Tag Archives: medication

The future of depression treatment is in your blood

I’ve written before about how prescribing medication for depression can be an imprecise science. Often it takes multiple tries before we find the right drug or combination of drugs to send your depression into remission.

A study from Dr. Madhukar Trivedi (front) demonstrated that measuring a depressed patient’s C-reactive protein level can help doctors prescribe an antidepressant that is more likely to work. (utsouthwestern.edu)

Scientists are working on that problem, though, and a new study shows promising results: Researchers found that a simple blood test can indicate which type of medication is most likely to work on a given patient.

In this study, researchers took finger pricks of patients’ blood and measured levels of a protein called C-reactive protein (CRP). They treated the patients with one of two medication options and found that people with low levels of the protein responded a lot better to one medication, while people with high levels of the protein responded a lot better to the other.

There is a lot more research to be done. More medications need to be tested alongside CRP measurements, and other markers need to be found to fill in the gaps where CRP isn’t enough of an indicator.

This is a promising start, though, and I’m excited to see where further research goes.

Go here to read more about the study.

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. Information in this blog is not intended as medical advice. Please consult your health care provider about decisions regarding your health.

Side effects to watch for with ADHD medication

The Centers for Disease Control estimates that about 11  percent of children (ages 4-17) have been diagnosed with ADHD and about 6 percent are taking medication for the disorder. The National Institute of Mental Health estimates about 4 percent of adults have ADHD.

With so many people in the U.S. being treated for Attention-Deficit/Hyperactivity Disorder — we’re talking tens of millions — it’s good to know potential side effects from common medications.

The usual prescription for ADHD is either a stimulating antidepressant, like Strattera or Wellbutrin, or a more powerful stimulant, like Ritalin or Adderall. These stimulants work in the brain’s prefrontal cortex, the region associated with attention, decision making and personality. They increase the levels of two chemical messengers: dopamine and norepinephrine. Dopamine is thought to act in memory formation and addictive behaviors, while norepinephrine plays a role in attentiveness and arousal.

With stimulants, common side effects include nervousness, agitation, loss of appetite, weight loss, increased heart rate, dizziness, etc. More concerning to me is a risk for schizophrenia-like symptoms including hearing voices, paranoia, and mania. These side effects occur in about 1 in 1,000 people taking the more powerful stimulants.

It’s important that when a health care provider considers prescribing stimulants to a patient with ADHD, he or she evaluates that patient for psychiatric risks, including a family history of mental health problems. If the patient begins taking the stimulants, care providers and family members should be vigilant about detecting psychiatric side effects.

ADHD medication can do a lot of good, but it should be used with care.

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. Information in this blog is not intended as medical advice. Please consult your health care provider about decisions regarding your health.

Avoiding time change depression

A Danish study recently found that depression diagnoses go up significantly (8 percent) in the month following the change from Daylight Savings Time back to standard time.

With the time change scheduled to happen this Sunday, let’s be on the lookout for signs of depression. Better yet, let’s be proactive in fighting it back.

The Danish researchers suggest the increase is tied to the loss of sunshine in the time when we really notice: The few hours at the end of the day, right when we’re getting off work and hoping to enjoy some free time. It also marks the coming of a long string of dark, cold days (especially in Denmark).

The article announcing the study begins with this disheartening quote by not-helpful Danish poet Henrik Nordbrant:

The year has 16 months: November, December, January, February, March, April, May, June, July, August, September, October, November, November, November, November.

I’d like to counter with this verse by poet Alexander L. Fraser:

Fear not November’s challenge bold—
We’ve books and friends,
And hearths that never can grow cold:
These make amends!

So here’s what you can do: Dust off your favorite books, call your friends, light your fire. In other words, make plans! Do things you love. Go out and serve others (I recommend this website for finding opportunities). Take an ice skating or art class. Bundle up and go for a walk in the sunshine when you can.

If you’re feeling depressed, there are many things you can do. Medication and therapy can be a big part of that.  With work and help, November can turn out to be a good month after all.

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.

Is Depression the result of a chemical imbalance?

The common thinking of the cause of Depression in the last 15-20 years has been that it is due to a chemical imbalance. Recently, it is found to be more complicated than that.
It is true that many people’s symptoms are improved with the use of antidepressants. Whether it be by a selective serotonin reuptake inhibitor (SSRI), or selective norepinephirine reuptake inhibitor (SNRI, tricyclic antidepressant or another class, they all are helpful for many people. But it is also believed that close to 50% of people do not benefit from antidepressants. Personally, I question that number when I think about my own practice and how many people have improved. In my own experience, I see 70-80% improving with antidepressants. The prior low numbers may be due to a person getting their meds from a general practitioner than from a specialist who is more adequately prepared to choose the correct type of medication. It could also be that in my practice, I follow my patients much closer than the typical GP who gives psychiatric meds to their patients. Additionally, most of my patients also receive from me some type of counseling or therapy and other health counseling so that should surely be a factor in my better outcomes.
Other factors that appear to be related to depression are genetic predisposition, other illnesses like Diabetes, heart disease, Parkinsons and Cancer, lifestyle factors such as substance abuse, exercise and nutrition. In the last few years there has also been much research directed toward inflammation and its influence on depression which is also showing a lot of promise.

Considering the complexity of issues related to Depression, in my practice I have a multidimensional holistic approach to target Depression.  I use a combination of psychotherapy, lifestyle counseling, nutritional counseling, spirituality, and medication prescribing if appropriate and the patient is interested. I have helped many many people overcome the terrible delibitating disease of Depression.