Optimizing Depression Treatments
Lost in the euphoria over a new class of antidepressants--the selective serotonin reuptake inhibitors--was the downside to these admittedly wonderful medications that came on the market in the 1990s.
Although SSRIs and other new antidepressants that work on the neurotransmitters in the brain have been a major advance in the treatment of depression, up to 80% of people suffer troublesome side effects that eventually take the glow off recovery. “These drugs were hailed as medical miracles, and in many ways they were,” says author Robert J. Hedaya, a clinical psychiatrist at Georgetown University Hospital and an expert in psychopharmacology. “But like many ‘wonder drugs,’ SSRI antidepressants have proven to be a mixed blessing.”
Hedaya notes that too many physicians dismiss the importance of treating side effects, telling patients to be thankful that the depression has abated. Some patients, however, find the side effects so disturbing that they stop taking the antidepressants.
This book addresses those side effects directly and offers a program that might mitigate some of the problems while allowing the medication to do its job. The most common side effects--weight gain, decreased libido and decreased mental acuity--are treatable chemical imbalances, Hedaya says. Through research and experience with his patients, he has developed recommendations regarding nutrition, exercise, stress reduction, and hormone and vitamin supplementation that, he says, relieve side effects.
For example, the nutrition component describes how eating protein-rich foods will help increase the levels of certain amino acids essential for manufacturing the brain chemicals serotonin and dopamine, which boost mood. Moreover, cutting out foods high in sugar can alleviate food cravings, irritability and sluggishness.
The exercise component not only helps in the obvious way of promoting weight loss, but it increases circulation, and boosts levels of serotonin and dopamine. Hedaya also recommends certain dietary supplements, hormones and other medications to offset side effects.
He is a champion of Viagra which, he says, greatly benefits men experiencing sexual problems because of antidepressants. He also recommends Viagra for women, although recent scientific evidence casts doubt on whether the drug is useful for women.
Finally, Hedaya promotes lifestyle changes to reduce stress and increase relaxation--proven methods to help restore energy and concentration.
Hedaya claims that 80% to 90% of his patients who try the approach feel better, and it’s not hard to see why that might be true. Much of his program (although not all of it) is based on solid scientific evidence, and would help anyone feel better, not just people taking antidepressants. People who use this approach, however, should be motivated to make the many lifestyle changes necessary to see results.
Hedaya makes a valuable contribution to the treatment of depression by merely acknowledging the problems related to antidepressant use, a topic that has been downplayed by doctors and the pharmaceutical industry. His motto--it’s not enough to survive depression, you can thrive--is admirable. Too often in the past decade, both doctors and patients have accepted the benefits of the new antidepressants without questioning how they can make the treatment even better.
