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Do Antidepressants Work?

A bottle of Eli Lilly & Co.'s Prozac is pictured at a company facility in Plainfield, Ind., Jan. 11, 2008.

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America has been called the “Prozac nation.” Millions of Americans spend billions a year on antidepressants whose brand names rain down in TV and magazine ads — Zoloft, Paxil, Wellbutrin, Prozac.

And depression itself is a tough and undertreated reality for millions.

But how well do antidepressants really work? A new study says that for millions of people, maybe not much better than a placebo. “Expensive Tic Tacs,” Newsweek called them last week. But what if they make a difference even so?

This hour, On Point: the complicated truth about depression and antidepressants.

Guests:

Joining us from New York is Sharon Begley, senior editor at Newsweek. Her cover story for the February 8 issue is “The Depressing News About Antidepressants.”

Joining us from Nashville is Stephen Hollon, professor of psychology at Vanderbilt University.  He co-authored a recent article in the Journal of the American Medical Association (JAMA) which found that for patients with mild to moderate levels of depression, placebos and antidepressants had about the same effect.

And from New York we’re joined by Robert Klitzman, professor of psychiatry at Columbia University, and director of their Masters’ of Bioethics program. He’s author of “When Doctors Become Patients.”  Read his take on the antidepressant debate in Newsweek.

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  • Ellen Dibble

    From the article of Hollon et al linked above: “The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms” (as stated in the intro).
    There have been a barrage of TV ads in the past few months to the effect if your antidepressant isn’t working, as it does’t for many, many patients, then you need to add another medicine, call your doctor now.” I think it’s Abilify they’re selling. I think Big Pharma offers medicines to mute symptoms but with a nasty trade-off; the brain doesn’t get to reprogram itself out of its dysfunction, sort of physical therapy for the brain circuitry that might be effective spurred on by symptoms. (Nor address actual brain dysfunction, an actual “sore,” if you will, the person is living with.)
    Maybe those pharma ads will stop now.

  • Gary

    These medications once specifically and rarely prescribed even to those who would be most helped, have now morphed into a money making scheme by the Medical Industrial Complex.

    It has a very similar analog in the financial sector, where the Credit Card industry rolled out cheap available credit cards as the conduit used to drain all assets from individuals, via higher interest rates (doses), home equity loans (symptom repressive drugs), and finally unemployment and bankruptcy (the result remains the same).

    The ONLY reason to advertise PRESCRIPTION drugs throughout the multi-media channels is to drive profit at the expense of the ignorant, facilitated by doctors (legal pushers), via their outlets on every street corner in America. Prescription drug advertising should be banned.

    Perhaps the war on “illegal” drugs waged by the government, is more akin to a turf war between drug lords over who gets to SELL their narcotics to America…at least that is how it appears.

  • Sally

    For mild depression, I agree. Save your money. And avoid the side effects. But for serious deep depression there is no easy solution. Yet, talk therapy is not properly compensated by insuranc and services are limited in time even for partial compensation. When those fail or are used up, what is left for person suffering from depression?

  • Bill

    I am sure that for severe depression some medicines can work for some people. They worked for me twice. It was a really a God send.
    But it was an extreme case (at least I thought so).

  • Ellen Dibble

    AARP lists the annual cost to the economy of drugs prescribed for everything, and I think PREMIUMS, and I hurt in my pocketbook everytime I see this shortcut being offered as a Band-Aid.
    The article cited refers to MILD depression, with a curve such that medication is indeed very helpful for severe depression, as Bill states. I don’t know how we commoners can pick apart what is severe and what is not. But I do know that where a physician might have had time to sit down with a patient and get a feel for where the person’s life and way of life were falling apart, now a physician looking at a configuration of symptoms that elude — that don’t fit into the diagnoses for which he has a more targeted treatment, that doctor is left with the psychoactive panoply.
    The way I see it, we have the illusion that medicine at last is “on top of things,” but it seems to make a lot of sense that lots of dysfunctions escape our understanding. And I think they get Band-Aids, for now. Try telling that to big pharma.
    In some ways, depression is seen as a punishment. Think of Verdi’s Aida, where Radames and Aida are shut into the basement until they die of lack of air. “If you would stop singing, you would last longer.” i think medications can be a way to make people stop singing. And I think Verdi zeroed in on the hormones revolving around passion to keep the pair singing a while, warding off the depression that was being inflicted.
    Think too of AA Milne’s Eeyore and Tigger, by which youngsters have been introduced to the depressive (the mopey and philosophical donkey Eeyore) and the manic Tigger (the bouncy, irrepressible tiger, more or less tended by the kangaroo mommy with her “strengthening medicine,” which turned out to be his favorite food). One doesn’t see these animals as having much potential as parents, but one doesn’t see Milne wanting to change them into resolute and steady sorts like Pooh or Kanga.

  • http://www.SSRIstories.com Rosiecee

    The Physicians Desk Reference states that SSRI antidepressants and all antidepressants can cause mania, psychosis, abnormal thinking, paranoia, hostility, etc. These side effects can also appear during withdrawal. Also, these adverse reactions are not listed as Rare but are listed as either Frequent or Infrequent.

    Go to http://www.SSRIstories.com where there are over 3,600 cases, with the full media article available, involving bizarre murders, suicides, school shootings/incidents [52 of these] and murder-suicides – all of which involve SSRI antidepressants like Prozac, Zoloft, Paxil, etc, . The media article usually tells which SSRI antidepressant the perpetrator was taking or had been using.

  • Bill

    I don’t want to get into an argument but I would have stopped singing altogether without those medicines. I would have stopped my life.
    I took them twice in my life and as I said before they were a God send. Each time I took them for about 9 months and then stopped.

  • Tom

    I have tried those mentioned above and a few others, Welbutrin was the only one that worked for me. It keeps the bottom from falling out.

  • chris

    I’m not presenting my experience as the definitive account of whether anti-depressants work, but I had very intense negative reactions, both mental and physical. The therapist and prescribing physician dismissed my complaints, saying such reactions were very rare. (Personal anecdotal evidence doesn’t carry weight, I understand. But I’m certain of what I experienced.) So I just stopped taking them on my own, a month after starting. … The reason I bring this up: I kept being pushed to try them (and start again) and wonder how much that was the result of effective marketing and insurance companies, or just a difference of opinion between a therapist and me on the proper treatment. Either way, I’m glad I resisted the pressure.

  • http://? kris johnson

    i wouldnt be alive writing this with out select serotonin re-uptake inhibitors, i had life long severe depression , to the point i have had a gun in my mouth before,,,there is no question that these things work, for mild depression not so much

  • Ben

    There’s good reason to believe that a lot of depression today is just a symptom of widespread Omega-3 deficiency. I’m no Doctor, but fish oil/flaxseed oil sounds to me like a better frontline treatment than drugs!

  • Viv

    One wonders if the economic depression or “recession” has some connection to this antidepressants issue. First, we have American pharmaceutical production which creates these products that are ineffective and lastly with Americans believing the magic powers of these pills, they don’t handle the underlying issues associated with their moods, thereby increasing their production and their morale. A bunch of Americans doped up means less production and more individuals on the dole.

  • Jon Allen

    I am sure that antidepressants can help a small subset of those prescribed to some extent, but unless depressing behavior patterns are disrupted in the process of treatment, recovery will not be forthcoming. Americans are far too sedentary, far too emotionally burdened, far too likely to fall into a counterproductive spiral of despair. Freud had no great insight, neither did Jung, nor any other great thinkers in the realm of psychology. The reality is that humans are living longer, but without significantly varietal, physical, and diversely enjoyable ways of living our lives, largely because of the pandemic of affluenza. If not for the completely nonsensical drive to keep up with the Joneses, many Americans and even Scandanavians would enjoy much better happiness in their lives.

  • Ericka Bohnl

    I am a clinical psychologist and I must say, the title, “the depressing new about depression,” of your guest’s book is offensive and misleading. It serve to further disseminate erroneous information about mental illness. Depression is not something that we feel about hearing upsetting news. It is clinical condition that one must experience for at least a month to be diagnosable.

  • Alice

    I’m a SSRI/Severe Depression success story. However, I’ve been on Paroxetine (Paxil) for over 15 years now. I was told at the onset that due to chronic Dysthymia symptoms, I’d would be on these pills “most likely for the rest of my life.” Naturally I am concerned about side effects (and I do have some) and what the effect will be on continuous use. Are there studies being done to determine damage/benefit of using them?

  • carol callaway lane

    Question:

    How often do the guests feel that people are misdiagnosed or have dual diagnosis of general anxiery disorder (GAD)? and therefore patients are noting improvement from their GAD and not a true depression?

  • Glenn

    What does it say about the double-blind studies that must have been performed prior to releasing these drugs? Isn’t one of the primary reason for these studies to detect the placebo effect, and to determine that the drugs are not only safe but also effective?

  • Ellen Dibble

    Ben, on omega-3 oils, I read a couple days ago that omega-3 fatty acids might prevent schizophrenia, since bad handling of these fatty acids seems to be part of that malady. It didn’t mention treating, just preventing — but who can anticipate schizophrenia…
    I didn’t know about depression. I am told to take it for immuno deficiency, allergies, and get lots of it, no help for allergy but so far not schizophrenic!

  • Courtney

    I think what’s disturbing about antidepressants is how *little* is actually known about them. I’ve been taking them since I was 18, and am now 32. They have been very helpful–but I think that there is too much that isn’t understood about how they work. For instance, both my sister and I noticed that while taking antidepressants we could drink much more alcohol than usual, and often did while taking them–we haven’t heard anything mentioned about this by doctors or drug companies. I stopped taking them for five years from 25-30, but had to begin again. I’m grateful for them. But this sort of sums it up for me: while staying with my sister in the Netherlands, my favorite thing to do was to ride a bike to the beach. I was suffering from depression and started taking medication again while there, and while the depression got better, the bike ride was no longer an ecstatic experience.

  • http://wbur Susan

    Question:

    I have been prescribed antidepressants (SSRI’s and wellbutrin) due to depression associated with an eating disorder. I have been told that these types of antidepressants will not help with depression at such a low body weight. Can you comment on the effectiveness of antidepressants for people with eating disorders (anorexia specifically)?

  • Brian

    Tom please stop talking and let your guests discuss the topic.

    You have rephrased the topic of this discussion no less than 15 times, possibly upwards of 20 in the first 25 minutes. Let’s get to the details and nuances.

  • Jemimah

    My doctor prescribed prozac as a possible remedy for hot flashes. It worked for about a week, then nothing. She then said I should try switching to Zoloft. Not only did my hot flashes get WORSE, but I was dizzy and started to feel both unhappy and angry…neither of which I’d been before the drugs. I weaned off of it as quickly as I could and would never go back.

  • http://moniqueortiz.com Monique Ortiz

    Antidepressants may work for some but they made me feel worse. I also didn’t like the idea of having to take pills for the rest of my life. Eight years ago I stopped taking Wellbutrin, against doctors orders. I changed my diet and dedicated at least an hour a day to working out and doing rigorous exercise. This routine has changed my life and I’ve been off of prescription drugs for well over 6 years. Other folks I know who say they have depression also state that they feel better when they are more physically active. Today, with our ipods, tv, and web, I wonder if people just aren’t getting out and doing enough physical activity. Being active always gets the good brain chemicals going, and that is a fact.

  • Mari

    I believe that depression results from adverse circumstances as much as it does to genetic predisposition. We live in times of great and rapid change. Many people find emptiness in their current circumstances at the same time doctors and big-pharma have been pushing antidepressants like crazy.

    Having been through the mill and put on these pills for awhile, I must report that I’d never been so depressed in all my life than when I was on the SSRI drugs. It was hell kicking them, too, even after only 6 months use.

    Good circumstances create good spirits. Drugged and depressed, nobody can make the changes required to address adversity and bounce back from circumstantial sadness in a whole and healthy way. The drugs often keep people sicker for much longer than they ought to be. That’s from my personal experience, not a scientific study.

  • Ellen Dibble

    I’m hearing Begley talking about serotonin and that maybe it’s not the whole story, just the most obvious part. And that the effects go beyond just that substance, and then the psychiatrist saying that brain science is tackling these things. Yes, indeed.
    And how on earth can talk therapy address a physiological issue? Except for maybe how the patient can “live with” it, or maybe how the culture can “live with” the suffering individual.
    Begley says “if people can think of other ways” than medication. And I’m thinking “other ways” than the rather costly method of cognitive therapy and other psychotherapy. I had a rather forthright dermatologist look at a baffling skin ailment and suggest a trip to Hawaii. And I thought: Right on! He understands. Nothing can be done under the circumstances. Thank you very much.

  • http://npr Suellen Manning

    I wonder why we in medicine always view the “placebo effect” as a negative..that is, proving that something does not work or that the patient’s symptoms are not “real”…why don’t we realize that we need to investigate the placebo effect and try to harness the body’s apparent ability to heal itself ? Why ? I would bet because there is no money to be made with this WELL PROVEN therapy..not that it will cure everything…but it DOES deserve investigation..thanks…

  • Hector

    These medications are only as good as the Doctors who prescribe them. Would you take chemo drugs without a qualified specialist, insulin? In the right hands anti-depressants are of tremendous benefit but they must be used in concert with some sort of therapy by professionals that know what they are doing. As is the case with most medications one size does not fit all. These drugs and therapy gave me my life back but it took a lot of work on my part as well as the attention of a well trained, experienced physician.

  • Jae Chung

    I had to write to express my outrage at the lack of scientific knowledge on the part of the female speaker when discussing what is such a serious issue. She brings a moral judgement of “just taking a pill” to what needs to be a discussion about the design of the research itself. Any study that overturns the volume of good research that has been conducted in the past decade, see studies by K. Ranga Krishnan or on Rajkowa (anatomical damage), must be examined carefully and objectively.

    The underlying tone of “it’s all in people’s heads” while ostensibly attacking the pharmaceutical company, deservedly at times, creates a danger that people who need help may not get it, because it is so hard to convince people in the first place that they can be benefited from it.

    Tom, I love your show and your intelligence, and so I am disappointed that on this topic you display a puritanical bias of “sweating it out.” To be sure, the question of in what circumstances medication is effective is a worthwhile one to have. But, it has to be an informed one, understanding that the notion of severe versus mild can fluctuate even in the course of the disease. And, yes, depression is a disease.

  • anne

    Please address the issue of sexual side effects and anti-depressants such as inability to climax or lack of desire.

  • daddy nearest

    Isn’t the Columbia professor just saying that there’s no way we can prove that the medications don’t work?

    I wonder where he got his last grant from.

  • Vanessa

    I was treated for depression for nearly ten years, and I feel like my doctors and therapists always brushed me off by giving me a script and letting me be. I had one doctor, in particular, with whom I didn’t meet for longer than ten minutes a month. He kept giving me stronger and stronger medicines, and the side effects seemed to include panic attacks and worsened depression. It wasn’t until I hit college that I was able to have someone listen to me. The intern at my college’s weleness center is the best therapist I have ever had. Between her and the school psychaitrist, I was diagnosed with a stress disorder and weaned off of my medicine. I have been fine ever since. Subsequently I feel like I was personally over-perscribed and ignored my whole life.

  • http://none Judith M. Shade

    I have been diagnosed multiple times by more than one GP/FP and given the gamut of antidepressants. They all had terrible side effects and I really needed psychotherapy (which of course at $100/hr my insurance wouldn’t pay) because I was really able to self-diagnose that I suffer from severe guilt and anxiety. There are no pills for guilt but a Valium every now and then solve my anxiety problems.

    Also, once you have been diagnosed with ‘depression’ forget ever getting insurance!

  • Erin B

    Alternatives to medication:Neurofeedback! No drugs, “training” one’s brain to behave differently.(my experience: The Neurodevelopmnent Ctr in Prov. RI), Very impressive results for treating my severe, chronic depression and PTSD. Drugs are a gamble– the best meds can have fleeting effectiveness, the worst can be debilitating.
    Brain Training exercises– video and physical. My doctors used to prescribe drugs but they were seldom covered by my insurance. The long-term effects were not consistent. My State subsideized health insurance covers this treatment.

  • Erin B

    Alternative!! NEUROFEEDBACK

  • Mary

    Good Morning, I’d like to echo the point made by Dr. Klitzman that this is a complicated picture. I know that too many primary care physicians are prescribing these medicines that don’t really understand how differently each person may respond to them. It has been my experience that it took the expertise of a psychiatrist to finally get my combination right for me. Having said that, I agree with the gentleman caller who was troubled by the message that this Newsweek article conveys to the general public — many of whom still suffer a stigma brought on by the cultural ignorance concerning mental illness. Using phrases like “an expensive TicTac” is deliberately provocative and doesn’t lend itself to an understanding of the complexities of this issue. I have used anti-depressants for a decade or more and am lucky enough to suffer very few side effects and have a very strong family history of mental illness that makes my decision a no-brainer. But, for many this kind of headline does not help their journey for what is right for them.

  • Lisa Timbers

    Two Points
    1. I’ve been taking Lexapro for 3 years to help my peri-menopause intense moodswings. After seeing a pscho-thearapist we agreed to try it as well as continue our sessions. Lexapro saved my marriage and my sanity. I stopped therapy within 1 month because I was so much better.
    2. The Newsweek cover really makes me mad. Attention-getting headlines creates such a problem in our society. Misleading headlines like “Antidepressants don’t work” just create problems. What does this headline do to those people in the grocery lines who are on the fence about taking antidepressants and headlines like that make them go over the edge. Particularly those who don’t read the article and realize that the headline was “just kidding!” Deplorable.

  • Ellen Dibble

    There is surely some danger in saying psychotherapists deal with “the ups and downs of life,” where it seems to me the measure of a society/culture is how we can handle these things among ourselves WITHOUT having to resort to “talk therapy,” and not costing the medical — our premiums.

  • Jae Chung

    And, yes, I agree wholeheartedly with Hector’s comment. The medication is most effective when the patient receives psychotherapy to help dislodge the cognitive and behavioral problems that accompany the neurological issue.

    Nothing is the sole answer. That means that we must develop a more integrated approach to help those who suffer, and even a mild depression (defined as two weeks of psychic pain) can cut deeply, and not simply propose false choices between medication and some other morally acceptable interventions. Okay, I’m done venting.

  • ruth clements

    just because you are depressed, doe not mean you have depression by Dr mary Ann Block.

    best book ever , a non drug approach to psychiatric disorders..

  • Cathy

    I’ve struggled with depression for 33 years and I’ve tried many treatments, from psychotherapy to anti-depressants to supplements and herbs. The safest and most effective for me have been psychotherapy, supplements and bitter herbs, such as artichoke or Swedish Bitters. I have have very good results with testing neurotransmitter levels and acting on those results with supplements. I want to know if any of the experts can address why psychiatrists do not do more neurotransmitter testing. Also, if low levels of specific neurotransmitters are thought to be responsible for depression, why aren’t they working on supplying the body with the missing neurotransmitters? Recycling too little serotonin in the brain doesn’t change the fact that there is still too little serotonin.

    Cathy Hasbrouck,
    Chester VT

  • John

    can you ask your guests the study of physical activity and the effects of producing brain activity

  • david House

    Good morning.

    4 years ago, I finally sought chemical help for anxiety and depression after working with a psycho therapist for some time. Lexepro was perscribed at its lowest dose while continuing therapy. After about 1 month, I felt a strong sense of well being that I had never experiecned before. The only down side was a bit of sexual dysfunctoin and feeling like I seeing life through a guase screen. After 1 year, I felt strong enough to stop the Lexepro, then the therapy. Big mistake.

    1 year later, I was in a state of dispair because I had allowed myself to get way to wrapped up in volunteer activism. Sleepless for days, thinking suicidal thoughts, I sought help from pyschiatrists, sleep docs and returned to my psychologist. I was put on sleep meds and the lowest possible level of PRozac. 2 months later, I am beginning to feel like life is worth living again. I don’t think a placebo would take 2 months to affect such a change if it was all in my head. Anti depressents are a blessing as far as I am concerned.

  • Lucas T Marshall

    Does Marijuana work for depression..

    Please ask guests…

  • Kathy

    Hello,
    I suffered from mild to moderate depression for years. I saw many different therapists to no avail. My last therapist suggested that I take L-Tyrosine, an over- the-counter amino acid which I found at my health store. Within two weeks, I cancelled my therapy. It has been nine years and my life has improved dramatically. I am not only not depressed, but almost giddily happy. The lable says it is a non-essential amino acid that plays an important role in the production of the neurotransmitters dopamine an norepinephrine. People with thyroid disease, melanoma, or those taking MSO inhibitors or other antidepressant drugs cannot take it. I would suggest it for anyone who is considering taking a prescription antidepression.
    Kathy

  • http://NPR.org ron

    I have taken Paxil for several years. I also had the opportunity for therapy. Unfortunately, my insurance provides only 6 sesions a year, which is nowhere near enough.

    The Paxil does help. Without it, I become quite maudlin. I do not like to think I must rely on drugs, still, they do help.

    The therapy was great and I wish insurance would provide for more. Prior to therapy and medication, I was a nervous wreck in public. I still have somewhat unusal behaviors when in public and under pressure, but the meds really help me deal with it.

    Stress in America is growing exponentially, with it grows the demand for a chemical response to stress and its related psycholoigcal effects.

  • http://parsleyspics.blogspot.com Leslie Parsley

    I have serious problems about anyone who writes about medications for depression or manic depression unless they suffer from or have a psychiatric/pharmacology degree. 1) Insurance does cover psychiatric treatment – much depends on the different plans a doctor provides; 2)There are usually two types of depression: situational (divorce, death, mild, etc.) and chemical; 3) No MD has any business treating it – they haven’t had the necessary training; 4) Only a psychiatrist with a pharmacology degree is qualified; 5) People who have a chemical imbalance often have to experiment with the doctor to find the right balance – the formula might work for years and then stop (body chemistry changes);
    6) NMHA has plenty of documentation about how depression, treated or untreated, leads to suicide;
    7) A true expert in the field is Kay Redfield Jamison;
    8) There’s a lot of overlap between depression and bipolar and other mental health conditions.
    9) You get 10 mental health professionals together and you will get 10 different opinions.10) Journalists usually serve to only misinform. 11) Shop for doctors – if you don’t like one, go to another.

  • Andrew

    I have been on prozac for over a decade – but now I have started have endocrine problems and there is a link between SSRIs and pituitary disorders. Even before the newsweek article, I started to decrease my dosage and Sharon Begley’s article only reinforces my decision to wean myself off these meds.

  • Laurie

    One thing I need to say, as someone who has dealt with both mild and severe depression in the past, and who has had both talk therapy and drug therapy (both of which helped in their own way, by the way, but neither of which I am currently using): I don’t see what’s necessarily wrong with the quick fix. Sure, if there are serious issues in your life that are making you depressed, you need to deal with them. But how long is it “necessary” to suffer while you figure them out? There is no nobility in extended suffering, folks. There’s nothing wrong with feeling better sooner rather than later, as long as it’s not keeping you from also working on your stuff.

    I sought talk therapy first when I was very depressed, and it was important, but the severity of the depression kept me from being able to stop the downward spiraling whenever it started, which was frequently. When I finally decided to try SSRIs, after a few weeks I found that my problems hadn’t gone away, but my utter inability to cope with them had abated. If that was a “quick fix,” so be it. I didn’t deserve feeling better any less because I sought medication.

  • Decklin Foster

    This kind of reporting is irresponsible. Does anyone remember last week when the MMR-Autism study was finally retracted after the discrediting of its author? When the flawed study originally came out, there was sensationalist reporting that invited you and me and other laypeople to make uninformed judgments about its conclusions. We saw what happened — people put their children and other people’s children at risk, and there were outbreaks of measles.

    I don’t see this as any different, *even if* this antidepressant study is backed up by further research. You and I do not prescribe antidepressants; qualified professionals do. And they do so based on their training and *their* understanding of current research, not the court of public opinion. I think it would be great if we could take an hour to talk about treatment of depression, but let’s not pretend we know everything about it because we heard there was one (one!) article in JAMA. Which of course we didn’t even read!

    I’m sure in another year or so there will be another sensationalist article about antidepressants being underprescribed. Research is a complex enterprise full of lots of conclusions in all different directions that need to be synthesized. This kind of reporting cherry-picks examples that make it look like a tug of war between two extremes, full of certainty. It might sell magazines, but it’s misleading and dangerous.

    (FWIW, I have bipolar disorder and I work as support staff in an institution that does research on depression.)

  • Ellen Dibble

    The people I’ve known and know who use antidepressants use it as a safety valve, and no question at all having that “safety” is a lifesaver for them. Just knowing that it is available is just huge. They can turn to the medications until they choose to switch off, and even if the antidepressants aren’t really working or have side effects, it is something to turn to.
    My understanding though is that antidepressants aren’t a “quick fix” by a long shot, and require a couple weeks to become effective, which can be discouraging in itself, especially if one is struggling with insurance and trying to find a compatible mental health provider.
    But I think if antidepressants ARE a quick fix, that might truly enable the individual the freedom (the escape, the safety) to find the self-generating solution/cure (in the cases where that exists).
    In short, you may not need to use this escape, knowing it is there. But I don’t think there are any so efficient right now.

  • Pat

    I think it is dangerous to have a journalist on to talk about the science of the issue unless the journalist also has credentials in this area. This guest seemed to want to make the point that a chemical understanding of depression is flawed, but did not seem to grasp the complexity of the fact that (as pointed out by another guest) psychological events can change brain chemistry.

    I am as leary of big Pharma as the next person and would agree that there is an overprescription of SSRI’s, but do not agree that these pills are little more than sugar pills. They have very specific brain chemistry effects that may or may not lead people to feel their depression is being well treated. I found her views to be overly simple. As one does science one realizes that there is a fuzziness to everything. The Hamilton Rating Scale for Depression is far from perfect as a measure of depression, and yet this guest seemed ready to place full confidence in it. I would have preferred to have a psychopharmocologist as the other guest on this show rather than a journalist.

  • Ben

    Ellen, fish oil has been shown to have effects like the SSRI’s, although I’m not saying it should replace them. Like vitamin D, omega-3 fatty acids are being touted as a brand new “miracle cure” or preventative for many health conditions. But actually, taking fish oil is just reversing a nutritional deficiency that has developed since the advent of industrial agriculture. Omega-3’s concentrate in the tissue and milk of animals that consume grass or other live plants. In the US most of our animals are today fed grain in feedlots rather than allowed to graze on pasture. Sure, it’s possible to find pasture-fed products or wild game that have all the omega-3 you need… or you can just keep your life simple and take fish oil instead. :-)

  • Pat

    Ben, something else to consider with respect to how our modern lifestyle, and especially the lifestyle of those in industrialized countries, differs from that of our forebears: amount of time spent outside. Seasonal affective disorder has already been shown to be a valid condition and capable of being treated with light. Instead of buying expensive lights to treat SADS, what would be wrong with spending a little time outside? For mild and moderate depression I would not prescribe anything until I tried having the patient spend 30-60 minutes outside during daylight, preferably around noon in the winter. I heard an interesting report recently that the strongest predictor of visual impairments requiring glasses was amount of time spent outside–the less time outside, the greater the need for glasses. Light goes through our retinas and has a chemical effect of the brain. We change the conditions under which we evolved at our own risk.

  • Bill

    I agree with an earlier comment and book recommendation I read in the comments above by Ruth Clements.

    I also would highly recommend the book “JUST BECAUSE YOU’RE DEPRESSED DOESN’T MEAN YOU HAVE DEPRESSION” by Dr. Mary Ann Block.

    Bill

  • Mark, M.D., MPH

    To listener “ANN”:

    (I hope I heard your name correctly — you were talking about 20 yrs. of depression & treatment, awa. estrogen & insomnia treatment).

    PLEASE do yourself the favor of looking into FUNCTIONAL MEDICINE. I believe you are right not to trust the drugs & that you are also experiencing side effects & perhaps even harm from them (such as the estrogen treatment). There ARE causes for your symptoms, and it’s highly likely that FM can find them for you. You can get a good idea of the rationale & approach from Dr. Mark Hyman’s book “The UltraMind Solution”. (Dr. Hyman is one of the leaders in the dissemination of FM practice in this country).

    Wishing you the very best,
    Mark.

  • Ben

    Pat, I think you’re on the right track. Our bodies make vitamin D from sunlight and new evidence is showing that vitamin D has a role in preventing depression (and just about every other “disease of civilization”). The problem is, at Boston’s latitude it’s impossible for our bodies to make _any_ vitamin D during the winter, even if we sunbath in swimsuits at noontime! (And from what I remember, the sun has other benefits that SADS sufferers are missing beyond just vitamin D.)

    I have personally experienced significant chronic pain with no obvious cause – it turns out that I was just Vitamin D deficient. This is probably the case with most Boston residents, especially those who work inside or have darker skin. The hard science is only starting on this vitamin. But if you just look at maps showing the incidence of different diseases (cancers, autoimmune) in the US, I don’t think it’s an accident that they are less common in the south. It’s fascinating reading – vitamindcouncil.org advocates vigorously for the vitamin, as does Boston University’s own Dr. Holick (uvadvantage.org). Watching them feud with the dermatologists over sun exposure if rather hilarious.

  • justanother

    This is a society full of blood sucking vampires. These corporations will suck every drop of our sweat and blood. Because they are protected by federal laws, and we taxpayers are the ones will pay for their greed. We are the losers no matter which way we turn unless we education ourselves, not being manipulated. When something goes wrong psychologically, rule out physical problems first, if nothing’s wrong physically, it’s time to look within ourselves, examine why are we depressed. The greatest debate is whether the cause of our depression is physical or psychological. Medication shouldn’t be totally eliminated to help certain people to be able to function through traumatic time.

    This culture has an essential problem, which smile and happiness is advertised 24/7. We need to accept the fact that we are not made for constant happiness. Maybe some people are, but very few. If you ask a happy person NOT to smile or be happy, that’s torture, vise versa, we shouldn’t expect people who are dealing with problems have to put up a happy face, and pretend to be happy socially. And if this kind of unrealistic expectation can be eliminated, it will take a lot pressure off us. Unrealistic social expectation and intolerance of accepting who we are will continue to trigger depression & anxiety.

    It’s time to look at the root problem, instead of putting temporary bandage on “deep” open wounds.

  • Pat

    Ben–I am in complete agreement with you. In my opinion is it essential to get sufficient Vitamin D (and I like your analysis of the geographical data) which can probably be obtained at our latitude only from supplements. However, I would argue that it is still important to get out in the sunlight because the brain chemicals released from sunlight hitting the retina is a whole additional mechanism. I because aware of this when my husband was prescribed a light for treating SADS and I read the instructions. The instructions emphasized the importance of making sure that the light hit your retina. I then realized that because I wear transitional lenses, I was probably not getting sufficient sunlight to the retina in the winter. Since then I make it a practice to go out for a walk without my glasses on as often as possible.

  • Brett

    I would argue that a lot of what is going on in the prescribing of psychotropic medications is a kind of experiment of sorts, because we don’t fully understand the array of factors in what is happening in the brain when a person suffers from depression, or anxiety, or any array of soci-psychological disorders, etc. This, in part, may very well be why some medications work for some people and some don’t.

    The most frequently identified neurotransmitter, serotonin, for example, may play a role in someone’s depression or anxiety, it may not. The makers of Buspar, for example, are betting that a person’s anxiety/depression is caused by serotonin levels being too high, as the medication suppresses those levels. Conversely, Prozac is a true SSRI in that it raises serotonin levels. Other medications, such as Effexor, raise levels of dopamine and norepinephrine (two other commonly identified neurotransmitters), as well as mildly elevates serotonin, and on and on…

    The treatment of both depression and anxiety is a tricky business to be sure. Does the anxiety/depression persist over time? Is it short-term? Does depression follow periods of anxiety? Are they both present simultaneously? Are there external factors in a person’s life which may reasonably produce anxiety or depression? The list of questions continues…More factors would be family history, a person’s history irrespective of family, a person’s job, lifestyle, natural psychological make up and response to stress, etc
    .
    All too often, people don’t seek treatment or make lifestyle changes when problems first set in, and they haven’t insurance which would cover psychotherapy, They are then reduced to going to their PCP’s; and, in a brief discussion of their symptoms, the doctor prescribes a medication.

    This is not the fault of the doctor, who often has had limited training with mental health issues in their medical schooling, as well as limited time with the patient. The initial prescribing also marks a beginning or baseline period. Much follow-up is required for a PCP to effectively treat the patient, either through experimenting with different drugs and dosages, or at some point referring the patient to a therapist. Patients need persistence and patience during this period; all to often, they get their medication and don’t follow-up effectively.

    Two factors are very important for a patient to receive good treatment with a mental health issue when relying on their PCP: 1) RAPPORT with the doctor, which includes effective communication on both the doctor’s and patient’s part, and if the doctor can spend a fair amount of time listening to the patient and gathering information from the patient, as well as closely monitoring a patient’s progress and response to medication. 2) The patient needs to stay focused on the view of being empowered and being in charge of his or her health. The patient needs to be able to say, “this isn’t working, and I need to explore “X” in my pursuit of proper treatment,” for example. The patient needs to be a good observer of his/her own internal dialogue and external behavioral changes; he/she needs to be a good data collector and historian for the doctor, as well.

    This second factor is very tricky for some because of the nature of anxiety/depression. Often people will seek help when they are feeling least empowered and in the least control of their lives.

    I was glad to hear in the show that the guests attempted somewhat to delineate chronic depression from brief episodes. If someone has had depression for two weeks, and particularly if he/she has suffered loss (a job, a home, a spouse, etc.), depression might very well be a normal response to those situations. A change of diet, exercise, increasing activities, or maybe a visit to a therapist for some very short-term intervention, support groups…may be better routes to explore than mediation. And, if medication is decided upon, perhaps the medications alluded to in the show, which are for more long-term problems may not be appropriate.

    If someone takes Prozac for two weeks, for example, and stops (even if it is stepped down properly), this will probably cause more harm than good. There are medications for more short-term episodes that are more appropriate. The trouble with these classes of medications is that they often carry abuse potential/carry dependancy issues. The side effects are a huge issue, as well, and for mild to moderate symptoms of depression/anxiety the side effects often far outweigh the symptoms of the condition. Also, in chronic conditions, medication can only do so much; some form of psychotherapy in conjunction with medication may be needed.

    There was brief mention in the show of “natural” alternatives such as St. John’s Wort. There are inherent problems with these, too. 1) TITRATION!!! In herbal supplements, QC measures are often lacking, so one capsule, tab, tea bag, etc. may have more concentrations of the herbal than another. This really undermines any genuine therapeutic component a herbal may possess. 2) There isn’t much known about how herbals interact with other types of medication; this can sometimes have grave consequences. 3) THey have generally not been subjected to clinical trials and scientific study.

    The biggest problem with the proliferation of these “new generation” medications is in how they are being marketed. This was mentioned toward the end of the show. A company can throw out the clinical trials that didn’t produce the desired effect from the medication, get it approved by the FDA, market it in the media ad nauseam, and can imply that it is a reasonable treatment for problems in that advertising, without specifically mentioning things like frequency, duration and intensity of the problem for which it may be prescribed.

  • Mark, M.D., MPH

    Anne,

    (?same person who called in, to whom I wrote above..?)

    The sexual side effects of this class of medications is extremely common (in both genders) and has been known since the original research on these drugs.

    The lack of efficacy of antidepressants for most patients has also been suspected & contested in the medical literature for at least half a decade. What’s the upshot of this study & OnPoint hour?: There are MANY, many ways to treat one’s depression. Perhaps even for the severely depressed there are things more effective than these drugs (highly likely, based on my knowledge & experience), but these studies have not been done. (Of course the same thing applies to all drugs. The reason for this is the underlying philosophy or “paradigm” of orthodox medical science).

    TWO CRITICAL POINTS TO NOTE IN REGARD TO ALMOST ALL CLINICAL STUDIES INVOLVING MEDICATIONS:

    1) The drug is tested, not against another treatment (unless it’s ANOTHER DRUG!), but against DOING NOTHING (i.e. placebo, sugar pill). It is common sense, as well as medical fact, that DOING SOMETHING (i.e. many possible things) will often if not usually be more effective than DOING NOTHING..!

    2) The studies on these drugs are extremely short — usually between 4 and 12 weeks, and very often not more than 8 weeks. For various reasons, such short studies are more likely to result in the APPEARANCE of an effect for the medication. But there are also MANY other reasons (some mentioned on the program) why research done in the orthodox medical tradition (especially that funded by drug companies, as most of it is) will tend to show that the drug has an effect when it may not.

    [However, as in point 1, this says NOTHING about the drug's effectiveness compared to some other (e.g. non-drug, or complementary/holistic) treatment. It is the fact that most drugs are not as effective as other treatments BECAUSE they attempt to suppress the SYMPTOMS of disease or imbalance rather than addressing the CAUSE. Functional Medicine is a scientifically-powered approach which identifies the cause/s of imbalance which result in disease symptoms, allowing their efficient & quite rapid treatment.]

    There are many physicians as well as popular books which can help you find the way out of your dis-ease symptoms. In terms of books, Dr. Hyman is one of the best authors & spokespersons. In terms of physicians & other practitioners, many of them can be found on the website of the Institute for Functional Medicine, http://www.functionalmedicine.org (‘Find a Practitioner’).

    Best wishes,
    Dr. Mark

  • Audrey

    My comments reflect my own experiences and observing the struggles of friends and relatives, as well as participating in support groups, both in person and online. I’m not a professional researcher.

    1. I believe that antidepressants are only good for a short period, but that the side effects seem to last forever, in spite of the fact that the drug supposedly leaves your system after a while. I think it causes permanent damage, somehow.

    My five worst side effects from antidepressants (beginning 1996) are weight gain (55 lbs.), destruction of libido (doesn’t help my marriage), memory loss (How do you spell “the”? Where’s my driveway? What’s my best friend’s last name? Why did I put the shampoo into the fridge? What’s the word for …?), eye-hand coordination (e.g., can’t throw a ball, play piano), and inability to think (e.g., can’t write properly, can’t do simple math, logic puzzles), although I used to excel at these things).

    2. It is the extremely rare doctor or therapist who really knows how to diagnose the problem and prescribe for it, or how to perform useful, productive therapy. Pills are an easy out for them.

    3. Most therapy is designed to keep the therapist employed, so the patient keeps coming back but often gets little in return other than someone to talk to. (Again, rare exceptions.)

    4. Regular exercise is a great help!

  • Mark, M.D., MPH

    “Hear, hear”, Audrey -
    But I’m sorry to hear of your experience. Most unfortunately, of course, it’s not uncommon.

    THINK ABOUT THIS, everyone:

    Look at the list of side effects Audrey lists above. Think about how PROFOUNDLY those affect someone’s life, especially her/his quality of life. Now imagine what the FDA’s regulatory response would be if a NONDRUG TREATMENT had anything LIKE that kind of list of side effects..!! Do you think such a treatment would be allowed to remain on the market, especially in the face of the MINOR (at best) benefit which many drugs seem to provide?!

    There are also a good dozen books — some by highly distinguished authors such as Marcia Angell, former editor of the New England Journal of Medicine — detailing the travesty, perversion & lack of scientific foundation of much medical research, especially drug research. It is now in the public record — based on their decades of professional responsibility for evaluating research for publication — that Dr. Angell & the editor of the British Medical Journal (two of the world’s premier general medical journals) agree that MOST of the currently-existing medical research can not be trusted!! In view of the high esteem in which medical research & treatments are held by the public, this is an ASTOUNDING admission by those in the know.

    Books such as Dr. John Abramson’s “Overdosed America” are also scholarly, easily-read EYE-OPENERS. Everyone should read them, because – in democracy – a populace that understands the truth is necessary for proper decisions to be made..; not to mention the immediate benefit for YOUR OWN HEALTHCARE DECISIONS.

    Dr. Mark

  • Ellen Dibble

    I suppose Mark, M.D., would favor a thorough airing of the issues he raises before the nation settles on health care reform. So there is some urgency.
    There is a woman at the local hospital in charge of “clinical trials,” and I tried to reach her to point out a few simple things I’ve been figuring out that I think deserve clinical trials — would save in money and suffering. I know a few things for the main and simple reason medicine is stymied in some matters. I say I’m learning to live in my body at age 60. But it’s about impossible to try to help others, given the medical establishment. I might know something that would help every 500th person, but how to find that 500th set? Vitamin D is an interesting example. I get a huge amount in additives in powdered milk, but I found when I had a flu that lasted most of a year that when it was primarily a bad tooth ache (jaw ache, neck ache), a vitamin D tablet almost immediately stopped the jaw ache. Since the flu (or whatever) kept coming back, along with the tooth issue (dentists were no help), and each time the vitamin D tablet stopped the toothache a hundred percent almost within an hour, more or less, every time, over months, I was happy. Also mad that I couldn’t share that. What was going on?
    Is there a venue for us to put together our own trials? Someone here suggested l-tyrosine, and I’m wondering if others tried that. I have a handful to be tried out.
    So I’m about to inflict myself on a clinical trials person. How to…

  • Brett

    Ben, the omega-3 fatty acids idea is a good one. If nothing else, it would help the cardiovascular system. If taken PROPERLY, it wouldn’t hurt a person, and I have never heard anything undesirable about this type of supplement, such as interfering with other medications a person takes, etc. Also, it seems there is a growing amount of clinical study of omega-3 fatty acids, much more data available than, say, on the popular herbal-of-the-month, particularly in the area of mental wellness/brain function.

    One may not wish to increase one’s fish intake, so supplements may be a good alternative. Let us not forget Flaxseeds, Walnuts, Pecans, and Hazel nuts for folks who are vegetarian or vegan. Eggs can also have high levels of omega-3′s in them if they are produced by chickens who are fed grasses and insects. Grass-fed animals produce meat that is much, much higher in omega-3′s than the grain-fed junk mostly found in supermarkets.

    I would also recommend someone either eat a diet rich in B complex vitamins/take a supplement. This will help balance out mood and is safe (it is water soluble, so one is safe in taking a B complex supplement). The timed-release ones would be good for mood balance (avoid commercial vitamins like Centrum, etc., as those have such low doses of B complex in them, as well as fillers that would destroy their remote benefit, so one is wasting one’s money). 50-100mgs. a day would enhance mood, and whatever one’s body doesn’t need would be passed off in urine.

    If one wishes to get the B vitamins in food: brown rice, sweet potatoes, bananas, and legumes, to name a few.

    The only problem with a supplement would be in niacin if one took excessive amounts each day, like thousands of mgs. kinds of excessive, so no real concerns there in the 50-100mg. a day proposition.

  • Audrey

    This is an addendum to my last post. I left out the good part. This shows how a good doctor and the proper diagnosis can make a big difference.

    A few years ago I fell into the deepest, darkest depression I can imagine. It came on for about a year and a half and peaked at the beginning of 2006, after a series of nasty events that gradually worsened my state until I cracked. For more than a year I couldn’t get out of it. I never smiled, laughed or felt good. I cried all the time, forgot to shower, shampoo or change my clothes, didn’t leave the house, slumped to the floor a lot, couldn’t sleep, sat in catatonic positions for long periods. It was agonizing for me and my husband, as well.

    I never considered suicide due to the “Ethan Frome effect,” which is that any attempt would fail and make things a million times worse. On the other hand, if I died, what if there was something on the other side of death, and would it be a million times worse? Great mental therapy against suicide!

    My life didn’t feel worth living, but I didn’t do anything self-destructive. The best time I had in a whole year (a year after the “big drop”) was during cataract surgery when I was under Versed (midazolam). (It doesn’t knock you out. You are still awake, though relaxed and groggy.) I felt great. When the surgery was complete and the doctor announced that they were removing the Versed tube, I begged them not to. I told the doctor that it was the happiest I’d felt in over a year. (Too bad they couldn’t have left it in.)

    That was my high point for the year. Some statement!

    Finally, after much searching, I found the most amazing psychiatrist. After an initial evaluation, he suggested antidepressants, even though I’d told him about my past negative experiences with them. He wanted to see for himself, so I agreed to try again. We tried a few different ones, but he agreed that they were not helping.

    He wanted to experiment with meds that were used for bi-polar disorder, so he told me about the benefits and gave me warnings about possible serious side effects and allowed me a couple of weeks to consider the possibility.

    This doctor respected me enough to provide information and allow me to make my own decision, rather than to just push the drugs on me.

    We agreed, and I was put on anti-convulsants, often used for bi-polar disorder. His plan was to start me on Tegretol and then, if my body didn’t react negatively, to add Lamictal.

    The first two weeks on Tegretol seemed to make little difference and I began to fear poor results. At our next meeting he recommended that I begin the Lamictal. I was worried, but having learned from a good friend (via email — I still wasn’t meeting people) that she was also on Lamictal for bi-polar disorder and it improved her life dramatically, I gave in.

    Shortly after the new diagnosis and meds, my life began to feel normal again. I was happy again. Yes, I was still bi-polar, but instead of a straight depression, I had both good and bad days. Since then things have improved, and I have remained on the same meds.

    Unfortunately, about a year ago my doctor joined another practice far away, so I lost the best doctor I’ve ever had. I am now seeing a psychiatric nurse practitioner. Last spring I complained about problems with concentration and motivation, so she put me on amphetamine-dextroamphetamine salts combo, which had the side effect of taking away my appetite.

    I decided that it might be time to try another diet.

    After a few months I lost 55 lbs., and returned to my proper weight — the same as I weighed in high school. I feel great about my physical appearance, so my spirits have lifted. My husband loves it.

    One dreadful aspect of my weight gain had been knee, leg, and back problems (although I didn’t know at the time that the weight gain was the cause). I was in pain in all three areas, sometimes worse than other times. My knees got so bad that I was using a cane to walk. Sometimes my knees didn’t seem to have any strength at all. Walking was often agonizing and climbing stairs took forever. I was prescribed painkillers and remained on them until a few months ago, when the weight loss removed the pressure on my knees and back.

    Today I can run and jump. The cane is put away in a closet, and I no longer have any pain in those areas. I am so glad that the weight came off. I’m also happy about the RIGHT DIAGNOSIS and the RIGHT MEDICATIONS. (Of course, I wish I didn’t have to take ANY medications, and I worry about side effects all the time.) I still do have some problems, which I believe are side effects of the antidepressants, but I’m happier than I’ve been in years, so I’ll just have to put up with past medication errors, and be glad that help finally came my way.

    Anti-depressants aren’t for everyone, and in spite of what at least one “On Point” “expert” said, they don’t always help those with serious depression. They are overprescribed and they often have dreadful side effects, some of which cause permanent damage.

  • Audrey

    Sorry my last post was so long. I guess I got carried away.

  • Brett

    Ellen, I experimented on myself with various amino acids over the years. I found phenylalanine to help right before an activity involving memory; also, tyrosine is synthesized in the body from phenylalanine. Tyrosine has been studied a bit and found to help in neurotransmission, and it has helped with drug withdrawal in detox programs. I would encourage anyone to learn about the supplements they may want to take before embarking on experimentation, as certain ones can become toxic at higher doses. I would also urge people to make every attempt to get certain nutrients in a good diet before thinking about just going out and buying a supplement. When I was vegetarian, I used “Bragg’s” on my food, which is a liquid supplement that tastes like soy sauce and has all of the essential and non-essential amino acids in it. With amino acids, as well as the B vitamins, it is better to take those as a group than individually.

    The trouble I see with anecdotal “evidence” gathered in support-group-type forums is that…it is, well, anecdotal. Sometimes a little bit of information/misinformation can be counterproductive. I have been around people with alternative lifestyles my entire adult life, and it is amazing how much not only misinformation is out there, but how there can be a kind of hyperbole and hysteria accompanying the information. For someone who is suffering NOW this can take him/her down many dead-end streets and delay valuable treatment.

  • Audrey

    Brett,
    You recommended B-complex vitamins and warned people to avoid “commercial” brands, but I’m not sure what you mean by that. Which brands of B-complex vitamin supplements might fit the bill, in your opinion? I would like to try a good one, as it isn’t always easy to get enough in foods.

  • Brett

    Audrey, thanks for your comments, and it is good to hear you are in a reasonably good balance and happy after so long! Sounds as though the doctor who helped you get the right diagnosis and medication was one of the good ones. It is important for the doctor make every attempt to ensure the patient stays empowered and this is achieved by careful listening and knowing the patient makes the ultimate decisions. It also sounds like you kept your sense of empowerment through it all, and this is not only what I would consider crucial but testimony to your strength!

  • Audrey

    Oh, one more benefit of the weight loss: my sleep apnea went away and my doctor told me to put my CPAP into storage.

  • Brett

    Audrey, I just mean the multi-vitamin type supplements like Centrum, that have very low doses and sugar fillers that eradicate the vitamins, are to be avoided. Really, most health-food store or drug store brands that are just B complex alone (all of the B vitamins in one supplemental, balanced formula) would be fine. I think very highly of Schiff brand because I have used them for almost 40 years, and their quality control standards are very high.

    If you do get a B complex supplement, I would say try an extended release one (good for mood stability) and don’t take over 100mgs. a day. You may have more vivid dreams (this is the B6) and you may have very yellow urine (this is food coloring and it simply means you are passing some of the vitamin off in your urine because you didn’t need that much). I think a good daily dose for mood is between 50 and 100mgs. Most of the brands use a whole rice or brown rice base for their product, so look for this. A side benefit is that this will give you extra fiber and increase natural metabolism…

  • Brett

    On the vitamin D idea, I would be careful in using supplements, as vitamin D is fat soluble and can be overdosed on because it is stored and not passed off in one’s urine. I wouldn’t take over 250 MICROgrams a day (on the highest end of the intake) if I did use a supplement, even less if I ate a fair amount of milk and yogurt.

  • audrey

    Thanks, Brett.

  • justanother

    How about all these natural store brands of Vitamin D and Calcium in Earth Fair health food market or The Whole Food market, are these better than the drugstores’ brand?

    My personal experience with commercial brand Centums Calcium chewing tablets with Vitamin D were negative. I started to have water retention and I didn’t feel good. Once I switched to brands of health food markets, they seem to agree with my body better. Besides I thought it is Vitamin D3 is more important than D1, right?

  • Ellen Dibble

    Brett, the vitamin D I took actually had been recommended by my doctor — or he has since, which made me smile since I know its magic. I live in New England, so I take cod liver oil and make sure to get plenty. So when doctors have no useful advice, not any specialist for miles around, I basically buy everything on the shelves of health food stores and pharmacies, and try to be methodical about it. In the case of the jaw situation (the toothache?), I think I had vitamin D tablets because I had been advised to keep them on hand, and trying one (maybe 10,000 IUs?) was not a help. So I tried another, or maybe two. It was a plain fluke of chance that I hit on that cure, and I don’t know what it relates to. I only do that when I get the toothache, not every day.
    I get most vitamins, with extra, by buying what I’ll call Green Powder. Health food stores have organic mixes with beet powder, alfafa powder, oh maybe 30 different vegetables. I mix some with unsweetened soy milk and put that on Fiber One.
    I’d like to know why tourmaline in detox foot pads when applied daily to my neck/shoulder has been holding at bay frozen shoulder/muscle knots for 3 years, after a decade of pain killers and chiropractors and physical therapy and specialists and MRI’s and what have you. The cost, the despair, the pain — I’d like to get that beyond “anecdotal,” and it seems to me a clinical trial would be the proper way.

  • Brett

    Ellen,
    10,00 IU’s=250 micrograms. Also, you took that in an acute situation, which I would think isn’t going to lead to overdose/toxicity, but I personally would not wish to take something along the lines of 20,000, 30,000, 40,000 IU’s a day for extended periods.

    Toxicity could occur in a matter of a couple of months with consistent high doses (so higher intake in an acute situation is fine). If one takes high doses over time, one runs the risk of high blood pressure, problems of nausea and vomiting, excessive urination, weakness, nervousness; and, if one ignores these symptoms, renal failure can occur.

    With cod liver oil, you are safe with vitamin D levels; it is running the risk of vitamin A toxicity that is the problem with cod liver oil. If one wishes to get more vitamin A but is afraid of toxicity, taking beta carotene is safer.

  • Brett

    I only know of tourmaline as a gemstone…but it IS made up of calcium, potassium, and…I don’t really know what else. In what form? Powder? DO you do a healing stone thing with that? I know people who use “stone therapy” for certain things. I find stones to have magical powers, but I wouldn’t want anyone to know that, so Shhh!

  • Ellen Dibble

    Thanks, Brett, for the inputs. I know vitamin D can make one itchy too. They tested my blood once and found lots and lots of vitamin D and all those good things, and I was itchy. But it was something else.
    I checked my bottle for justanother, and my vitamin D is actually 1000 IU apiece, which they say is 250% daily requirement, but it doesn’t specify what kind of D it is. It comes with calcium 120 mg. Brand Life-Fitness.
    I know A and D are stored in fat (fat-soluble) and so one can overdose, but you’re right, my use doesn’t go there. I never heard of vitamin D for an ad hoc use like the one I found for pain, though.

  • John

    I think primary care physicians need to be more aware of the nutritional dimensions of depression. Others have commented about B vitamins, Vitamin D, and omega 3 fatty acids.

    A researcher here in Milwaukee has found links between depression and celiac disease, an autoimmune disorder that causes damage to the intestinal lining and often results in malabsorption of nutrients. Simply giving the patient an antidepressant (or even a nutritional supplement) may be overlooking other conditions that require treatment.

  • Brett

    Ellen,
    I have filed your use of vitamin D for tooth/jaw pain in my “first aid tricks” section of household remedies! Seems like a simple thing to try, especially if its 3:00am and Morpheus is standing around looking at his watch and tapping his foot!

  • Brett

    That’s interesting, John; it makes sense. The bulk of nutrient absorption happens in the intestines, as well as medication absorption, so…your point is an important one; physicians need to spend a reasonable amount of time ruling out physical problems as a possible cause of mental health issues. All too often, they don’t, but merely start out by treating the prominent symptoms/complaints for which the patient makes the appointment.

  • cory

    Does anyone enjoy 100% mental health? Are we all just mentally ill by degree?

  • Alycia

    I not sure about any of you but the road of meds was awful and I will never go back

  • justanother

    ***Does anyone enjoy 100% mental health? Are we all just mentally ill by degree?***

    Let’s just settle it for being “human being”. All the terminology were created to recognize our conditions, which all have existed since the dawn of human kind, maybe just a certain degree of difference due to our over exposure to chemicals that has polluted our environment. That we are in debt to ourselves to clean up our environment.

    I haven’t finished the whole broadcast, but it boggles me why a person having minor depression for short time period needs to be medicated. Like my earlier post, I do believe taking medicine under certain severe condition, but not whenever we hit the road block or bumps. It’s our way of thinking needs to be changed, which is accepting that if there’s happiness, there’s the other side of it. Only accepting the course of nature, we feel more peaceful. It’s our Bubble Gum Culture make our depression worse. We neither need to glorify happiness nor be over frightened by depression.

    Everyone has bipolar more or less.

  • Caroline

    As I listened to this show yesterday I really wanted to call in. But I was not in an area I could place a call.

    I suffer from moderate chronic depression, which seemed to begin after the birth of my son 8 years ago. I was at that time diagnosed with postpartum depression. I also suffer from an extreme PMS which my OB/GYN diagnosed as PPMD. I take the Birth Control Yaz for hormone therapy to control the PPMD, which works wonderfully; it has leveled my mood swings and swelling, cramping to an acceptable level.

    Though I no longer get the severe PMS mood swings I do still have the depression. Which I have been on a variety of Anti-depressants and I feel no longer work for me. Approximately 5 years ago I was on an Anti-depressant that I felt great on, I believe it was wellbutrin. I took it for a while and I thought maybe my Depression had passed and spoke to my Doctor about going off the Medication. We began a weaning process. I was okay for maybe 9 months then I began slipping back into Depression. I didn’t notice it right away, but it was trying on my family around me. It took me at least another year to realize how bad it had gotten. I went back to my Doctor and requested to go back on medication.

    After trying numerous different types of anti-depressants I requested to go back on the one I began to take 5 years ago. I am now on a generic form of wellbutrin, because now my insurance does not cover Mental Health doctor Visits or Drugs, and it is more affordable.

    I have been on this for nearly 8 months now and I am finding no relief. I am beginning to wonder if the Generic is really as effective. Or can your body learn to block these drugs overtime.

    I also want to comment on the Therapy aspect, I went to a counselor in the past and I found it very difficult to talk to someone I don’t know about myself. They were very patient and willing to listen but I felt like I was repeatedly complaining and it made me very uncomfortable. I also don’t feel I ever got past the things that were bothering me. It just didn’t work for me.

    I would like to know what other options I have. What can I do? I just want to be a happy pleasant person, for me and my children.

    I have a dark rain cloud hanging over me all the time, and find it difficult to hold back the tears.

  • Brett

    Caroline, excellent point about generic vs. brand name drugs. While I can’t speak to comparing the two with regard to psychotropic medication, I know that certain generic forms of other drugs I take are NOT as effective.

    I also work in the mental health field, and I can say that having to periodically change dosages and medications is common in treating depression and anxiety. Sounds like a methodical response of moving one variable at a time might be a benefit in settling on the right medication/dose, etc. First, maybe go back to the brand name and see if there is improvement, next, maybe have the doctor prescribe a slightly higher dose, and so on.

    On the therapy side, not all therapists are right for all people, so maybe that therapist just wasn’t a good match? Also they are paid to listen to your troubles, and they get paid well to do so. If a therapist is good he/she will present a balance of empathy for your “complaining” and having you work on small steps in between sessions. This balance often helps people to feel they are doing more than using therapy to vent their emotions.

  • Ellen Dibble

    Caroline, I see your health insurance now does not cover “mental health” (therapy?) or the brand name that worked for you. I think Brett missed that. Or I’m off.
    Anyway, let me focus on “I just want to be a happy pleasant person for me and my children.”
    No, I’ll focus on the helplessness of the therapist confronting all the evils and woes of the world, second-hand.
    I’ll put that paid-for advisor/ally up against the unpaid-for person on the street. The person who isn’t responsible for you, and is therefore neutral, indifferent. So what? You won’t rant and vent; you’ll be more in the moment, less into expectations, more into the real things that happen when two are together.
    What’s my point? I’m just elbowing Brett about the health insurance situation you face. I think you are stuck with being unpleasant to yourself and others (children too!), and I can tell you there are plenty of people who are not at all depressed who are plenty unpleasant. They think their well-being is a birthright of some sort to more or less blanket the world with their privileged sense of all-rightness. (Happiness is contagious; I read it in the newspaper last fall. But happiness is not arrogance. I digress.)
    The world can move between attacking you for being AWOL, missing in action, and attacking you for showing up and being out of sorts. Go figure.

  • http://wbur.org jon

    I noted during the show and some of the comments alot of criticism of primary care physicians prescribing anti-depressants. I am a practicing pediatrician in the Boston metro area. In the “ideal world”, emotionally suffering patients would also work with a skilled therapist and for those requiring medications be managed by a child and adolescent psychiatrist. Of course we don’t live in the ideal world. There is a tremendous shortage of child and adolescent psychiatrists. Many are not accepting new patients and often will not even accept insurance and require parents to pay out of pocket. Many children and adolescents are unwilling to speak with therapists, have poor insurance coverage for therapy or are unable or unwilling to make the time investment necessary to engage therapy. They are also often unwilling to engage in healthy lifestyle changes such as getting adequate sleep, healthy diet and exercise which would improve their emotional state. At the end of that, you still have a young person in front of you who is suffering and looking for help.

    I have tremendous concern for damaging headline stories designed for shock value and magazine sales. I have witnessed many dramatic success stories with the use of SSRI in depressed and anxious adolescents.

  • Brett

    You are right, Ellen, in that the lack of health insurance/limited funds for medication and therapy do often supersede and limit choices, and this can be particularly troublesome if a person has found relief in a combination of strategies but that those choices are not covered by insurance or are cost prohibitive otherwise.

    My current insurance doesn’t cover my asthma medication and insulin for diabetes, so I can relate. I also used to take medication for an anxiety disorder (Effexor) but once my insurance changed, I decided to get off the Effexor
    (especially considering I had many unwanted effects from that medication far outweighing any anxiety or depression from GAD). I couldn’t afford asthma mediations, medications and supplies for diabetes, AND Effexor. My lifestyle changes back in 2001, which included a lot more exercise, a very strict diet (the B complex addition helped immensely), plenty of time outside, and engaging in activities I love at a greater frequency, helped me personally.

    I profoundly empathize with the health insurance/monetary factor in a person’s life. I also very much empathize with someone going through a state of constant depression without finding any lasting relief. I was really only focusing on Caroline’s general issues with generic vs. brand-name medication and therapy. If Wellbutrin works for someone, and the generic isn’t effective (the cost issues notwithstanding), it makes sense to revisit going back on the brand-name/increasing the dose. If a person didn’t find relief with a therapist, maybe therapy isn’t the right route or maybe the therapist wasn’t the right match.

    I don’t quite understand what you are saying in most of the last two paragraphs of your last comment, but if a person is feeling like there is a dark cloud hanging over him/her all of the time, and has tears that are constantly on the surface, he/she is hurting on some level. Most of us have gone through those times, but frequency, duration and intensity in those kinds of feelings are the factors which would compel a person to seek help. I don’t believe people have to be “stuck” with those feelings, but I also don’t believe this is what you were really saying(?)

    My impression of what you were saying is that people have to take us the way we are sometimes–as we do others–and we can only worry about that so much. I can remember being depressed and having the stereotypical “furrowed brow” of an anxiety-ridden person at the height of being bothered by those conditions and people saying to me, “hey, smile, it can’t be that bad!” I, at times, was very affected by that and felt guilty, etc. But we are only capable of so much; if we can take it easy on ourselves in those situations and recognize that others are limited in how much they can understand of what we go through internally, we can reduce our feelings of guilt and being hard on ourselves.

    The Dalai Lama says that we all have the right to be happy; and, by the same token, we all have the right to be unhappy from time to time (he only mentions the first part, though). In my opinion happiness is fleeting, but then so should unhappiness be too. If sadness and not being in the moment are pervasive, especially to the point of interfering with what we consider normal, day-to-day functioning, seeking help is warranted (of course, the monetary cost notwithstanding). Parents, particularly moms, I feel need regular breaks to do things for themselves. Everyone needs a hobby, solitary time, and friendships that are purely our own (outside of married life). Married people and people raising a family often get so mired in their responsibilities, they can lose sight of themselves.

  • Brett

    jon,
    You make some very important points that can’t be overstated. I feel people often expect something akin to miraculous treatment from PCP’s, and even from therapists. All any health care professional can really do is point someone in the direction of wellness. Most of the work is up to the patient. I find many people often don’t quite recognize what is really being transacted between doctor/therapist and patient when they seek treatment. If clinicians are reduced to putting a “band-aid on a compound fracture” it is often because further treatment is beyond their control.

  • Ellen Dibble

    There may be millions of sorts of depression, and maybe the Dalai Lama isn’t talking about neurological blackouts (see justanother as to what a toxic environment can do; see Nature channel photos of frogs and eagles in the throes; grant them peace!) and doesn’t address that deserving a certain state of mind has nothing to do with it. Some kinds of feeling awful are quite different. If you are vomiting with flu, to some extent you have to just go with it. Some day researchers will figure some of this out.
    The thing about asking for help is that people are all around that “help” just by being there, in some cases there is nothing more that can be done. An enormous amount of boost can come from the this. I guess I know because I am alone so much. But our ancestors settling the west, for example, would be alone a lot. The modern procedures for “tuning out” wouldn’t be there.
    The situation for children and adolescents is different in some ways. A child may have it inculcated that the family is pretty air-tight, and other adults especially are out of bounds. It seems to me each family has certain things they talk about, a certain range of subjects and vocabulary of meanings, and children can get “chilled” (no pun intended) out of meaningful dialogue with a physician or a therapist quite easily. “Our family doesn’t ever talk to the guidance counselor.” “If we have to discuss anything with the doctor besides shots, we have failed.” Something like weight is kind of hard to hide or explain away, the way a parent might teach a teen to construe an issue in such a way that the doctor doesn’t really deal with it. Certainly I was like that, isolated without even knowing it. I’d say there was no there there. You’d have to wonder where to begin. I don’t think the physical things that I’ve spent decades sorting out could really have been addressed, and the minister preaching at the Episcopal School preached a sermon so hot I remember it still, “The Red Hot Now Time,” he told us. Yeah, right, we thought. We are treading water till eternity. Or so I thought. But I think that was the message: We may be miserable, but we are here for each other.
    And without that for square one, the young person sitting with a pediatrician is not going to be connecting enough to get real direction or wanting to connect enough to find a mentor (could students be assigned to get others linked in — I think in the schools here they do that; especially for those in any way disabled) or open to letting a professional help, part of that being knowing not all professionals will be the right match.
    And then, where are those professionals? Nope, not enough of them. The peer advisors might be all that’s available. Let the mediator types (lawyers directories list them nowadays) who are trained to deal with difficult situations help train the teenagers who are (fortunately) still eager and willing to give it a try. I know locally the mediators train students at day-long trainings here and there.

  • http://npr.org Kristen

    I’m with Lisa and some others who stated that antidepressants literally saved their marriages, their lives, their careers, and their souls. Unless you have fallen deep down inside that limitless black hole that is depression, and unless you have been trapped in there for weeks or months or years, you’re not even qualified to participate in this conversation. And for God’s sake don’t tell the people who are on the edge of the abyss that antidepressants don’t work! They need a lifeline, not some half-researched article saying there is no help. Let them experience antidepressants on their own and let them make up their own minds. I’ve been on antidepressants for the last ten years, and am now on Lexapro and I love it. I love my life. My entire attitude has changed. I can live life with that long sought-after moderation of outlook–normal highs and normal lows, and I can talk to myself like a friend and say calm down, it isn’t that bad. And when a low mood does appear, I have the psychological equilibrium to lift myself out of it. Depression doesn’t allow you speak positively to yourself. It’s like the negative person you hate to be around, and it’s too busy putting the black hole’s lid back on top of you so you can stay down there in the dark where it knows you belong. With Lexapro, when the inevitable bad day does appear, I can say to myself, “Hey, I can do this. I’ve done it before and I can do it again.” Before antidepressants, my Internal Critic would have laughed and said “You’re too dumb to do this so don’t even try.” I have learned to talk back to to my internal critic who wants me to fail. I continue to be amused by all the research that states that antidepressants don’t work, while they obviously work just fine for me and for many, many others. So go on writing about how it’s all just placebos and sugar pills. In the meantime, I’ll continue to take my Lexapro and go on with my good, good life.

  • Brett

    Mentors for young people are sorely needed in communities, yes, and in each community an investment in being creative and thinking outside the box to facilitate mentoring relationships ought to be a part of the way any community functions.

    Reliance on others and developing interdependent relationships is key to mental wellness and in having strong communities.

    We do live in a toxic world, in every aspect of that term. We can get rid of some of that toxicity, but it takes quite an effort. On a personal level, we can take that far, but to a point of limitation; on a global level, though…(?) at least we are even more limited as individuals in our actions. When someone is talking about prolonged, marked depression, though, where they are in darkness, a darkness that does not subside even when they are in the midst of activities that normally bring them joy or satisfaction, despite others being present who are willing to reach out to them, despite their desire to be reached out to, despite a life consistent with happiness or contentedness, then they are in need of some support beyond being “here for each other.”

    If someone has true clinical depression, friends, family, clergy, etc., often are not enough and can sometimes exacerbate the problem. Considering the toxicity of our environment, beyond eating whole foods instead of processed foods, avoiding alcohol and drugs, getting exercise and rest, spending time away from excesses in day-to-day stimuli. avoiding toxic people, etc., is about all we can do. I have been around too many people who have treated someone with clinical depression as if he/she simply is living too much in a toxic world, and this can be sometimes Pollyannaish and even fatalistic in its concept.

    Mild depression, or acute episodes of depression, no matter intensity, can be dealt with or endured, as in “vomiting with flu,” but, like the “flu,” enduring those is contingent on there being a time-limited quality to the depression. And, as I’ve said before depression can be a normal response to a given set of external circumstances. I have worked around so many people for so long who have severe and prolonged depression, and as much as there are some commonalities in all people with anxiety and depression, there are no definitive solutions. If there is anything that consistently seems to help people, it is an array of interventions and support. Ultimately, it is up to the individual, but hopefully communities can facilitate the process.

  • Ellen DIbble

    I agree that well-functioning communities, especially for young people, would help in encouraging access to proper strategies, which would include insurance. I think most of us know that plenty of mental health providers would court the business especially of independently paying customers, just as the drug companies maneuver to enlarge the “market.”
    I am not talking about toxic the way Brett is though. I’m talking globally to some extent. There was a time when lead coming out of auto tailpipes and peeling pain in walls got into children’s blood and then bones and brains, thwarting them for life. Now I hear about children in cities and industrial centers with much higher levels of allergies. The more the human waste stream grows, the more types of toxins get everywhere. People who get hit particularly hard don’t surface much, for obvious reasons. I read about people whose immune systems are ruined by a particular exposure, say an hour or so, or maybe a month or so. And there are others who grow up in a kind of trash heap and maybe have addled neural circuitry so ingrained they wouldn’t know a “clean environment” or a “settled” “happy” frame of mind if they saw it. It is all too easy for me to say. I worked in a kind of smokestack, a room whose fresh air vent had inadvertently never been opened, so furnace fumes and molds were the air, and no, the windows were for light not air. This was before people knew about “sick buildings” and multiple chemical sensitivities. So I got allergic to oh maybe 140 things, all foods except green peppers and sweet potatoes. I’ve told you this story. I couldn’t be in the same room with a battery. It was very bizarre. Any idiot would have quit the job on day one. My body was already polluted with heavy metals, and I didn’t have a good baseline to say, the problem is the air. I bought into the idea my body should be handling whatever it was. It took a second decade to get rich enough to pay for a study that would show the heavy metal “load,” and by then I kind of understood that while most of the allergies had lifted after leaving the toxic room (after about 3 years, with treatment), plenty of problems remained. And with the heavy metals in my blood I am pretty much stuck with that. The cost of chelating it all out? Again, I’d be paying for that. It could be, say, $400,000. A cheaper way ($600 a year for life) proved impossible given the symptoms I live with. Although my body is off the charts in heavy metals, and I suppose it is from growing up in an industrial center, with all the toxins from the 1950s — various things worked together — I am doing pretty well. It shocks me because I think this should be front and center in insurance. The test is maybe $200, and it clarifies so much. I see that my body works differently from others’ and this explains a lot. Children in China who burn computers for a living are probably turning into versions of me, and I’d like to use my experience to help them. I’m pretty sure depression is “another animal,” as they say. Likewise bipolar.
    After a degree of toxins, the barrel overflows, and the body loses its balances in many ways, immune recognition, plain accumulating and multiplying dysfunctions. It’s just emotionally very difficult, and physically very difficult. And it’s politically difficult insofar as nobody wants to think this is a reality, not insurers, not developers, not manufacturers, etc. Read A Civil Action by Jonathan Harr (sp?), about Woburn, Mass and W.C. Grace, if memory serves.
    I really don’t think physicians should be treating that with antidepressants, not unless really necessary. It would be like adding one more toxin. But for some there would be no alternative. I get rashes. Others go black.

  • justanother

    ****If someone has true clinical depression, friends, family, clergy, etc., often are not enough and can sometimes exacerbate the problem.****

    Brett, that is so very true.

    I personally have experienced severe anxiety/fear for years, not knowing why. It took me years to finally realize my problems. People have depression and anxiety/fear are most mentally vulnerable and sensitive, the temporary change of our personality and behavior (expression and speech) can be very frustrated with ourselves and our families. One struggles between pride and gradual rejection from society. One not only experience the rejection from people you meet, the most hurtful truth is the rejection and intolerance from your family. This is the first time I truly experience “reality”. Yes, I have gone thru anger, frustration, fighting against, and the most vulnerable feeling I have ever felt before. All I wanted was to make my family understand the change of my interaction with people, and not judge or get caught up by it, that way we can go on and make our day easier, but most of the time, I got brushed off and being judged at. And part of where my anxiety come from is constantly feeling apologetic for my change of body language, then i got more tense, then you know how cycle can get vicious.

    My biggest fear is if something goes wrong with my communication tools (like facial expression and speech), I see all glooms for my future in this society, which it heavily depends on those skills. My personal experience tells me if our anxiety comes from the fear of losing, fear of changing, or any fear, often times either we put blame on ourselves or others, or we are angry at either one. But doing either won’t make our life better, I realize nothing has to be instantly understood, or instantly solved with an “answer”. The way to ease anxiety is fine tune our way of looking at life, human and society. That way I’m able see a larger picture, I started to understand what human are made of, and I am part of that elements, I become more forgiving of myself and others. With that being said, I’m still working on some of my issues, but when i hit road blocks, I allow myself to go around by zooming out myself with less tunnel vision.

    Let’s nurture our society with encouragement, forgiveness and tolerance.

    “Everyone is fighting some kind of battle everyday.”

    Peace

  • justanother

    I just want to make it clear that depression/anxiety comes from/with so many different reasons and forms. My above comment only covers my personal and some cases I know of.

    Thanks

  • Brett

    Thanks, justanother, for relating your personal story. I too have suffered from prolonged anxiety in my life, to the point where it is an actual disorder. I have managed it well throughout most of my life, but about ten years ago, it overpowered me and I sank into a deep depression. Many people with sustained anxiety– particularly when the presence of which can not be squared with external conditions that may warrant anxiety–can often have a period of depression following, if the anxiety is left untreated.

    I was fortunate in that I had one or two friends who understood my mood changes, increased intolerance to situations I had previously handled typically well, and withdrawal. Albeit many friends, and especially family, did not understand this, and this exacerbated my anxiety, depression and feelings of guilt and shame.

    We all, as you say, are fighting some kind of battle everyday, and it is helpful for those of us not in some kind of emotional or physical crisis at a particular moment to keep this close in our consciousness as we assess how we treat of others.

  • justanother

    Thank you, Brett, also for sharing your story. I found in some cases, it’s very tricky to distinguish if it’s physical trigger anxiety or the other way around.

    I think “online” psychotherapy can be very helpful for some people, it’s an alternative for certain type of depression/anxiety. Dose anyone offer this kind of therapy? I found it very helpful to share each other’s journey and what they have come away from that journey.

    ***and it is helpful for those of us not in some kind of emotional or physical crisis at a particular moment to keep this close in our consciousness as we assess how we treat of others.***

    This is the gift of our journey, I love it. :-)

  • justanother

    I forgot to mention what helps me to ease anxiety, except to change my way of thinking, exercise and diet/food supplement really helps too.

  • http://www.pnart.com peter nelson

    1) The drug is tested, not against another treatment (unless it’s ANOTHER DRUG!), but against DOING NOTHING (i.e. placebo, sugar pill). It is common sense, as well as medical fact, that DOING SOMETHING (i.e. many possible things) will often if not usually be more effective than DOING NOTHING..!

    This comment makes no sense at all (and “Dr Mark” is an MD??)

    Any properly designed study is double-blind, so neither the subject not the person administering the drug knows whether he’s getting an AD or a placebo. So if there is a measurable improvement, say, on the HAM-D or HAM-A scales, then the AD is producing a benefit.

    I’ve read hundreds of studies in the major peer-reviewed research journals and there is no questions that AD’s produce significant benefits for a significant portion (30-50%) of the clinically-depressed population.

    That said, the science on the underlying neurophysiology stinks! Drugs which increase receptor site availability of one or more neurotransmitters such as norepinephrine, serotonin, or dopamine by attenuating their reuptake have been around for decades – the tricyclics, for example, came out in the 1960′s! SNRI’s, SSRI’s and NDRI’s have been out for 20 years or more. And yet to this day there are no widely accepted models accounting for why they work, or for their enormous range of (often horrible) side effects.

    Yet the reason why 10′s of millions of scripts are written every year for these is because people are desperate. Depression is a serious illness with major human consequences – anyone who thinks it’s just a case of the “blues” is clueless. And as weak as the science is on AD’s, it’s vastly better than the science on “talk therapy or “alternative” (e.g., nutritional) therapies.

  • Brett

    This is so important; I would say the combination of rituals you mention are also key to my management of anxiety and stresses. I play music, which helps a lot. Eating whole foods replete with lots of fiber is SO important (getting a lot of the B complex vitamins really helps me regulate my moods and worries). I also function so much better with regular exercise that includes a lot of aerobic activity. And, as you say, “changing my way of thinking” or monitoring my internal dialogue and making adjustments in perspective, what professionals call “cognitive behavior therapy,” is something I have to make a concerted effort to attend to. I have to sometimes say to myself at 4 in the morning, “you can’t do anything about that now, so let it go and go to sleep. and tomorrow you don’t have to solve everything, but maybe just focus on one aspect of what you are concerned with and make one variable move a bit, maybe just act on chipping away rather than having all the answers…and so on.

  • Brett

    justanother, my last comment was in response to what you are saying! :-)

  • Ellen Dibble

    I have been trying to get access to smily faces without any luck. Anyway.
    I am ten years older more or less than Brett, so I know better. Hah! Here’s one more piece of advice. Learn the difference between “stewing” and letting your brain digest this or that. You can get serious indigestion of the various levels of consciousness if you try to straitjacket it, to belt it too tightly. Let it breathe.
    How to prevent the kind of thinking that is destructive? I make a ritual of laughter. Like tears that release, it is a mode that heals even as it hurts. I use my TV as a laugh box. First I found the funniest home videos on Sundays (opposite 60 Minutes but so what), and then there is a Spanish language version of funniest home videos, with Latino animals and so on. Then I found Craig Ferguson late at night, who also can make me laugh till I forget everything, dropping it all into that other perspective that makes sure nothing gets stuck. My prescription: the outrageous.

  • Brett

    “Latino animals”??? …uh…would that be chihuahuas dressed as ballerinas while walking on balance beams? Or is it just animals owned by Hispanic people doing pet tricks followed by a timbales player doing a rimshot/a mariachi band playing in the background? … (insert smiling emoticon here)

    And, speaking of smiling emoticons…(insert snare drum rimshot followed by a cymbal crash here) I just do a colon, followed by a dash, followed by the right side of the parentheses. It automatically turns into an emoticon on here…I don’t know why, but I think it has to do with gnomes living in my computer…I think that’s it, probably it…no, that’s it…I think. I wonder what would happen if I used a sad face…let’s see : :-( Did it work? I won’t know until I post!

    I have a Macbook Pro, so it may not work on a PC (I don’t know this, but thought it was a good excuse to put on airs about my Mac!) What did that “Stacker” guy used to say…oh yeah, “Go Tell That!” Of course, it may just be a touch of cabin fever on my part from all of this snow!!!

    Laughter is the best medicine. When all else fails, I try to pretend being in the middle of an absurdist play (not recommended for a person with schizophrenia having a brief psychotic break, though). I often use humor on this forum, but it doesn’t quite work; it’s hard to convey tone, which limits things quite a bit. Some people get really offended or don’t pick up on that I use irony sometimes to emphasize the absurdity of a viewpoint that is in opposition to my own. Some I think don’t like it simply because I’m one of those “LIBRULZZZ” as W would have said as he nodded quickly.

    I joke around a lot in my personal life, and I am grateful to have the right forum when I perform my music, it helps engage people in between songs…

  • Brett

    It worked…the sad emoticon…that’s amazing!

    P.S. -Ellen, I thought you said you are 60? I’m 55, not that it matters, but you probably don’t wish to add on 5 years out of a misunderstanding! Life is hard enough…

  • Ellen Dibble

    :-) :>)
    I just turned 63. I can either average up or average down.

  • Ellen Dibble

    ;-) Latino animals speak in squeaky or gruff Spanish, with a curious sense of humor that with my limited Spanish (and no subtitles) is perplexing at times.

  • justanother

    Haha… Brett, you are very animated! Having a good time there in front of your MBP? Alright, another Mac snob (besides me) the rest have to put off. :P

    I truly believe in some cases, our brains get addicted to our habit of thoughts and behavior if we keep on feeding that need. To break that habit is like detox, it could be a sequence of process or simultaneously. We can first break habits by disciplinary to gain our capacity, then figuring out the root of our nagging thoughts, or juggle them at the same time if capable of. These are just my observations, and I’ve never read any psychotherapy books (intended to stay away), so I’m sure there are professional terminologies for those treatment, but I’m just not that savvy about it.

    I also notice that often times if a condition has a terminology, people tend to be more acceptable with one’s condition, but if there’s no result of diagnose or uncertain, people tend to deny how one feels. I understand mental health has been gradually gained more attention in recent years, but still more empathy and understanding go to physical health problem than mental health problem, when both equally shares the agony.

  • justanother

    It would be nice to post music in between our comments. Personally I love lala.com, the best music sharing/upload/download site. It allows you to listen to a “complete” song i/o just sound bites which often undermines a good music.

    Not sure if you’ve seen this IPod video from Mad TV, since you are also a MBP user, let’s have a laugh! :D

    http://www.youtube.com/watch?v=w5ZZPgWZh5g

  • Brett

    jusanother,
    thanks for the link. I had to laugh, the PC jab at the end was…you know…gratifying…I don’t do the Ipod thing or even download any music through Itunes (also, thanks, btw, I’ll have to check out lala.com, although, I mostly listen to regional music–being a musician, I am more influenced by fellow musicians I know and by music of bygone eras, as in pre-1950. I do have my exceptions, though).

    One of the things (of many) that compelled me to get a MBP was the great track record of their operating systems. My Mac is also not at all quirky, and it has always been more intuitive for me than any PC I’ve used. I’ve never had any issues with viruses…on and on.

  • Aaron

    There are a many different arguments in the comment section which I find interesting. I think the evidence speaks the truth on this topic. There is absolutely no evidence that anti-depressants work. The placebo pill works just as effectively as the legitimate pill proving the medication to be unsuccessful. It just goes to show you how powerful thoughts in the brain can be. Change your thinking patterns and you can change your mood. I have always questioned the validity of doctors and their belief that multiple SSRI brands must be tried until a good fit is found. How can one SSRI work and another brand not work? Why is no one able to explaine why that is? That statement alone proves my argument to be true and that it is placebo.

    I have suffered from serious depression for most of my life and understand that it is an addiction of the mind. The mind is addicted to negative thought patters which alters the mood. I have no success with medication and always found exercise, diet and social events to be the best course of action for rehabilitating the mind.

  • http://none sergio bustamante

    Anti depressants work like magic!!! I suffer from major depression, generalized anxiety disorder, panic disorder, and social anxiety disorder. It was horrible. I got sick at age 17, dropped out of high school and would rarely go outside for 10 years. I couldnt even answer my phone!! Finally after my family and neigbors said i was the laziest man on earth (they didn’t know anything about mental illnes, ignorant people), I went to see a pscyhiatrist on my own. He gave me zoloft. 7 months later it didnt work. Then he switched me to paxil. BOOOOOOOM!!! It worked like magic!! wow. 100% of my panic attacks went away. 100% of my GAD went away. 100% of my social anxiety went away. About 80% of my depression went away. The only problem was that it took soooooooo long to work. It took 6 months to work, cuz that’s how long it took to reach the right does. My doctor would raise the does VERY SLOWLY. I think thats why many stop taking them or say they dont work. you have to stick with it!!! Anyway, i went to the phillpines and got married. I am so happy. To recap, anti depressants take a LOOOONG TIME TO WORK! That’s the problem. They take many many months to work, and thats AFTER you find the right dose!! People confuse this for it not working. After 6 months, if the anti depressant doesnt work, switch to another one, and wait another 6 months. In the end you will find one that works for you.

  • http://pulse.yahoo.com/_VMOBN6XAKEZCP4FI2D7IY2N3QQ Nick

    Will u email me please my name is Nick , thank you so much

    nickaroo321@yahoo.com

  • http://www.facebook.com/DugsJohnson Doug Johnson

    I suffered off-and-on with depression from my teens to my
    late 20′s. When I was 27 it got to the point I was having a hard time
    functioning. Unwilling to continue living like that and unwilling to die I put
    all of my goals aside – quite a task itself – and committed to doing whatever
    it would take to find true healing. 

    I soon began what would be the most
    important journey of my life, a healing journey lasting over three years. This
    journey profoundly changed the rest of my life and slowly, healing episode by
    healing episode, brought complete healing to my depression as well as several
    other things, such as an eight-year lower-back problem.

    I was on Prozac for a year of this journey and it stabilized my mind so I could do the work I needed to do to truly heal. When I went off the prozac the depression returned but by that time I new how to get to the true roots of my depression and heal them.

    I have an essay on my
    website about the journey. Please check it out: http://www.dougthedrummer.com/content/view/9/38/

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Jul 25, 2014
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