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Antidepressants: Sometimes it’s like having a hammer and no nails

Medicines on the table

The dominance of pharmaceutical approaches to depression treatment continues virtually unchecked, although a recent reduction in the use of antidepressants among children and teens has followed black box label warnings.  Antidepressants are now the 3rd most widely prescribed drug class in the U.S.

Etiologic and therapeutic debates NOW focus on issues such as improving response rates via new biological treatments, improving access to care, the roles of inflammation, infection, hormones, and neurogenesis, and the interaction of genes and environment. The importance of diet, nutritional status, environment, and lifestyle as antecedents, triggers, and mediators of depressive disorders are EMERGING, as hypotheses about the myriad underlying pathways and multifactorial nature of the mood disorders are brought under scientific investigation.

We can begin to think about depression as a psycho-spiritual-cultural-political-developmental-biological-genetic experience.

Since the 1950’s, virtually all antidepressant drug advances have been based on enhancing monoamine neurotransmission, mainly through blocking reuptake of serotonin, dopamine, and/or norepinephrine. Although these strategies have shown some clinical efficacy, they have failed to induce full recovery in more than 50% of patients.

There are many limitations to the use of these drugs including side effects, drug interactions, length of time to effectiveness, cost, variable patient responses, and treatment-resistance.

Keep in mind, drugs like Prozac, Lexapro, Zoloft, etc. work by inhibiting the reuptake of serotonin.  That is, they take the serotonin the brain is already producing, and help it stay around LONGER.  What they do not do is help your brain make MORE serotonin.

So, what happens if you’re serotonin levels are low to begin with?  You guessed it.  The drugs don’t work as well, because it’s like having a hammer and no nails.  The key is to assess your brain chemistry first, then provide your brain the raw materials it requires so it can make ITS OWN serotonin in the first place, if that indeed is what is needed in the first place.

Measurement of key brain chemicals including serotonin, dopamine, and/or norepinephrine is now clinically available (and has been for over a decade).  This permits personalized evaluation and treatment, so we can tailor the therapy to the biochemical imbalance.

It’s very science geeky and cool, but critical to the overall outcome of people with depression.