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Do Anti-Depressants Really Work?

Depression affects many Americans but are we reaching for the wrong treatment?

The television program, 60 Minutes, recently addressed the volume of research on the lack of efficacy of anti-depressant medications. This research began over a decade ago and has shown that anti-depressant medications are not much more effective than placebo (sugar pill). In fact on 60 Minutes, Dr. Irving Kirsch (associate director of the placebo research program at Harvard) questions whether the only benefit they have is the placebo effect. The placebo effect creates an expectation of healing so powerful that it can actually decrease symptoms. The placebo effect works with pain, irritable bowel syndrome, knee pain and much more. Even though individuals with depression may get better taking these medications, it may not be due to the medication, rather to the placebo effect.

Here are the statistics on depression in the US:

  • $11.3 billion dollars is the annual amount of money spent on anti-depressant medications in the US
  • Americans consume more anti-depressants than any other developed nation
  • 17 million American's take anti-depressant drugs
  • From 1988-1994, the use of anti-depressants increased by 400%
  • 1 in 10 Americans over the age of 12 take an anti-depressant

In Great Britain a review of studies on published and non-published (which are often not published because they don't show a positive benefit of medications) research showed the same lack of efficacy especially for mild-moderate depression. The medications seem to be more effective for moderate-severe depression. Great Britain has now revised their recommendations for treatment of depression to limit use of medications as first-line treatment to only those individuals with more severe depression. For mild depression, exercise, for example is as effective as medication.

Integrative medicine also offers many substitutes to medication which may be better first-line treatment for mild-moderate depression instead of medications:

  1. Omega 3-fatty acids have been shown in several studies to boost the effect of medication and reduce suicide risk in those with depression.
  2. B-vitamins such as B-12, B-6 and folic acid are important in the manufacture in the body of the neurotransmitters that help our moods - dopamine, serotonin, etc and have been shown also to boost the effectiveness of medication
  3. Inositol - is another B-vitamin has been shown to improve depression without medication
  4. 5-Hydroxytryptophan, a serotonin precursor, is an amino acid that has shown effectiveness similar to prescription medications in some studies
  5. Yoga, acupuncture, and massage have all been shown, along with physical activity to improve mood
  6. Therapy also helps. Many people on medications do not seek therapy and studies show that it helps!

It's difficult to explain why so many Americans are depressed and anxious and why this number has increased so dramatically. Is it possible that our lifestyle — the Western diet, lack of activity, stress — is really the cause of this problem? It is known that high levels of the stress hormone, cortisol, is associated with a higher risk for depression. The Traditional Chinese medicine viewpoint is that all illness is due to an imbalance. Rather than going for the quick-fix — a pill — maybe the focus should be on modifying our lifestyles to be more in balance — at least as a first step.

More from Carolyn C. Ross M.D., M.P.H.
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