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13 Myths and 13 Truths About Today’s Antidepressants

13 Myths and 13 Truths About Today’s Antidepressants

You can thank tuberculosis for the 29 antidepressants we now have on the market.

No, that’s not an urban myth, that’s actually true.

Sixty years ago, a drug called iproniazid was being used to treat tuberculosis.  But when the doctors discovered their previously discouraged TB patients dancing in the hospital hallways one evening, researchers began studying its possible impact on depression.

It turned out to be effective in treating depression in many people.  Unfortunately, doctors learned the hard way that iproniazid came with a notable danger: if while taking the drug the person drank wine, ate cheese, or consumed any other food that had the amino acid tyramine in it, the person could experience a drastic spike in blood pressure that in some cases resulted in sudden death.

And so the search was on for a drug that could treat depression without running the risk of killing the patient.

Since then, controversy about the use and effectiveness of these drugs has grown about as immense as their popularity, and the conversation around antidepressants has created two distinct camps: one declaring that antidepressants are life-saving and the other insisting they are somewhere between worthless and down right dangerous.

With emotions running high, it’s not surprising that a slew of myths from both sides have crept into social media, making the discussion even more confusing.

In the interest of science and truth, below are 13 of the more popular myths with fact-based commentary that comes from the scientific community and my thirty-plus years as a psychiatric nurse.

MYTH #1: Antidepressants are the best and fastest way to treat depression.

TRUTH: The chances that antidepressants are the “best” treatment for depression are only about 30% statistically.

Research has shown that of those who are clinically depressed, about 30% of them respond best to a consistent exercise routine.  Another 30% respond best to cognitive-behavioral therapy.  Only 30% respond best to antidepressant therapy.

But for that 30%, antidepressants can be a godsend.

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As to their speed, well, antidepressants are anything but fast.  Most antidepressants will take at least 1-2 weeks before their effects can be felt by the patient.  Sometimes, it’s as much as a month.  And for the full effects to be known, doctors ask you to wait 6 weeks.

Once they’ve kicked in, the dose may still need to be adjusted.  Since the best rule of thumb for prescribing antidepressants is “Start low, go slow,” your doctor will likely start you on the smallest dose available and then, if necessary, titrate the dose up after she’s seen how you’re responding… which will take more time.

Not exactly a “quick fix.”

MYTH #2: Antidepressants are basically serotonin supplements.

TRUTH: Antidepressants are not supplements. They are highly complex drugs that require careful monitoring by an experienced doctor.

Scientists have not yet found a way of capturing or manufacturing the brain hormones called neurotransmitters (like serotonin, norepinephrine, dopamine) themselves, the way we’ve been able to manufacture insulin (for diabetes) or thyroxine (for hypothyroidism).

They have, however, found a way of making parts of the brain more sensitive to the neurotransmitters that are necessary for strong mental health, effectively increasing the levels that way.

But again, the increase in sensitivity takes time, which is why it takes 2-6 weeks before you really know how the medication is working for any given individual.

MYTH #3: Antidepressants will change your personality

TRUTH: The short answer to this is, No. They will not make you gregarious if you have always been shy or analytical if you have always been intuitive. Your core self will remain entirely intact.

But there’s a much bigger conversation going on about this that’s worth touching on.

Peter Breggin, the brilliant psychiatrist who wrote Talking Back to Prozac and Toxic Psychiatry pondered this philosophical point: when someone is born with a pessimistic view of themselves and the world–a sort of human Eeyore–is that their core personality? Or were they born with a chemical imbalance that is actually hiding their core personality?  

The answers to these questions are worth exploring.  But I’m a bit more of a pragmatist.  So my questions are more like this: Is the person in emotional pain because of a psychological inability to reach their dreams and aspirations?   And if so, does that person want to change? If the individual is suffering and wants to increase their ability to do something, I’m in favor of trying to help, as safely and with as much integrity as possible.

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MYTH #4: They are addictive

TRUTH: The chemicals that make up antidepressants have no addictive qualities.  According to the American Society of Addiction Medicine, one of the key components to addiction is the inability to control one’s behavior. Antidepressants have no such effect on the brain.

In fact, many of my patients on antidepressants report feeling that they have more control over their behavior and lives, not less.  They no longer feel imprisoned by the crushing fatigue and brain fog. They feel able to socialize again and be more productive.

It is true, however, that your body may get used to the drug being there (which would be considered more of a physical dependence, not addiction), and that a decrease in dosage may cause you some side effects of withdrawal. So it’s vital that when the time comes for you to stop taking an antidepressant that your doctor taper the dosage down slowly, sometimes over a period of weeks.  Stopping abruptly could cause some unpleasant, but temporary, symptoms, such as nausea, diarrhea, headache, lethargy, and other flu-like symptoms.

MYTH #5: Once you start taking them, you have to take them the rest of your life

TRUTH:  People who have suffered numerous bouts of depression, and who have also found relief from antidepressants, are usually urged to stay on medication indefinitely.  So yes, some people choose to take antidepressants for decades.

But the vast majority of people are on them for only a few months after they’ve achieved remission.

Why is the length of time so important?  Because studies have shown that continuing on antidepressants for several months after most of the symptoms are gone decreases the chance of a relapse later on.  Stopping the medication too soon could cause a return of the depressive symptoms.  And each occurrence of depression makes effective treatment just that much more difficult to achieve.

The more depressive episodes you’ve experienced, the longer you should stay on antidepressants. How long that is, is up to you and your physician.  So try not to cut corners by going off the medication too soon.

MYTH #6: They ruin your sex life

TRUTH:  Many of these medications effect sexual function in some people, especially at the beginning of therapy.  Sometimes it’s nothing more than they cause the sensations in the genitalia to be less intense at the beginning of therapy.  But in some cases, antidepressants can cause erectile dysfunction and make it difficult to experience orgasm, even after being on them for a while.

Fortunately, the percentage of people who experience this side effect is fairly low.  And if you are not currently active sexually, these side effects may be of little concern to you.

If you are sexually active, and you do have side effects that decrease your ability to participate or enjoy sexual contact, it’s important to be direct with your doctor about this.  Solving the problem may be as simple as switching medications.

MYTH #7: They make you gain weight

TRUTH:  Some antidepressants cause a change in appetite in some people.  For instance, while nortriptyline (Elavil) and fluoxetine (Prozac) might increase it, bupropion (also known as Wellbutrin) often decreases it. Since one of the side of effects of moderate to severe cases of major depression is weight loss, this might not be a bad thing.  But as a rule, antidepressants don’t themselves pack on the weight.

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However, if you are already overweight or have a medical condition that would worsen with weight gain (such as diabetes, orthopedic problems or cardiac disease), my recommendation is always the same:  before you try an antidepressant, get into some kind of exercise program.  Get a personal trainer, swim at the Y, ride your bike, or take an exercise class, and see if you’re among the 30% whose depression can be alleviated through exercise.

Regular moderate exercise increases oxygenation to the brain, releases feel-good hormones, improves self-esteem, and helps us connect more with the outside world, all of which contribute to a better mood.  By all means, try this for a month and see if it doesn’t brighten your mood considerably!

MYTH #8: They make you feel numb

TRUTH:  Usually the opposite is true.  Sinking into clinical depression can be so painful, emotions may shut down all together, leaving the person feeling emotionally numb.  When the depression begins to lift (through whatever treatment), people often comment that they feel alive again, that they are experiencing color again, instead of everything looking and feeling grey.

It is true that in some people, antidepressants even out some of the highs and lows, and that evening-out can feel strange, perhaps even dull or numb, to someone used to the emotional roller coaster.

MYTH #9: Antidepressants work on all kinds of depression.

TRUTH:  Not even close.  For instance, depression that is caused by bipolar disorder (previously known as Manic-Depression) must be treated with an entirely different class of medication (such as mood stabilizers or antipsychotics) than those that are used to treat major depression.  Antidepressants can actually trigger psychotic episodes in those with bipolar disorder.

Depression due to a loss of some kind, such as divorce, death of a family member, loss of job, etc. is usually best treated with support groups or individual talk therapy, such as Human Needs Counseling or Cognitive Behavioral Therapy.  If after supportive counseling the person still feels stuck in their emotional quicksand, a short course of antidepressant therapy can help get them unstuck and moving forward in their healing.

MYTH #10: Antidepressants are like antibiotics–they cure what’s wrong

TRUTH:  Depression is nothing like an infection, and antidepressants bear no resemblance to antibiotics.  This particular myth probably stems from our society’s penchant for taking something vs. doing something to resolve pretty much any discomfort.  Backaches are addressed with muscle relaxants instead of strengthening exercise and stretching.  Headaches are addressed with vasoconstrictors and anti-inflammatories instead of meditation and a non-allergenic diet.  We’ll throw medications at anything troubling, if we think they have a chance of making it quietly go away.

Depression is much more complex than most people realize.  There is a long list of stressors that can cause depression, and in most cases, it’s not one but several that are involved.  Maybe it starts out as feeling unattractive after a break up, but picks up steam when the person also has lost self-esteem because the relationship had been abusive.  And maybe, because of the abuse, the person now has terrible anxiety about trusting people and no longer believes in their own lovablility.  And all of that together causes so much pain, the person tries everything they can think of to relieve the pain… including behaviors that are actually far more destructive than they ever are helpful.

In my 30+ years of working with depressed and traumatized people, this complex storyline is the norm, not the exception.  Medication alone might be a good place to start, but it’s not going be enough to get this person safely to the other side of this crisis.  The person also needs education and coaching to have a good chance at fully recovering.

MYTH #11: Once you feel better, you can go off the medication

TRUTH:  Most doctors recommend staying on antidepressants for at least 6 months, to allow the brain to adapt to the higher level of sensitivity.  And as stated earlier, discontinuing antidepressants too soon can set you up for a recurrence of the symptoms.

Once you and your doctor have settled on the right antidepressant for you, and your symptoms have resolved, the general consensus is that patients should stay on an antidepressant for at least a year. That way, your brain has the chance of adapting and sort of “locking in” the changes, decreasing the chances of remission. If this is your first depressive episode, stopping treatment sooner than 6 months may increase your risk of your symptoms returning.  If it’s your second or third, most doctors recommend at least a full year.

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MYTH #12: The side effects are worse than the depression

TRUTH:  As someone who has herself suffered bouts of severe depression, I’d have to say that nothing is worse than depression.

But more to the point, it is true that antidepressants may cause uncomfortable side effects in some people.

For instance, in some cases antidepressants can briefly cause or intensify thoughts of suicide.  Antidepressants across the board often cause dreams to become quite vivid, sometimes even a bit “wild.”  I always found it more entertaining than disturbing, but it’s different for everyone.

Tricyclics (TCAs) side effects tend to be along the lines of dry mouth, dry nose, dry skin, blurred vision, urinary hesitancy, weight gain, drowsiness, and/or constipation.  Selective Serotonin Reuptake Inhibitors (SSRIs) sometimes cause agitation, anxiety, irritability, jitteriness, confusion, headache, reduced sexual desire or ability to perform, insomnia, change in weight, diarrhea and/or nausea.

But it is also true that many people have few, or no, side effects while on them.  There’s no way to know ahead of time whether you might experience side effects or not, and if so, what exactly those might be.

MYTH #13: They’re all about the same.  So if one doesn’t work, none of them will.

TRUTH:  There are 29 separate antidepressant formulas on the market that fall into one of 7 different drug classes:

  • Aminoketones
  • Monoamine oxidase inhibitor
  • Norepinephrine and dopamine reuptake inhibitor
  • Serotonin and norepinephrine reuptake inhibitor
  • Selective serotonin reuptake inhibitor
  • Tricyclic antidepressant
  • Tetracyclic antidepressant

Each drug class works differently in the brain, and even drugs within the same drug class have chemical differences. For instance, citalopram (Celexa) and escitalopram (Lexapro) are both SSRIs and chemically very similar.  And yet, people react very differently to each of them.  Many patients have told me that they’ve tried both and found that one of them gives them great relief while the other hardly affected them at all.

There’s no way to predict how each individual’s brain will match up with any given antidepressant.

Featured photo credit: miszaqq via 123rf.com

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Last Updated on February 21, 2019

Top 9 Foods for Incredible Brian Health And Brain Power

Top 9 Foods for Incredible Brian Health And Brain Power

Your brain is the most intricate and powerful organ in your entire body. It’s essentially a super-computer with brain power like a Ferrari.

If you have a Ferrari, would you put cheap gasoline in it? Of course not. You want to put in high-octane performance fuel to get the most out of your investment.

When it comes to the brain, many people are looking for the top foods that will supercharge the brainpower to help focus better, think more clearly and have better brain health.

In this article, we’ll look at the top 9 brain foods that will help create supercharge your brain with energy and health:

1. Salmon

Salmon has long been held as a healthy brain food, but what makes this fish so valuable for your brain health?

It’s important to understand that your brain is primarily made up of fat. Roughly 60% of your brain is fat. One of the most important fats that the brain uses as a building block for healthy brain cells is omega-3’s.

Omega-3’s are essential for building a healthy brain but one of the most important omega-3’s for your brain is DHA. DHA (docosahexaenoic acid) forms nearly two-thirds of the omega-3’s found in your brain.[1]

Omega-3’s and DHA in particular help form the protective coating around our neurons. The better quality this coating is, the more efficient and effective our brain cells can work, allowing our brain power to work at full capacity.

Studies have shown that being deficient in DHA can affect normal brain development in children, which is why so many infant formulas and children’s supplements are beginning to include DHA.

Being deficient in DHA as an adult can cause focus and attention problems, mood swings, irritability, fatigue and poor sleep.

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2. Blueberries

Blueberries top the list as one of the most beneficial fruits to maximize your brain health and performance.

Blueberries have some of the highest content of antioxidants, particularly anthocyanins, than any other fruit, which helps protect the brain from stress and promote healthy brain aging.

Blueberries antioxidant content also help reduce inflammation, which allows the brain to maintain healthy energy levels.

Blueberries have begun to receive attention for their connection to brain performance.[2] Studies have demonstrated that eating blueberries on a regular basis can not only improve brain health but also brain performance as well including working memory.[3]

Blueberries not only taste great but are low in calories, high in Vitamin C, Vitamin K and Manganese.

3. Turmeric

Turmeric is a very impressive spice that has well-researched and proven to have tremendous benefits for your brain. Turmeric’s main compound that benefits the brain is called curcumin, which is responsible for turmerics bright yellow appearance.

Curcumin has been shown to have anti-inflammatory, antioxidant, antiviral, antibacterial, antifungal, and anti-cancer properties.[4]

Curcumin increases the production and availability of two important neurotransmitters serotonin and dopamine, two important neurotransmitters involved with happiness, motivation, pleasure, and reward.

Curcumin has been well documented to have powerful anti-depressive effects. In one study, it was found to be as effective for depression as popular medications such as SSRI’s like Prozac.[5]

Curcumin has also been shown to:

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  • Increase blood flow to the brain.[6]
  • Increase BDNF production, a powerful stimulator of neuroplasticity.[7]
  • Increase DHA availability and synthesis in the brain.[8]
  • Increase antioxidant levels in the brain to prevent brain aging and inflammation.[9]

4. Coffee

Coffee is the wonderful elixir of energy that many people cherish every single morning. The biggest reason people drink coffee is to get a dose of caffeine.

Caffeine is a natural neurological stimulant that not only gives you energy but also prevents adenosine, a neurotransmitter involved with feeling tired, from binding in the brain.

Many people are surprised to find that coffee actually contains a large quantity of antioxidants called polyphenols, which are important for reducing inflammation in the brain and keep your brain energized. The antioxidants in coffee also provide a neuroprotective effect, protecting the brain from stress and damage. [R]

Coffee can also:

  • Improve alertness and concentration.[10]
  • Help with neurodegenerative disorders like Parkinson’s disease.[11]
  • Reduce your risk of depression.[12]
  • Improve your memory.
  • Provide short-term boost in athletic performance.[13]

5. Broccoli

What was your least favorite food as a kid growing up?

Most likely, broccoli was your answer.

Broccoli may not have been your top choice, but it might be the top choice for your brain.

Broccoli contains a compound called sulforaphane. Sulforaphane has been shown to promote the proliferation and survival of brain cells by reducing inflammation and boosting production of BDNF. It has also been shown to boost neurogenesis, the production of new brain cells.[14]

Broccoli is also loaded with important nutrients Vitamin K and Folate. Vitamin K plays a vital role in protecting brain cells.[15] Folate plays a crucial role in detoxification and reducing inflammation in the brain.

6. Bone broth

Bone broth wasn’t just created to combine with soups, you can actually drink bone broth by itself.

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Drinking bone broth has become one of the biggest trends in the health and wellness industry and for good reason. Bone broth isn’t actually a new thing. Bone broth has been used for centuries as a healing tonic to promote health and longevity.

Much of the nutritional benefits and value of bone broth comes from its substantial vitamin and mineral content. Primarily calcium, phosphorus, magnesium, and potassium.

Your gut is called your second brain for a reason. Research continually shows that there is a direct and indirect connection between your gut and your brain. Your gut also houses and stores many important brain compounds involved with optimal brain performance. Therefore the health of your gut is vitally important for your brain health and performance.

Bone broth has become a go-to tool for helping heal the gut and provide the gut with the vital nutrient and resources it needs to heal and perform optimally.

With the vast amounts of nutrients that bone broth contains, it makes the list as a go-to food for your brain health.

Look for high quality, organic bone broth for the best results.

7. Walnuts

Walnuts are one of the top choices of nuts for brain health. Walnuts also look similar to a brain.

Amongst the wide variety of nuts available, walnuts contain the highest amounts of the important omega-3 DHA. DHA, as seen above, is a critical building block for a healthy brain.

Walnuts also contain high amounts of antioxidants, folate, magnesium, potassium, and phosphorus, which help to lower inflammation.

Melatonin in walnuts is an important nutrient for regulating your sleep. Having low amounts of melatonin can make it challenging to get good quality sleep and getting poor quality sleep can dramatically impair brain health and performance.

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8. Eggs

For years, eggs were put on the nutritional naughty list; but now, eggs are finally getting the credit they deserve. Eggs can provide a tremendous boost to your brain health and longevity.

Eggs, particularly the yolks, contain a compound called choline. Choline is essential for building the neurotransmitter acetylcholine. Acetylcholine plays an important role in mood, memory, and intelligence.

Egg yolks contain some of the highest quantities of choline. This is very important because low levels of choline can lead to low levels of acetylcholine, which in turn can cause increased inflammation, brain fog, difficulty concentrating and fatigue.

9. Dark chocolate

You’re about to love chocolate even more because chocolate, particularly dark chocolate, is great for your brain.

Chocolate boosts levels of endorphins, your brains “feel good” chemicals. This is why you feel so good eating chocolate.[16]

Chocolate also increases blood flow to the brain which can help improve memory, attention, focus, and reaction time.[17]

Dark chocolate contains high levels of magnesium, which has been coined “natures valium” for its ability to calm and relax the brain.

Lastly, dark chocolate has one of the highest antioxidant profiles out of any other food, including popular superfoods like acai berries, blueberries, or pomegranates.[18]

Conclusion

Your brain is a high performing organ and it uses quite a lot of energy, roughly 20% of the bodies energy demands.

In order to maintain a healthy brain, you need the right fuel to ensure that your brain has all the nutrients it needs to perform as well as adapt to the stress of life.

If you want to keep your brain performing well for a lifetime, then you want to make sure you are including as many of these brain health foods as possible.

More Resources About Boosting Brain Power

Featured photo credit: Unsplash via unsplash.com

Reference

[1] US National Library of Medicine National Institutes of Health: DHA Effects in Brain Development and Function
[2] Canadian Science Publishing: Enhanced task-related brain activation and resting perfusion in healthy older adults after chronic blueberry supplementation
[3] US National Library of Medicine National Institutes of Health: Cognitive effects following acute wild blueberry supplementation in 7- to 10-year-old children.
[4] US National Library of Medicine National Institutes of Health: Curcumin: the Indian solid gold.
[5] Herbal Medicine: Biomolecular and Clinical Aspects. 2nd edition.: Turmeric, the Golden Spice
[6] US National Library of Medicine National Institutes of Health: Effect of combined treatment with curcumin and candesartan on ischemic brain damage in mice.
[7] Science Direct: Curcumin reverses the effects of chronic stress on behavior, the HPA axis, BDNF expression and phosphorylation of CREB
[8] US National Library of Medicine National Institutes of Health: Curcumin boosts DHA in the brain: Implications for the prevention of anxiety disorders.
[9] PLOS: A Chemical Analog of Curcumin as an Improved Inhibitor of Amyloid Abeta Oligomerization
[10] US National Library of Medicine National Institutes of Health: Effects of Caffeine on Cognitive Performance, Mood, and Alertness in Sleep-Deprived Humans
[11] American Academy of Neurology: A Cup of Joe May Help Some Parkinson’s Disease Symptoms
[12] American Academy of Neurology: AAN 65th Annual Meeting Abstract
[13] US National Library of Medicine National Institutes of Health: Effects of caffeine on the metabolic and catecholamine responses to exercise in 5 and 28 degrees C.
[14] US National Library of Medicine National Institutes of Health: Hyperammonemia induces glial activation, neuroinflammation and alters neurotransmitter receptors in hippocampus, impairing spatial learning: reversal by sulforaphane
[15] Oxford Academic: Vitamin K and the Nervous System: An Overview of its Actions
[16] Diana L. Walcutt, Ph.D: Chocolate and Mood Disorders
[17] Health Magazine: Chocolate can do good things for your heart, skin and brain
[18] Chemistry Central Journal: Cacao seeds are a “Super Fruit”: A comparative analysis of various fruit powders and products

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