The Top 5 Depression Songs

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Sunday, January 10th, 2010

Feeling depressed?  As follows, are 5 depression songs that capture some of what it might feel like.  But even as we present them, please remember that clinical depression is treatable.

1) Alone Again, Naturally

This Gilbert o’Sullivan classic is about a man who is stood up at the altar by his wife-to-be.  Its dull beat, wry cynicism and confrontation – “if God exists / why did he desert me?” made it a chart topper when it came out.

An oldie but goodie, captures the sorrow of depression that can make even optimism painful.

2) Fire and Rain

The great singer James Taylor was going through a rough period in his life which culminated in the loss of a good friend of his.  To commemorate her and express his pain, he wrote this beautiful song.  One of many great quotes from it:  “Lord knows when the cold wind blows / it’ll turn your head around.”

A strong metaphor for hard times.

3) Numb

Linkin Park shouts out how they have “become so numb.”  Raging, aggressive and powerful, this song can capture the feeling of deep rage that you feel – even as you barely have the strength to go on.  The anger is turned inwards, and you have become numb; exactly what this song portrays.

4) I hope tomorrow is like today

Dull, mellow and sad, this song captures the negative outlook that accompanies depression.  When depressed, we can forget that things will get better.  Even when we’re stuck in a rut, we’re scared by change – or the hard things we would have to do to make it happen.

“I hope tomorrow is like today” – there is something deeply sad about that statement.

5) Rehab

This catchy song has a superficially optimistic beat – but it has a darker energy underneath.  In it, Amy Winehouse shares the painful feelings in her soul in this pop song.  She acts out her depression by drinking and living aggressively, and the people around her just want her to get help.

The doctors tell her that they, “just think you’re depressed.”

But that doesn’t stop her from drinking her woes away.

This song has a tragic follow-up – poor Amy did end up in rehab not too long after this song came out.

If these songs depressed you too much, please remember that depression is treatable.  Napoleon once said, “if things don’t change, I’ll throw myself in front of a cart.”  Mozart said that his heart was like a frozen wasteland.  People can overcome depression.

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A Quick Guide to Depression Treatment

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Monday, September 21st, 2009

a girl wearing red stares at the ground sadly

Depression.

Are you unhappy, worried about your life, and things don’t seem to matter?

It might be depression.  And that should mean change of some sort.  What that means can vary: it can mean eating healthier and exercising, to seeing a therapist and taking medication.

It’s important to realize what we know about depression – and what we don’t.

First, we aren’t sure what causes depression.  While often depression can be linked to a significant event, it also often just happens, so to speak.  It seems to make more sense for depression without a reason to require treatment.

And we don’t know how much of depression is normal.  If someone just lost their parents, for instance, or was diagnosed with a fatal disease, it only makes sense for them to feel down – depressed.  Making it more complicated, most depressive feelings pass with time.

The standard medical treatment for depression is, nowadays, medication.  But there are reasons to hesitate before turning to medications, like how little we know about them.  Also, they have only OK results – they work in about 60% of people who take them, as opposed to about 30% who respond to a placebo, or a sugar pill.

And that’s at best.  Some studies have shown significantly lower success rates, and how well antidepressants work over the long run also seems to be lower.

Worse.  Medications for depression often have serious side effects, including sexual dysfunction and can even cause suicidal thoughts.  And they can be physically addictive.

On the other hand, antidepressants can help and are sometimes lifesaving.  There is a reason that millions of people have taken them, and it’s not all due to adroit marketing by pharmaceutical companies.  A good therapist can help you weight the pros and cons of medication and help find the right path.

Treatment – initial evaluation

If you’re concerned about possibly having depression, you should see both a regular doctor and a therapist for an evaluation.  There are many physical causes of depression.  Vitamin B12 deficiencies, for instance, as well as low levels of folic acid can cause depression.  And physical conditions like hypothyroidism also can cause poor mood.

As such, the first step for treating depression should be a phyiscal work up to eliminate these and other conditions.  Tests should be done for thyroid hormone levels and to ensure both proper levels of nutrients and proper digestive working.

Dietary modification and exercise  are worth a try as an initial treatment for depression.  Some doctors claim to see astonishing transformations from that alone, and several studies have shown that vigorous exercise works as well as medication for treating depression.

Seeing a therapist is a very good idea.  Their expertise and ability to help you with your problems can be phenomenal just by itself.  The fact is that therapy has been shown to be just as effective as medications for treating depression – with the only side effect being a smaller wallet.

Treatment – SSRIs

If you decide to go onto medication, a decision that shouldn’t be made lightly and should ideally come after trying the ideas above, most likely your doctor will recommend an SSRI.

The SSRIs are now the most commonly prescribed medication for depression.  They are so called because they are Selective Serotonin Reuptake Inhibitors.  What does that mean? Well, imagine two cells in your brain.  There’s a gap in between the two, which is full of chemicals and substances, including serotonin.  This stuff interacts with receptors on the cell, activating and creating all sorts of activity.

The SSRIs prevent cells from taking up serotonin, or removing it from the space in between the cells.  That keeps serotonin around longer, which means it activates more of the receptors for it.

Why this does anything to improve mood we simply don’t know.  Serotonin is a widely used neurotransmitter, and substances that effect it have unpredictable effects.  Some pain killers effect it, as well as LSD, which causes hallucinations.

The SSRIs work in about 2/3 of patients who use them.  In terms of side effects, they very commonly cause sexual dysfunction like inability to orgasm and some digestive issues.  Shockingly, they have been linked to a significant increase in suicidal thinking, perhaps doubling the risk of it.

Treatment – Tricylics, MAO-inhibitors

These are older classes of medication but work on similar neurochemicals that the SSRIs do.  The tricylclics might be slightly more effective than the SSRIs, but there are very good reason that both these medications are not used typically for initial treatment.

Tricylclics can be fatal in overdoses, and have other significant side effects.  MAO inhibitors are also somewhat toxic and make the user extremely sensitive to certain foods, like cheese.  If one of those foods are eaten, a life threatening increase in blood pressure can happen.

Treatment – if things don’t improve

If the ideas above don’t help with your depression, several things should be considered.

First, the depression may be caused by a related mood condition called Bipolar Disorder.  Bipolar disorder often causes depression that does not respond to typical antidepressant treatment.

Second, switching medications is definitely worth considering.  Several studies have shown that a significant percentage of people who don’t respond to initial treatment do to their second, or third medication.  Importantly, there are medications that don’t work on serotonin that may work if an SSRI doesn’t.

In some cases, it might be worth considering adding a different class of medication.  Antipsychotics have shown some but modest ability to help treat depression.  Stimulants like Ritalin and Adderall might help increase energy and motivation.

In the worst case scenarios, physical interventions like electro-shock therapy might work.  Electro-shock therapy is actually the most effective treatment for depression we have, but comes with serious side effects like memory loss.

Thoughts

Depression is a serious problem and medications can help.  That said, there are limitations to both our understanding of the condition and the pills to treat it.  If you’re feeling depressed, you might want to consider if it makes sense.  As direct/rude as it may sound, if your life is crappy, why would you expect to feel otherwise?

The best treatment would seem to be seeing a therapist who very well understands the relevant issues.  They can guide medication decisions as well as help you with the problems in your life that may be causing the depression.

Remember:

Never lose hope.  Never give up.  There is a combination of dietary change, exercise, therapy and medication that will change things for the better.  Sometimes clouds cover the sun, but that doesn’t it isn’t there – or that it won’t shine again, soon.

If you are feeling actively suicidal, please consider getting immediate help.

You might like:

10 Ways to Treat Persistant Depression

Agomelatine: A New Treatment for Depression

Thanks for reading!

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depression

Valdoxan or Agomelatine for Depression

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Monday, August 24th, 2009

Pills

Valdoxan or Agomelatine: A new depression treatment

About 40-50% of people taking the current antidepressants, or the SSRIs, stop treatment shortly after starting.  This is because that class of medications has certain significant side effects, like nauseua and sexual dysfunction.

Valdoxan, generic agomelatine, is a new medication that is generating a lot of excitement because it seems to be an effective antidepressant that doesn’t have those problems.

Valdoxan is a synthetic analogue to melatonin, a natural substance your body has that plays a role in sleep regulation.  Chemically, it serves to activate the melatonin 1 and 2 receptors, while also acting as an antagonist to 5-Ht2.  This latter activity may serve to promote release or norepinephrine and dopamine.

It’s important to note that Valdoxan has significantly different chemical action than the selective serotonin reuptake inhibitors (SSRIs).

Possible Advantages

Valdoxan may not have the same rate or degree or type of side effects as traditional antidepressants. It may not cause nausea, sexual dysfunction and other common side effects.

It may start working faster, with some efficacy observed at just two weeks, not the four typically needed for antidepressants.

Both these elements may mean that people will be less likely to want to stop taking it and could start expereincing benefit at an earlier time.  In some studies, only 15% stopped use of Valdoxan, which is much less than the rate traditional antidepressants have.

This may mean a very significant advantage over traditional treatment.

Concerns

Several studies of Valdoxan have not shown significant advantage over placebo.

Because Valdoxan is heavily metabolized by the liver, people with some form of liver damage may experience toxicity.  One study showed that some degree of liver impairment could lead to a 50-fold increase in drug concentration.

Valdoxan may, like the SSRIs, increase risk of suicidal ideation.

Efficacy

The number one question people have about any medication is, how well does it work?  It appears that there have been 7 major studies to date which have analyzed the efficacy of Valdoxan for treating depression, and there are others going on to see if it works for generalized anxiety disorder and other conditions.

Positive studies

One study showed that Valdoxan was significantly more effective as a treatment for depression than Prozac.

A study of 711 people treated for depression showed that it was significantly better than placebo and had effect starting at 2 weeks.  Additionally, that study showed that severely depressed people were more likely to respond to Valdoxan than to Paxil.

Another study of 238 people showed a roughly 55% response rate versus 35% response to placebo.

Negative Studies

Several have also shown little or no benefit over placebo.  An unpublished 6 week long study of 414 patients showed that Valdoxan had a response in 53% of those taking it compared to 47% who responded to placebo.  That same study showed that Prozac did have a significant response.

And another 6 week long study of 607 patients showed that neither Valdoxan or Prozac had benefit for treating depression over placebo.

What it means

Valdoxan is not free from the problems that typical antidepressants have, that sometimes they don’t seem to work much better than placebo.  The studies seem to indicate that it is about as effective as traditional antidepressants while having significantly less side effects and possibly faster onset of action.

These advantages may make it extremely popular.  That said, the concerns around its metabolism have yet to fully be addressed, and there may be other issues that time will reveal.

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Problems with Abilify for Depression

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Monday, August 17th, 2009

test

Abilify: way oversold

You probably have seen a TV ad recently for Abilify. I do all the time. It’s terrible.

Each time I’m amazed at the audacity of its makers, Bristol-myers Squibb.  They’re making a killing off those ads; they sold 30% more in 2009 than in 08 of the stuff.

But what don’t they tell you?

The ads position Abilify as an option if your antidepressant doesn’t provide complete symptom relief.

(That includes pretty much everyone. Antidepressants flat out don’t work in at least 33% of people, and completely eliminate symptoms in almost no one.)

But the ads don’t mention that Abilify is a very powerful drug mainly used for schizophrenia and mania.

That it has hardly any scientific backing for its ability to treat depression. And that there are many, many other options that should be considered first when depression doesn’t fully respond to an antidepressant.

Abilify is an antipsychotic

Abilify is primarily used for schizophrenia and mania, not depression. Like most antipsychotics, it has serious side effects. Use for just 1 year can potentially cause irreversible movements like facial tics or leg twitching. It can potentially cause diabetes. And an astonishing 25% of people who use it experience akathisia, an intense feeling of being unsettled.

People who have akathisia can experience severe anxiety that prevents them from working, sleeping and daily activities. Again, there’s a 25% chance of getting some form of it from Abilify.

Other common side effects from Abilify include headaches, insomnia, and vomiting. Weight gain is pretty common too.

This is in a medication being sold to people who’re somewhat depressed.

Abilify hasn’t been tested nearly as much as it should

Based off the heavy advertising, you’d think it was scientifically established that Abilify works.  Hardly.

Two major studies commonly cited for showing its efficacy showed about 25% improvement as opposed to 15% placebo. That’s only 10% difference. So if you are taking this medication, you’re just as likely to feel better as you are to feel extreme anxiety and being unsettled. That isn’t even the worst part.

The worst part is that 25% efficacy rate was from studies that were manipulated to make the drug seem better!

To achieve this, the study makers tested for depression in several different ways. They then analyzed the results and threw out the ones that showed their drug didn’t work. If you’re curious, the ones that didn’t show they worked were the ones where people reported how they felt in self-reports.

So you could be saying “I feel horrible,” and they’d count you as a success story if some other measurement showed some improvement.

That’s not all. Even taking the 25% efficacy rate as legit, it’s almost meaningless. The measurement of mood took place on a 60 point scale, and Abilify had only a 3 point difference. Hardly impressive.

So you get a pretty small chance of getting slightly better on this drug.  Is it worth the side effects?

Other treatments are better

Other treatments for treatment resistant depression work better with less side effects. If you’re really that depressed that you are considering heavy medication (as if SSRIs weren’t that strong), you’d probably be better off considering lithium or other options first.  See this article for a discussion of those methods.

Sources:

Aripiprazole in Refractory Depression?

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Treating Treatment Resistant Depression

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Sunday, August 9th, 2009
test

At least 1/3 of the time depression doesn’t respond to the first medication tried.  If another attempt doesn’t work, it becomes “treatment resistant depression.”

If your depression isn’t lifting, here are ten ideas you might want to consider:

1) It might not be depression proper.  Bipolar depression – depression associated with the mood disorder Bipolar – does not respond like unipolar depression to antidepressants, and may instead require mood stabilizers.

One analysis says that up to one fourth of treatment resistant depression may be bipolar in nature.

2) Physical factors absolutely must be checked for, something that many doctors miss.  One study showed that perhaps half of people with depression have low levels of folic acid. Deficiency of Vitamin B12 is another common nutritional reason for depression.

A wide variety of digestive disorders may also cause depressive like symptoms or contribute to resistance to medications.  Evaluation of nutritional intake and very importantly how the body processes it is essential.

3) Thyroid problems often cause depressive like symptoms.  Even when treated, hypothyroidism can contribute to depression if the replacement hormones aren’t carefully chosen.  Adrenal problems are also very common along with conditions like hypoglycemia.

Treatment resistant depression is a strong reason to undergo testing for physiological issues that are implicated in depression.

4) Your depression may not go away if you still experience stressful life events and/or feel a lot of pressure.  Remember, depression can be a natural response to what’s going on in your life, and in that case, the only way to help it is by dealing with the root causes.

5) Switching medication is very common, especially considering how often initial treatments fail.  SSRIs are the first used medications, then alternative modern medications like SNRIs or DNRIs.  If those fail, tricylcic or MAO inhibitors are used.

It’s almost normal for your first try to not work.  Don’t give up or get discouraged.  Try different types of medication in different combinations.

It’s essential to have a doctor who understands the details of the antidepressants and give you proper guidance.

6) For very serious depression that doesn’t respond to treatment, electroconvulsive therapy might be worth considering. ECT, though it has side effects, may be the most effective treatment for depression with efficacy rates around 75%.

7) Lithium or other mood stabilizers alongside antidepressants might help.  They’ve shown excellent results in some studies – 45% response versus 11% for placebo. Patience is key; it takes 3-4 weeks and careful monitoring to achieve results.

8) Anti-psychotics also increase recovery rates, but they have significant side effects such as sedation, weight gain and possibly irreversible tics, so use is cautioned.

9) Stimulants like Ritalin and Adderall have shown mixed results. Theoretically, someone who is depressed and lacks energy might get a motivating kick from stimulants. In one study of 60 patients, 40% on Ritalin improved as opposed to 23% not, a statistically insignificant difference.

10) Don’t forget therapy.  An increasing amount of people just take antidepressants without seeing a therapist.  This means they miss the chance to work on the issues causing them to be depressed.

11) Extra point:  Exercise can help revitalize you.

Remember: Never give up

Never give up.  With the right combination of therapy, medication, exercise and dietary modification, things will improve.  Depression can rob you of the ability to see that there is hope.  There is a future, and you have the power to make it better, but you need to get the right help.

If you are experiencing suicidal thoughts right now, or do in the future, please consider getting immediate help. You can call 1-800-273-TALK or other hotlines to talk to someone right now.

You might like:

50 Tips to Make Friends

Agomelatine: A New Treatment for Depression

Sources:

Treatment-Resistant Depression: Recent Development And Future Directions
Treatment-Resistant Depression, Souery, Papakostas and Trivedi

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Do Antidepressants Work as Promised?

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Thursday, July 30th, 2009

test

Note: This is an editorial

Antidepressants – what’s going on?

One out of ten Americans are currently on antidepressants.  That’s just the beginning.  More than 25% of college students at some schools are on them.

Everyone is being given them for all sorts of reasons.  Are they really that effective or safe?  Maybe.  That said, there is a horrible secret.

We don’t know how antidepressants work.  We don’t know if they are safe for long term use.  And finally, we don’t know how well they work, and for what reasons they should be prescribed.

There’s too much money at risk for the big drug companies to bother to answer these questions.

After all, antidepressants are ideal money-makers, $80 billion annually.  They have to be taken daily for months if not years, and it can be impossible to tell if they’re working.  And they have serious side effects, like possibly doubling your risk of committing suicide.

Flawed studies

Everything we know about antidepressants comes from medical studies.  But the studies are really screwed up.

First, who runs the studies?  The drug companies.  What do they have at stake?

Good results mean that they make hundreds of millions of dollars.  Bad results mean they’ve wasted years of research and development.  What do you think happens?

Positive results in the studies are inflated on average 32%.  One analysis of 74 trials covering 12,500 patients showed that 36 studies gave negative results – and a shocking 11 of those were reported as being positive!  And if the negative studies can’t be spun positive, then we simply don’t hear about them.

Studies on antidepressant safety and efficacy are 94% positive – but if negative studies were published, they’d only be 51% positive.  The difference between what we hear and what is actually going is especially big for new drugs like Remeron.

The less time spent testing the drug means the less chance of picking up annoying side effects and saves operating costs.  Because of that, most studies don’t track long term use, and some studies last only a month.

That’s right.  Despite antidepressants being taken for months if not years, most research into them only goes on for a month or two, ignoring long term risks.

Extremely limited research

Millions of people take antidepressants.  By contrast, the studies which confirm their efficacy and safety study at most a thousand patients.

The initial studies for Prozac that approved its use had only a few hundred patients complete the study.

Some quick math.  30 million people have taken Prozac.  Now imagine there’s a serious side effect that occurs in 1/10,000 of the people who use it, and was missed in the initial studies.  That’s 3,000 people.

Antidepressants aren’t benign drugs, far from it.  They can cause thoughts of suicide in up to 4% of children, anger and violence in adults, alongside more mundane issues like nausea, restlessness and sexual dysfunction.

The Serotonin Hypothesis – a myth?

We don’t know how the medications work.  The Serotonin Hypothesis – that reduced levels of serotonin in the brain cause depression – is inaccurate and lacks scientific basis.

Lowering the level of serotonin in the brain doesn’t cause depression.  Increasing its levels directly doesn’t do much, either.  And if low levels of serotonin were to blame for depression, antidepressants wouldn’t take several weeks to work – they would work within days because that’s how fast they raise levels.

To cap it off, antidepressants that don’t target serotonin – like Wellbutrin – work at about the same rate as those that do.  Clearly the serotonin hypothesis is a vast over simplification that’s convenient for the drug companies.

Use in bipolar?

Antidepressants are very heavily used in patients with bipolar disorder.  Unfortunately, the data seems to be at best only moderately in support of such use, and there are no antidepressants approved for use in Bipolar (July 2008).

The STEP-BD, Systemic Treatment Enhancement Program for Bipolar Disorder, a study run by the National Institute of Mental Health, seems to show that antidepressants are only as effective as placebo for bipolar depression.

And while antidepressants aren’t much better than placebo for bipolar patients, they may exacerbate mood cycling.

Use for depression

A similar major study of antidepressant efficacy for regular depression, STAR*D, showed similarly lackluster results.

STAR*D’s data is open to interpretation, but at the least indicates that antidepressants are not as effective as thought.  About only 50% of patients experienced improvement initially, and over a year span efficacy was only about 25%.

For the vast majority of uses, antidepressants may work only as well as placebo, or a sugar pill.  Placebos, after all, show about the same 25% efficacy.  Due to the psychological nature of depression, the placebo effect absolutely must be monitored for.

Conclusion

Antidepressants do help some people, and do save lives.  A black-box warning in 2003 which sharply reduced their use may be linked to a significant increase in teen suicides.

But they are also huge money makers with highly inflated efficacy rates, and should not be as heavily prescribed as they are.  In many populations, they are no more effective than placebo, but unlike placebo have significant side effects.

Their use in Bipolar patients should be carefully examined.

You might like:

10 Ideas for Treatment Resistant Depression

Agomelatine: A New Treatment for Depression

50 Ways to Make Friends

Sources:

Why antidepressants are not antidepressants: STEP-BD, STAR*D, and the return of neurotic depression
Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?
Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature
The Shocking Truth – Boston Magazine

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