brain.
“Let's make this clear. The scientific revolution in identifying and manipulating brain circuits is already under way,”Vaughan writes. “... Advances in neuroscience are not just discoveries, they also shape, as they always have done, how we view ourselves. As the Prozac nation fades, the empire of the circuit-based human will rise...”
Whether or not this will actually make for happier, healthier, more balanced people is questionable, if you ask me. Yet this is what we may have to contend with in the future.

The Benefits of Energy Psychology

The Emotional Freedom Technique (EFT) is a form of psychological acupressure based on the same energy meridians used in traditional acupuncture to treat physical and emotional ailments for over 5,000 years, but without the invasiveness of needles. Instead, simple tapping with the fingertips is used to transfer kinetic energy onto specific meridians on your head and chest while you think about your specific problem -- whether it is a traumatic event, an addiction, pain, anxiety, etc. -- and voice positive affirmations.
This combination of tapping the energy meridians and voicing positive affirmation works to clear the "short-circuit"—the emotional block—from your body's bioenergy system, thus restoring your mind and body's balance, which is essential for optimal health and the healing of physical disease.
Some people are initially wary of these principles that EFT is based on -- the electromagnetic energy that flows through the body and regulates our health is only recently becoming recognized in the West. Others are initially taken aback by (and sometimes amused by) the EFT tapping and affirmation methodology. But believe me when I say that, more than any traditional or alternative method I have used or researched, EFT has the most potential to literally work magic.
Clinical trials have shown that EFT is able to rapidly reduce the emotional impact of memories and incidents that trigger emotional distress. Once the distress is reduced or removed, the body can often rebalance itself, and accelerate healing. For example, one study involving 30 moderately to severely depressed college students showed significantly less depression than the control group when evaluated three weeks after receiving a total of four 90-minute EFT sessions.21
A study of 100 veterans with severe PTSD22 who participated in the Iraq Vets Stress Project showed an astounding reduction of symptoms after just six one-hour EFT sessions. After completing six sessions, 90 percent of the veterans had such a reduction in symptoms that they no longer met the clinical criteria for PTSD. Sixty percent no longer met PTSD criteria after only three EFT sessions. At the three-month follow-up, the gains remained stable, suggesting lasting and potentially permanent resolution of the problem.
In the following videos, EFT practitioner Julie Schiffman shows how you can use EFT to relieve your depression, anxiety, and panic attacks. But remember, most of the time one is placed on medication, there are serious emotional health challenges going on. It is imperative to recognize that doing EFT by yourself will likely not work for this problem. You need to be seen by an EFT professional who is experienced and can help guide you through the process Those who suffer from depression really should see a qualified EFT therapist.23

 Important Concluding Thoughts
I know firsthand that depression is devastating. It takes a toll on the healthiest of families and can destroy lifelong friendships. Few things are harder in life than watching someone you love lose their sense of joy, hope, and purpose in life, and wonder if they will ever find it again. And to not have anything within your power that can change things for them. You wonder if you will ever have your loved one "back" again.
It's impossible to impart the will to live to somebody who no longer possesses it. No amount of logic, reasoning, or reminders about all they have to live for will put a smile back on the face of a loved one masked by the black cloud of depression. I urge everyone to familiarize yourself with the most common warning signs of severe depression and suicide risk, and don’t hesitate to intervene if you recognize them in someone you know, and/or seek help if you experience them yourself.
There are times when a prescription drug may be helpful. But it's unclear whether it is the drug providing benefits, or the unbelievable power of your mind that is convinced it is going to work. Studies have found that up to 75 percent of the benefits ofantidepressants can be duplicated by a placebo.
Oftentimes you cannot change your circumstances. You can, however, change your response to them. I encourage you to be balanced in your life. Don't ignore your body's warning signs that something needs to change. Sometimes people are so busy taking care of everybody else that they lose sight of themselves. If you have been personally affected by depression, my heart goes out to you. A broken body can be easier to fix than a broken mind. Depression is real. It is my hope that you don't feel judged here, but that you are encouraged and inspired by those who have been there.
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Thursday, August 1, 2013

Help Beat Depression By Gardening

Heuchera cultivars at the BBC Gardeners' World...
Heuchera cultivars at the BBC Gardeners' World show. (Photo credit: Wikipedia)
By Dr. Mercola
Every year, some 230 million prescriptions for antidepressants are filled, making them one of the most-prescribed drugs in the United States.
Despite this, the incidence of all forms of depression is now at 10 percent, according to 2012 statistics1, and the number of Americans diagnosed with depression increases by about 20 percent per year2.
Such statistics are a strong indication that what we're doing is simply not working, and that instead, these drugs are contributing to other serious health problems. Fortunately, there are other, safer, more effective ways to address depression—including something as simple as spending more time outdoors.

Gardeners Are Happier than Most Others

According to a recent survey for Gardeners World magazine3, 80 percent of gardeners reported being “happy” and satisfied with their lives, compared to 67 percent of non-gardeners.
And the more time spent in the garden, the higher their satisfaction scores—87 percent of those who tend to their gardens for more than six hours a week report feeling happy, compared to those spending less time in their gardens.
Monty Don4, a TV presenter and garden writer, attributes the well-being of gardeners to the “recharging” you get from sticking your hands in the soil and spending time outdoors in nature.
I can personally confirm this as over the past year I have started a major interest in high performance agriculture and biodynamic gardening, and have been busy applying it to my edible and ornamental landscape. I hope to soon teach all that I have learned.
Interestingly, fitness researchers have also found that when you exercise outdoors, you exercise harder but perceive it as being easier than when exercising indoors, which can have significant health benefits.
This feeling of well-being can have more far-reaching implications for your physical health too. According to recent research from Johns Hopkins5, having a cheerful temperament can significantly reduce your odds of suffering a heart attack or sudden cardiac death. According to lead author Lisa R. Yanek, M.P.H., an assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine6:
"If you are by nature a cheerful person and look on the bright side of things, you are more likely to be protected from cardiac events. A happier temperament has an actual effect on disease and you may be healthier as a result."

What the Research Says About Exercise and 'Ecotherapy' for Depression

Three years ago, I interviewed medical journalist and Pulitzer Prize nomineeRobert Whitaker about his extensive research and knowledge of psychiatric drugs and alternative treatments for depression. He mentioned an interesting study conducted by Duke University in the late 1990’s, which divided depressed patients into three treatment groups:
  1. Exercise only
  2. Exercise plus antidepressant
  3. Antidepressant drug only
After six weeks, the drug-only group was doing slightly better than the other two groups. However, after 10 months of follow-up, it was the exercise-only group that had the highest remission and stay-well rate. According to Whitaker, some countries are taking these types of research findings very seriously, and are starting to base their treatments on the evidence at hand.
The UK, for example, does not routinely recommend antidepressants as the first line of therapy for mild to moderate depression anymore, and doctors there can write out a prescription to see an exercise counselor instead under the “exercise on prescription programme7.”
Part of the exercise can be tending to an outdoor garden, taking nature walks, or repairing trails or clearing park areas—as discussed in the BBC video above. According to Dr. Alan Cohen, a British general practitioner with a special interest in mental health8:
“[W]hen people get depressed or anxious, they often feel they're not in control of their lives. Exercise gives them back control of their bodies and this is often the first step to feeling in control of other events.”
Within the first few years of the introduction of this so-called “Green Gym” or “Ecotherapy9” program in 2007, the rate of British doctors prescribing exercise for depression increased from about four percent to about 25 percent.
Studies on exercise as a treatment for depression also show there’s a strong correlation between improved mood and aerobic capacity. So there’s a growing acceptance that the mind-body connection is very real, and that maintaining good physical health can significantly lower your risk of developing depression in the first place. According to a 2009 report on Ecotherapy by the British Depressionalliance.org10:
“94 percent of people taking part in a MIND survey commented that green exercise activities had benefited their mental health; and 100 percent of volunteers interviewed during an outdoor conservation project agreed that participation benefited their mental health, boosted self-esteem and improved confidence. Furthermore, the National Institute for Clinical Excellence asserts that for ‘patients with depression... structured and supervised exercise can be an effective intervention that has a clinically significant impact on depressive symptoms.’”

Ready, Set, Garden!

Aside from increasing your sense of well-being, keeping a garden can also improve your health by providing you with fresher, uncontaminated food, and cutting your grocery bill. And you don’t need vast amounts of space either. You don’t even have to have a backyard. Apartment dwellers can even create a well-stocked edible garden.
There are tons of creative solutions that will allow you to make the most of even the tiniest space, and engaging your own creativity to solve space limitations can be part of your therapy. You can also start growing sprouts which is rapidly rewarding as, unlike gardens, in about one week you will have food that you can harvest and eat.
In her book The Edible Balcony, Alex Mitchell details how to grow fresh produce in small spaces. Filled with beautiful color photographs throughout, the book helps you determine what might work best for you, depending on your space and location, and guides you through the design basics of a bountiful small-space garden. For example, those who live in a high-rise apartment will undoubtedly have to contend with more wind than those who live on the bottom floor. There are solutions for virtually every problem, and in this case, wind-tolerant plants can be used, or you could construct some sort of protective screening.
You can use virtually every square foot of your space, including your lateral space. Hanging baskets are ideal for a wide variety of foods, such as strawberries, leafy greens, runner beans, pea shoots, tomatoes, and a variety of herbs. And instead of flowers, window boxes can hold herbs, greens, radishes, scallions, bush beans, strawberries, chard, and chiles, for example. Just start small, and as you get the hang of it, add another container of something else. Before you know it, large portions of your meals could come straight from your own edible garden.
To learn more, please see my previous article on creating edible gardens in small spaces. I garden both outdoors and indoors. As I mentioned previously, sprouts are one of my favorite tight-space crops, as they provide so much nutrition, which is another critical factor for beating the blues and they give you far more immediate feedback than growing a garden.  Visit at the link above for more information on this subject.
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