Interview with Forsakken

Overcoming Depression
By N.A. Foy

  
Introduction

If I were a medical advocate for an adult family member that has been diagnosed with depression I would look at several different ideas on how to help that particular family member.  In this paper I am going to look at various treatments that can be used for depression such as medication, alternative remedies, therapies, and other possibilities.  I will discuss some of the questions I would ask the doctor regarding the medications he was considering to use.  Then I will take a look at one medication that is used to treat depression.  Finally I will discuss what my decision for this family member would be and why. 

Treatments For Depression

Monoamine Oxidase Inhibitors

Various treatments are used to treat major depression.  Monoamine Oxidase (MAO) inhibitors help to block the reuptake of serotonin and norepinephrine.  Monoamine Oxidase is an enzyme involved in the removal of these two neurotransmitters from the brain so when this enzyme is inhibited these neurotransmitters can become more active.  MAOs are effective but can be rather dangerous and a change in diet may be necessary in order to prevent heart trouble (Mayo Clinic 2010).

Tricyclic Antidepressants  

Another class of drugs that are used to treat depression are called Tricyclic antidepressants.  These medications seem to help certain people that other medications do not help.  Like MAOs they are serotonin and norepinephrine agonists in that they block the reuptake of these neurotransmitters.  These medications are overall less risky than MAO inhibitors (Mayo Clinic 2010).

Specific Serotonin Reuptake Inhibitors (SSRI)

Specific serotonin reuptake inhibitors (SSRI) are generally a more popular choice for treating depression today.  Some of these medications are fairly well known such as Prozac and Paxil.  They are used to treat both moderate and unipolar depression and are generally safe with little side effects.  These medications are considered to be serotonin agonists as they block the reuptake of serotonin (Mayo Clinic 2011).  It is questionable how affect Tricyclic antidepressants are on teenagers and children as one experiment demonstrated that they are no more effective than placebos (Sommers-Flanagan & Sommers-Flanagan 1996). 

Serotonin and Norepinephrine Reuptake Inhibitors (SNRI)

Serotonin and Norepinephrine Reuptake Inhibitors (SNRI) affect the same neurotransmitters as Tricyclic antidepressants but with fewer side effects.  They have less side effects because they have fewer nonspecific actions (Carlson 2008, pp 473).

S-adenosylmethionine (SAMe)

Some natural remedies may help with depression.  One of these remedies is S-adenosylmethionine (SAMe).  Studies that have been done on this medication seem to indicate that it is more effective in treating depression than a placebo.  This may be due to being a serotonin agonist.  It also has lower risk of side effects than most prescribed medications.  Unfortunately not enough studies have been done to prove its effectiveness (University of Maryland Medical Center). 

Tryptophan

Tryptophan is one of the essential amino acids that we obtain from our diet.  Since serotonin cannot pass the blood brain barrier, it’s precursor tryptophan can.  However, getting tryptopham to the brain is a rather complex process as it competes with other amino acids when crossing the blood brain barrier.  One may assume that eating a diet in protein will heighten tryptophan in the brain, however, because a high protein diet also supplies other amino acids to the brain the tryptophan will have more trouble crossing the barrier.  However, a diet high in carbohydrates releases insulin, which will clear away the other amino acids that will heighten the chance of tryptophan to enter the brain.  This may be the reason that when someone is feeling depressed they tend to want to eat simple carbohydrates.  However, consistently using this method to decrease depression may come with health problems such as weight gain, blood sugar problems, and other issues.  Plus, after the beneficial feelings of eating these foods wears off one may feel worse than they were to begin with.  Rather, it may be beneficial to take an L-tryptophan supplement to help ease depression (South, date not specified).  Studies have also been done where participants were deprived of foods containing tryptopham and their depression returned showing that this amino acid has an effect on mood (Carlson 2008, pp. 476-477).

5-Hydroxytryptophan (5-HTP)

Some use a 5-Hydroxytryptophan (5-HTP) supplement to help ease depression and studies have been done to verify this although more high quality studies still need to be done.  5-HTP is actually what tryptophan converts to before it becomes serotonin.  However, unlike serotonin it is able to cross the blood-brain barrier.  There have been noted risks if 5-HTP is taken with other prescription antidepressants and there hasn’t been enough studies done to determine other possible side effects of 5-HTP (Wikipedia 2011). 

Omega 3 Fatty Acids

A large study has revealed that Omega 3 fatty acids may be helpful in treating those with unipolar depression as long as it isn’t accompanied with an anxiety disorder (Centre hospitalier de l'Université de Montréal (2010).  Omega 3 appears to be another serotonin agonist as it helps serotonin to flow more freely throughout the brain.  Many Omega 3s can be derived from various foods such as fish and flaxseed and it can be taken as a supplement (Johnson, 2010).

Electroconvulsive Therapy

Another method for treating depression is Electroconvulsive Therapy (ECT).  In this treatment patients are give a tranquilizing drug to help avoid injury.  The patient then is hooked up to electrodes and a shock is sent through them causing a seizure.  ECT is known to be more rapid than drugs and usually lasts about twelve sessions.  This treatment is best used for patients who need immediate relief from depression before medications have the time to be effective.  Prolonged use can create brain damage and memory trouble.  This may help depression due to releasing the anti-seizure neurotransmitter GABA (Carlson 2008, pp 474-475).

Transcranial Magnetic Stimulation

A similar method to ease depression called transcranial magnetic stimulation (TMS) is used and is less risky than ECT.  This is where a coil of wire is placed on the scalp and a magnetic field which produces and electrical current that goes to the brain.  The downfalls of this treatment are that it may be painful for the scalp and can elicit seizures when it is repetitively with high frequency (Carlson 2008, pp. 475).

Vagus Nerve Stimulation

Stimulation of the vagus nerve may help those who have depression that is not very easy to treat.  To use this method, a pulse generator is put into the chest and a wire that is attached to it is threaded under the skin and attached to where the left vagus nerve is located on the neck.  Electrical signals are sent through the vagus nerve to the brain.  This method isn’t effective with most people but it does help some.  It is also an expensive method that generally isn’t covered by insurance.  Side effects generally are rare but they are possible such as heart problems, damage to the vagus nerve, breathing problems, among other things (Mayo Clinic 2010). 

Sleep Deprivation

Another treatment for depression is deprivation of REM sleep.  Like most medications this usually starts to show affects over the course of a few weeks.  One advantage of this method is that it seems to have lasting effects once the deprivation is discontinued.  This method may also speed up the effects of antidepressant medications (Carlson 2008, pp. 481-482).

Exercise

Exercise has been shown to help decrease the symptoms of depression.  This is because it releases feel good chemicals such as endorphins, reduces some immune system chemicals that may effect depression, and warms the body creating a calming effect.  It can also boost self-esteem, help one become more socially active, and ease stressful thoughts.  There are many other health benefits that come from exercise but there are also risks such as injury and heart failure if one doesn’t take proper precautions.  One disadvantage for using this method is that many people with unipolar depressive disorder severely lack motivation and may have trouble getting started with an exercise program (Mayo Clinic 2011). 

Therapy

Anyone who struggles with unipolar depression should receive therapy for help.  One style of therapy that is often beneficial is cognitive-behavioral therapy CBT).  This therapy can help retrain one’s thinking about self and about surroundings.  Irrational thoughts can play a part in increasing depression such as “I am a total failure because I didn’t do well on this test.” In CBT the therapist will help the patient dispute such agonizing thought processes.  Other techniques may be given as homework such as reading, recording certain thoughts as they occur, meditation exercises, among other things to help improve the patients thought processes.  There are many advantages to this such as there are no side effects, it has been shown to be effective, and insurance companies often help cover the cost (Corey 2009 pp. 282).

Questions For The Doctor

There are many questions that I would ask about the various drug therapies.  First I would ask how certain drugs affect neurotransmitters.  Many antidepressant drugs seem to be serotonin agonists but I would ask what other neurotransmitters are possibly affected.  I would also ask if it could be risky to use natural supplements such as Omega 3s or 5-HTP along side of the medications.  I would be concerned about the long-term effects that the drugs could have on the brain so I would ask if there was a risk of the make-up of the brain being changed.  If the person who is being treated takes other substances regularly such as alcohol or illegal drugs I may ask what kind of effects will antidepressant medications have along with the use of these drugs?  I would also like to know in what areas of the brain the drugs are affecting.  If a drug is prescribed I would like to know what other methods could be used to enhance the drug’s effectiveness such as partial sleep deprivation, diet, and/or sun exposure.  I would make sure to ask the obvious questions about side effects and what to do when an unwanted side effect occurs.  I would like to know how the drugs would affect cognitive abilities such as memory and clear thinking.  Another important question to consider is how addictive is the drug and how can this addiction be broken if necessary. 

Wellbutrin

I am going to take a look at Wellbutrin (bupropion hydrochloride).  This antidepressant differs from many other antidepressants because it doesn’t fall under the categories of Tricyclic antidepressants and SSRIs.  Rather it seems to be more chemically related to phenylethylamines.  It is thought to be a dopamine-norepinephrine reuptake inhibitor with its primary behavior effects related to the norepinephrine (wikipedia 2011).  It is used to treat major depressive disorder and has been shown to be effective in three placebo-controlled studies.  However, controlled studies have not shown the effectiveness of long-term use.  Wellbutrin should not be used in people who are susceptible to seizures and should be administered in a way that will minimize such things as insomnia, agitation, and restlessness.  A sedative-hypnotic may want to be administered during the first part of treatment to avoid such things as seizures.  Some side effects of Wellbutrin include seizures, thoughts of suicide, panic attacks, headaches, insomnia, gastrointestinal disturbances, rashes, neuropsychiatric disturbances, and cardiovascular problems.  Wellbutrin may have negative reactions if used with other drugs.  Caution should be used when co-administering Wellbutrin with other drugs that are metabolized by CYP2D6 isoenzyme.  This is because Wellbutrin inhibits this isoenzyme.  Caution should be taken when using certain antidepressants, antipsychotics, beta-blockers, and Type 1C antiarrhythmics.  MAO Inhibitors should be avoided because they increase the toxicity of Wellbutrin.  Drugs that lower seizures should be used with caution.  Wellbutrin can lower alcohol tolerance so alcohol should be avoided when using this medication (The Internet Drug Index, 2011).  One interesting advantage that Wellbutrin has compared to other antidepressants is a low risk of sexual dysfunction and may even increase sexual function in those without clinical depression (Wikipedia 2011).

What Decisions Would I Make

Making a decision for this family member would be rather tricky.  It would depend on many factors such as their degree of depression, financial situation, lifestyle of the family member (for example if he was an alcoholic this would have to be taken into consideration), etc.  I would probably recommend engaging in cognitive-behavioral therapy with a professional, as I believe this can help with various degrees of depression.  Secondly, if medically able to I would recommend setting up an exercise program.  Even something as simple as a half an hour walk in the morning may be beneficial in relieving depression.  Diet would be another important factor.  I mentioned earlier that while a diet high in carbohydrates may feel good initially, when that feeling wears off the depression may get worse in the long run.  Therefore, reducing simple carbohydrates in the diet and sticking with produce, whole grains, lean meats, and healthy fats may be beneficial in the long run.  When it comes to taking pills I tend to favor the more natural ones such as 5-HTP and Omega 3s, however, if prescription medication were the only way to allievate the depression then I would seek one that is low in side effects such as an SSRI or Wellbutrin.  Only if it were an emergency or last resort I would use methods such as ETC and TMS. 

Alleviating depression can be a very complex process as people respond differently to different treatments.  If it is not an emergency situation the best ways I believe helping depression is through therapy combined with a change in lifestyle.  If this doesn’t work then other methods such as medication many need to be implemented in order to help a person feel better. 

References:

Carlson, Neil R;  “Foundations of Psysiological Psychology” Seventh Edition.  2008 Pearson Education Inc.

Centre hospitalier de l'Université de Montréal (2010, June 21). Treating depression with Omega-3: Encouraging results from largest clinical study. ScienceDaily. Retrieved December 20, 2011, from http://www.sciencedaily.com/releases/2010/06/100621111238.htm  

Corey Gerald (2009) – Theory and Practice of Counseling and Psychotherapy, Eight Edition.  Thomson Brooks/Cole. 

The Internet Drug Index (2011) – Wellbutrin – Retrieved from http://en.wikipedia.org/wiki/Wellbutrin

Johnson, G. R. (2010) – Health Mad: Omega-3 Depression Cure – Retrieved from http://healthmad.com/mental-health/omega-3-depression-cure/ 

Mayo Clinic (2010) - Monoamine Oxidase (MAO) inhibitors – Retrieved from http://www.mayoclinic.com/health/maois/MH00072

Mayo Clinic (2010) – Tricyclic Antidepressants and Tetracyclic Antidepressants – Retrieved from http://www.mayoclinic.com/health/antidepressants/MH00071

Mayo Clinic (2011) – Selective Serotonin Reuptake Inhibitors – Retrieved from http://www.mayoclinic.com/health/ssris/MH00066

Mayo Clinic (2011) – Vague Nerve Stimulation for Depression – Retrieved from http://www.mayoclinic.com/health/vagus-nerve-stimulation/MY00183

Mayo Clinic (2011) – Depression and Anxiety: Exercise Eases Symptoms – Retrieved from http://www.mayoclinic.com/health/depression-and-exercise/MH00043

Sommers-Flanagan, John; Sommers-Flanagan, Rita; Efficacy of Antidepressant Medication  with Depressed Youth: What Psychologists Should Know.  Professional Psychology: Research and Practice, Vol 27(2), Apr, 1996. pp. 145-153.

South, J. MA (date not specified) – Offshore Pharmacy:  L-Tryptophan Nature’s Answer to Prozac – Retrieved from http://smart-drugs.net/ias-tryptophan-article.htm

University Of Maryland Medical Center (2011) - S-adenosylmethionine – Retrieve from http://www.umm.edu/altmed/articles/s-adenosylmethionine-000324.htm

Wikipedia (2011) - 5-Hydroxytryptophan – Retrieved From http://en.wikipedia.org/wiki/5-Hydroxytryptophan

Wikipedia (2011) – Bupropion - Retrieved From http://en.wikipedia.org/wiki/Bupropion