An Overview: Depression and Treatment

     Most of us know or have a loved one someone suffering from anxiety, depression or loss of interest in life. We may even be that person. Maybe it started as circumstantial, and with the help of family, friends, therapy and resilient character, we were able to overcome. However, others are not so privileged. The longer one is depressed, the more likely their depression may become what is clinically called an “illness”, as long-term changes start to take place in the brain.

Why do some people get depressed and not others?

     Though everyone inevitably suffers at some point, only a portion of these people go on to develop a lasting mood disorder. Some are more genetically vulnerable, while others are more environmentally vulnerable. The same way the body’s immune system fights hard to overcome an infection, the brain fights hard to compensate for neurological changes caused by life’s pressures, but sometimes it just gives way.

What causes depression?

     There are so many complexities involved in how depression manifests in the brain and how it takes place. For some, when life hits hard, a stress hormone called cortisol rises, giving way to neuronal changes in the brain’s structure. This can lead to a drop in the neurotransmitters traditionally known to regulate mood, pleasure, reward and energy: serotonin, dopamine and norepinephrine. Some people have low genetic baseline levels of these neurotransmitters. Once life’s hardship hits’, their neurotransmitters drop to abnormally lower levels, culminating in depression. Others have less “gray matter” in the brain, and thus lack some of the nerve signaling required for neurotransmitters and parts of the brain to communicate properly. Others have more trouble generating new cells in the brain.  All and any of this can lead to depression. It is an illness like any other.

Are anti-depressants harmful?

     The objective of anti-depressant medications is to improve mood and quality of life, but also to reduce the risk of suicide. The use of anti-depressants can prevent and reverse some of the permanent changes that happen in the brain due to depression. Anti-depressants raise levels of these neurotransmitters, either by stimulating a receptor involved in their release, or by blocking another substance in the brain responsible for their break down.  However, often, increasing levels of one neurotransmitter, lead to an equal and opposite reduction in another neurotransmitter, often leading to what you commonly know as “side-effects”. Furthermore, these receptors that need to be stimulated in order to improve mood, when stimulated in the brain, do improve mood. These same serotonin receptors also exist in the heart, lungs and gut. This often leads to side-effects like nausea, diarrhea or constipation, and fast heart beats in the first 6-8 weeks of most anti-depressant use, until our body builds tolerance. Though, they do not work for everyone, anti-depressants can be lifesaving in those with clinical depression.

Why do so many people not respond to their anti-depressant medications?

     Anti-depressants are unique in that after being ingested, and absorbed in the stomach, they are metabolized by the liver, and must also travel to the brain and attach to specific receptor, to take their action. This is where genetics come in. anti-depressants, are both activated and cleared by the liver. Some people’s liver enzymes clear these medications too quickly, leading to lack of response. Others, too slowly leading, to accumulation and unwanted effects. To add to this, we all have genetic variations in our brain receptors, affecting the way we respond to psychiatric medications. While one variation might mean excellent response to one medication, another might mean total lack of response. The trial and error of this challenge can be mitigated by taking a pharmacogenetic test to see how you will respond to different medications. The study of how genes interact with drugs is called pharmacogenetics.

What to expect with antidepressant use?

     Unlike many other medications, anti-depressants do not act to improve immediately. This is because they make long-term changes to neurotransmitter levels in the brain, as well as brain signaling. It takes time to for the brain to build sufficient levels of neurotransmitters for improved mood. In the first 2 weeks it is common to experience improved appetite, at 4 weeks possibly improved sleep but the real effect takes place at the 6-8-week mark, during which side-effects such as nausea, constipation, fatigue or insomnia should also be slowly subsiding.

Do I have to take anti-depressants forever?

Generally, on an initial diagnosis of depression, anti-depressants are taking for at least one year. If it is a second or third episode, clinicians recommend 5 years. However, the need for an anti-depressant varies from person to person. Some people will need treatment longer than others, while others will bounce back quickly. Depression is an illness in the brain, like any other illness, and remission rates vary. If you are someone who is feeling depressed, it is crucial you speak to your Doctor, and let loved ones know, in order to get the care you need to thrive. Depression is an illness not a weakness, and we are here to help with your newly discovered diagnosis.