Why many Anti-depressant medications fail to help.

 

Anxiety and depression often go hand in hand along with chronic long term inflammatory issues in patients. Chronic inflammation, and the pain and suffering (both psychological and physiological) that accompanies the inflammation often leads to "burn out" in many different chemical and hormonal systems associated with depression and anxiety.

 The adrenaline system is often compromised (as explained in the Chronic Fatigue and Inflammation article) leading to issues with fatigue and anxiety. Various other neurotransmitters in the brain associated with happiness and satisfaction become over taxed and deficient leading to feelings of sadness and hopelessness. The psychological strain of the inflammatory condition and other "life" psychological stresses also contribute to these various chemical and hormonal imbalances and deficiencies. The end result is very often patients end up being placed on medications (anxiolytic and anti-depressant medications) by their conventional medical doctors to help manage and cope with these symptoms.

Unfortunately, quite often these medications can be ineffective in managing peoples symptoms. Sometimes people get partial relief in some of their symptoms and no relief in others. And quite often a dose of a medication will be less and less effective over time, leaving patients and their doctors trying to alter the doses and ultimately the type of medication used to treat the patients symptoms. In order to figure out why this happens, we need to examine how anxiety and depression disorders are different and how the medications affect both of these conditions.

Anxiety and depression are often "lumped" together and treated as the same thing in the conventional medical world. Chemically, they can be very different disorders and thus need to be treated differently. There is obviously some cross over between anxiety and depression symptoms, but the diagram below will "separate" the primary symptoms for each condition. There is a spectrum in between these two groups of words, and most people with mood disorders fall somewhere in between. Some might have 80% anxiety based symptoms and 20% depressive symptoms while others may have more depressive symptoms than anxiety symptoms. Each person suffering with mood issues will have a unique  "A" to "D" ratio.
 

 

The depressive symptoms on the right are most often associated with deficiencies of the neurotransmitter Serotonin. The symptoms on the left are most often associated with deficiencies of the neurotransmitter Norepinephrine (a form of adrenaline). Most modern antidepressant and anxiolytic medications attempt to address imbalances or deficiencies in these two neurotransmitter systems.

Serotonin is a neurotransmitter that enables one nerve cell to communicate and "share" a "happy" signal with another nerve cell. It creates a chemical "link" from the end of one nerve cell to the end of an adjacent nerve cell. If we have lots of serotonin, we have enough to transmit enough happy signals between nerve cells and we feel "happy". If we are deficient in serotonin, these chemical connections are lacking and we don't feel as happy (depressed). Common sense would tell us that if we are deficient in serotonin and that is causing our depression, we should increase our serotonin to improve the depression. Many people think this is what the anti-depressants do for us. These medications DON"T increase our serotonin. They simply make the serotonin that we have work harder, they don't increase the amount we have.

Most of these drugs are called Selective Serotonin Re-uptake Inhibitors. These drugs don't increase the amount of serotonin that you have. They make the serotonin work longer at the receiving nerve cell which essentially "transmits" a longer happy signal to the cell. If you are deficient in serotonin and you take an SSRI medication, you may feel better not because you are increasing your serotonin levels, but because you are making the serotonin that have (which is a deficient amount) work better.

The problem with this approach is that unless you address what caused the deficiency in the first place (underlying cause) and address the actual deficiency, you will always be dependent on the medication to feel "normal".  If you try and wean off the medication without addressing the cause of the deficiency and correcting the deficiency, you will still be deficient when you wean off the medication and your symptoms of the deficiency will return. This serves the drug company quite well as you will only feel good while you are taking the medication and will unlikely be able to wean off it.

If you address the cause of the chemical deficiency and work to correct it, then when you wean off the medication, your symptoms will be less likely to relapse as you are no longer deficient in the chemical associated with the symptoms.

Another key problem with trying to manage these symptoms long term with medications is ultimately they become less and less effect over time. The reason why this happens is relatively easy to explain.

There is a process or processes going on in your body which is leading to chemical / neurotransmitter deficiency and burnout (Inflammation, psychological stress, poor diet, etc)  If you become depressed or anxious at 30 years old,  you may find a medication at a certain dose that will "magnify" the effectiveness of the serotonin that have to a functional level. If the process that is causing the deficiency or imbalance persists for years, you will become more and more deficient in the chemical associated with your symptoms. The dose that alleviated your symptoms initially will become less and less effective. Remember, the medications only magnify the effectiveness of the neurotransmitters that you have. If this amount continues to decrease, then the magnification effect will become less and less, and your symptoms will worsen over time. Eventually, these neurotransmitter levels can get so low, that there isn't enough for the medications to magnify, and the medicines become completely ineffective. This is when you will likely have to try a new medication.

It's critical to identify any processes that may be "burning up" the neurotransmitters associated with your symptoms, remove or correct these processes, and work at repairing the deficiencies before trying to wean off any medications. When this is done properly, success in weaning off you medication and not relapsing is more likely.

Another key reason why these medications fail is they are often prescribed for the wrong imbalance. In the diagram above, you will see common depression symptoms on the right and common anxiety symptoms on the left. Many people who come into clinic with a depression diagnosis, look at this chart and tell me their symptoms are all on the left side of the chart. These symptoms are associated with nor-epinephrine imbalances predominately. If this patient is given a medication that works mostly on serotonin (selective serotonin re-uptake inhibitor) it's unlikely to produce positive results for the patient. And if someone with a serotonin imbalance is given a drug that works on nor-epinephrine imbalances they are unlikely to have much success either. It's critical to determine the your specific neurotransmitter imbalance before beginning a medication or nutritional protocol to try and correct it. This can often be done based on your symptoms but there are saliva and urinary testing options available to to help with this.

 

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Dr. Scott Woodworth
Naturopathic Doctor

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