Tag Archives: antidepressants

Arthritis drug boosts antidepressant’s effectiveness

I was excited to read this week about another new treatment possibility for depression: An arthritis drug, when paired with an antidepressant, has been shown to work amazingly well.

It’s all about inflammation. Older studies have shown that depression leads to inflammation. Inflammation messes with the chemical balance in your brain and can prevent antidepressants from restoring that balance.

I’ve written before about how taking an over-the-counter anti-inflammatory medication can cut the depression symptoms for people with bipolar disorder, but this takes that treatment theory to another level.

This time, researchers got serious about tackling inflammation. They brought in an arthritis drug Celecoxib (used to treat pain, redness, swelling and inflammation from arthritis) and paired it with an antidepressant (Lexapro).

For an incredible 78 percent of patients, depression symptoms diminished by at least half. Sixty-three percent reported their depression was completely gone. That’s compared to remission in just 10 percent of patients taking Lexapro alone (with 45 percent saying symptoms had reduced by half).

Furthermore, where antidepressants typically take four to six weeks to start working, patients taking the arthritis drug saw results in just one week.

This new treatment method could prove to be a game changer for many!

Satu Woodland is owner and clinician of Mental Health Solutions, an integrative mental health practice located at Bown Crossing in Boise, Idaho. She sees children, adolescents, and adults.

 

Promising new treatment for depression

Here’s some good news for people who have been having a hard time finding treatment that works for their depression: Scientists are on their way to developing a new and improved one.

The hippocampus.
The hippocampus.

Researchers recently figured out which pathway in the brain antidepressants affect. They call it the BMP signaling pathway, and it’s in the hippocampus. They learned that Prozac and other drugs interrupt this pathway, triggering the brain to produce more neurons — neurons that affect mood.

Armed with this new understanding, they turned to the lab mice. Researchers injected the mice with a brain protein already known to block the BMP pathway. They discovered the protein–called Noggin–does a better job blocking the pathway than traditional antidepressants do.  But more importantly, mice receiving this treatment showed strong signs of overcoming depression.

I mentioned a couple weeks ago that I wasn’t sure what depression looked like in rats (or mice), but this study enlightened me on some symptoms: When you hang mice upside down by their tails, some will struggle for a long time to right themselves, and some will give up. Giving up is a sign of depression. Similarly, if you put mice in a complicated maze, some explore and some cower. Cowering is a sign of depression, too.

The mice who were receiving the Noggin injections struggled more and explored more than their counterparts who weren’t receiving treatment.

I’m always excited by new discoveries about how the brain works. With our growing understanding, medication for depression will only get better and better.

Satu Woodland is owner and clinician of Mental Health Solutions, an integrative mental health practice located at Bown Crossing in Boise, Idaho. She sees children, adolescents, and adults.

Medicating for depression: The basics

Today I want to take a few minutes to go back to the basics: Let’s talk about prescribing medication for depression. It’s a process that my colleagues and I engage in every day, but for new patients it’s unfamiliar and deserves an introduction.

When someone comes to me with depression (and we’re talking about regular depression this time–bipolar depression is a whole different topic), the first decision we make together is whether we’ll treat with therapy, medication, or both. In my experience, a combination of the two is the most effective approach, but every patient is different. Today we’ll just talk about the medication side of treatment.

Antidepressants

Once we’ve decided to proceed with medication, we usually start with an antidepressant. There are several kinds of antidepressants, so we choose one that has been shown to best treat your particular symptoms — lack of motivation, irritability, trouble sleeping, sleeping too much, fatigue, trouble concentrating, restlessness, suicidal thoughts, or loss of enjoyment of the things you normally enjoy, for example. We talk about side effects, your family history, your ability and willingness to take pills regularly, other medications you’re taking, and your other health conditions and make a decision from there. We adjust the dosage as we watch your symptoms and side effects over the next several weeks.

If you’d like a breakdown of different types of antidepressants, I recommend this article from the Mayo Clinic.

What I really  want to focus on today is what we do when the antidepressant we choose is not working for you. The largest and best study out there on medicating for depression found that about a third of depressed people are “cured” by the first antidepressant prescribed to them — their depression symptoms go into remission.
If you’re not one of the lucky third, my next step is usually to try another type of antidepressant. In that same study, about 25 percent of the people who tried a second antidepressant went into remission. Those results are good enough to make trying again a strong option.

If the second antidepressant doesn’t work, we can choose to either try a third antidepressant — the study showed 12 to 20 percent of patients are cured by the third antidepressant — or we can try adding another medication on top of what you’re already taking. That’s called augmenting the antidepressant.

There are three main types of medications we can add to your antidepressant regimen: mood stabilizers, thyroid hormones, and antipsychotics. I’ve found that each of these has the potential to activate the antidepressant you’re already taking. Even if you haven’t experienced any improvement with the antidepressant, it can start to work when combined with something else.

Mood stabilizers

When you hear mood stabilizers, think Lithium. Lithium is one of the most studied and proven medications out there. You may think of it as a treatment for bipolar disorder, but it can work well as an augmentation for your antidepressant. I use it when there’s a history of bipolar in a patient’s family or when a patient’s moods are turbulent — maybe they struggle with anxiety and insomnia in addition to depression. There are other mood stabilizers out there that work well, too: I often prescribe Lamictal, for example.

Thyroid hormones

Adding thyroid hormones to antidepressants is a course that hasn’t been studied as well as adding mood stabilizers, but it appears to work well and be tolerated better than lithium in a lot of patients. The most commonly prescribed thyroid hormone for depression is called T3. It’s often used to speed up the effects of an antidepressant, but it works to enhance antidepressants at later stages, too.

Antipsychotics

The third augmentation option is an antipsychotic. Originally designed for treating schizophrenia, this class is becoming more and more popular for treating depression. A lot of my patients have seen huge improvements after adding an antipsychotic. My favorite is Abilify. People tolerate it well and see good results: Two studies from several years ago showed about a quarter of people who added Abilify to an ineffective antidepressant saw a remission of their depression. Abilify can be expensive, though, depending on your insurance, and if it is, I try other antipsychotics first.

There are so many options for treating depression, and different people respond better to different drugs. It’s hard to know in advance which option will work the best, so it can take several tries before we hit on the right strategy.

The good news is that if you’re on medication and it’s not working, that’s not the end of the line. Far from it. There is some combination out there that will work for you; we just have to find it.

Satu Woodland is owner and clinician of Mental Health Solutions, an integrative mental health practice located at Bown Crossing in Boise, Idaho. She sees children, adolescents, and adults.

Why do antidepressants take so long to kick in?

Quick review of some of the biology behind depression, as scientists understand it: Depressed people are short on a chemical messenger called serotonin. The most popular type of antidepressant (the SSRI) blocks serotonin from reabsorbing into brain cells, leaving more of it hanging around to do its job: boost your mood.

Minutes after you swallow your SSRI pill, the drug bonds to its
targets. But patients don’t see the expected mood boost until weeks or even months later.

Scientists have been trying to understand the delay for a long time, and this week I read some good news: There’s been a breakthrough.

The surprising thing is that it has nothing to do with serotonin. A team of researchers at the University of Illinois at Chicago have been studying a different signaling molecule called the G protein. In previous research they’ve found that in depressed people, these proteins tend to get stuck in a fatty part of the cell membrane called the lipid raft. While stranded there, the G proteins can’t signal. The researchers suggest this diminished signaling could explain the numb feeling people with depression experience.

The team took rat brain cells and bathed them in SSRIs. Over time, they saw the drug build up in the lipid raft area, and as that happened fewer G proteins stuck around. They escaped to areas where they could better do their signaling.

So that’s it, they concluded. That’s why antidepressants are taking so long to work: They’ve got to build up in the cell membrane enough to send the G proteins on their way.

Here’s the part you really care about: Understanding this should lead to better antidepressants. There’s more research to do, but eventually SSRIs will work to speed up that G protein migration, hopefully leading to quicker effects.

This is definitely a topic I’ll be keeping an eye on. I’ll keep you posted!

Satu Woodland is owner and clinician of Mental Health Solutions, an integrative mental health practice located at Bown Crossing in Boise, Idaho. She sees children, adolescents, and adults.

Long-term antidepressant use could reduce the risk of myocardial infarction

Coming out this month in the British Journal of Pharmacoloy is an interesting article about the links between selective serotonin reuptake inhibitor (SSRI) usage and the risks of myocardial infarction. It has been believed for awhile that a SSRI, which is a particular class of antidepressant, acts immediately to prevent future heart attacks presumably by its anticoagulant properties. In this study they concluded there was something else in SSRI’s that works long-term to prevent heart attacks.
I am wondering if it is related to inflammation? In recent months, SSRI’s have been found to decrease inflammation. Perhaps that is the same mechanism that prevents future heart attacks? Or is there something yet undiscovered?

This is yet another example of how the body and brain effect each other. When one improves the condition and health of the body, the brain also is effected for the positive! It also works the other way around. If one improves brain health, the health of the body will improve also! If you have had a heart attack or are at high risk, you might want to discuss with your nurse practitioner or doctor the possible treatment of a SSRI.  Your heart and brain will thank you!

Little known differences between bipolar depression and unipolar depression

12/08/10
In my practice I often see patients self referred or sent in by their general practitioner who tell me that he or she has Major Depressive Disorder. Problem is, medications and therapy have had little success so my expert advice is needed.

When evaluating a patient it is crucial not to miss the diagnosis of bipolar depression. A recent article in a Chilean medical journal (Rev Med Chili 2010 Jun) identifies suggestions of how a proper diagnosis can be achieved. This information resonates with my practical experience seeing patients through the years.

First it is important to use standardized diagnostic criteria such as the DSM-IV or ICD 10 manuals. Second it is important to check whether certain clinical features are present. These features tend to be less known to the general practitioner and population. These criteria include whether there are previous episodes of mood elevation. Mood elevation can include times when mood is either positively elevated as in euphoria or high energy that is distinct from other times, or it can be negatively elevated. An example of the latter would be “road rage”. One is driving and the person in front of him lingers a little too long at the stop sign and the drivers gets unusually angry and wants to punch the guy out. We all have heard of that happening.

Another lesser known criteria is current or past episodes of psychotic depression which are episodes of depression that are so severe and debilitating that a person has great difficulty getting out of bed in the morning and functioning.

Recurrent depressive disorder before the age of 25 and a strong family history of mood disorder and suicide are other red flags for Bipolar Disorder.

Finally there are the signs related to past antidepressant usage that can be valuable information in proper diagnosis. If a patient has had a lack of response or “wearing off” to well conducted antidepressant treatment, or an unusually fast response to antidepressants with features of elation these are all red flags of Bipolar Disorder.

Finally, it is important that the proper professionals are utilized in making the diagnosis. While it can be a starting place, it can not be adequately done by self-diagnoses through the internet!

Depression: Should I go herbal or the medication route?

 
I have some patients who come to me for Depression who wonder whether St. John’s Wort is adequate in the treatment of Depression. My answer is it depends on the severity of the Depression. 
 
In mild to moderate cases where the Depression has been experienced for 3-6 months or less I would suggest the possibility of St. John’s Wort as a chemical remedy. There has been some recent promising research showing the effectiveness of St. John’s Wort in these cases. The advantage of using St. John’s Wort is not only in its effectiveness but it has fewer side effects than antidepressants. Antidepressants can have side effects such as weight gain, sexual dysfunction, fatigue and insomnia for some. Usually I see these side effects in the higher doses of antidepressants. There are some antidepressants that are worse than others as far as side effects are concerned.
 
If the Depression has been going on for greater than 3 months and especially for recurrent types of Depression I would suggest trying an antidepressant. Both St. John’s Wort and antidepressants increase Serotonin and other neurotransmitters.
 
This article is not meant to say that other forms of help should not be tried. I am a strong believer of Cognitive Behavioral Therapy (CBT) which seems to have the most promising research out as far as effectiveness. However, in the more severe types of depression the best combination appears to be a therapy like CBT combined with an antidepressant. That appears to be the quickest route to the remission of moderate to severe Depression.  
 
If you are not sure what type of treatment is best for you I would suggest you confer with a mental health specialist who prescribes, either a Psychiatric Mental Health Practitioner (Sometimes called an Advanced Practice Nurse) or a Medical Doctor. In some states Clinical Nurse Specialists (CNS) in mental health can also do the evaluations and prescribe medication.