Views on Depression Treatment

[Guest guest]

Andy has offered some excellent ideas for treating depression. With

longtime experience on this topic I wanted to offer some thoughts.

These are not intended to support or refute Andy's ideas, but rather

to paint a bigger picture so that all avenues may be considered in

perspective.

There are few if any clinical studies validating natural treatments

for depression. The ones that do exist include SAMe, St s Wort,

with sporadic evidence for Ginkgo. Rhodiola Rosea can work remarkably

well, though few available clinical studies to support it, but it has

a potential downfall of suppressing cortisol. With 5HTP, response

rates in trials have been near zero. It is good for sleep,

relaxation, calming intrusive thoughts, but only anecdotally improves

mood. When it does, it seems to have a high poop-out factor. GABA is

hit or miss for anxiety. Sometimes glycine, magnesium, or a combo of

all three works better. Anxiety herbs include valerian and

passionflower. Tyrosine and/or DLPA are hit and miss. Way back in the

1970's there were two small clinical trials with DLPA, and at low

doses of just 150mg per day it worked as good as tricyclic

antidepressants, though it took longer to do so (4-6 weeks). Many

minerals, vitamins, and herbs can improve depression. But many can

make it worse too.

There will always be exceptions to the rule, as in anything in life.

While a certain supplement may make sense, on paper, for a particular

symptom, it may not work and may even make the person feel worse. For

example, DLPA or tyrosine for a fatigued anhedonic depression. There

is a rate limiting enzyme that determines how much of these

substances will be converted to norepinephrine and dopamine. If the

rate limiting step is flawed, which is highly likely when mercury is

involved, then no amount of the supplement is going to do its job.

The only way to increase NA/DA in this case is with a medication to

enhance what little NA/DA is already there.

We often assume that all the receptors and messengers are in good

working order so that the supplements can do what they should. That

is often not the case. They may be upregulated, downregulated,

damaged, or destroyed.

Mileage varies dramatically. While B12 for example might be helpful

for many, it can be psychotic depression inducing to others, as with

me.

Medications. As with all supplements, mileage varies, and the same

rule applies...it is a game of hit and miss, trial and error. It is

often not helpful to base the choice of medication or supplement on

the symptom cluster. For example, one person with intractable anxiety

not responding to huge doses of Klonopin or Seroquel, later responded

remarkably to a low dose of Lithium, which is by no means on the go-

to list of anxiety meds. For someone else, serotonin meds made their

anxiety worse. A dopmamine agonist worked for them, which is just the

opposite of what would be expected from an armchair quarterback view.

For someone else, a norepinephrine drug worked best.

There are forums that deal specifically with psychiatric meds. They

seem to put all their focus on meds with hardly any focus on

supplementing the body with what it needs. Other forums focus heavily

on supplements, but ignore the potentials low doses of meds can

provide. It is my opinion both camps are wrong. It is a combination

of strategies, an acceptance of all available options, that leads to

the best outcomes.

Scientifically determined through metastudies of thousands of

patients in multiple trials, the antidepressants showing superiority,

though just a few percentage points, include Lexapro, Effexor,

Cymbalta, Remeron, and Milnacipran. Anecdotally some of the ones I've

seen that help a lot of people as add-ons include Modafinil or

Ritalin. Wellbutrin is hit or miss, is a miracle for some, and a step

in the grave for others. But all SSRIs, SNRIs, and tricyclics can and

do work well, even if the particular choice doesn't seem to fit the

symptom profile. Anything that alters the brain, whether it be a med

or a supplement, has the potential to make the person feel worse. Few

studies have looked at this, and all of them hide it when printing

abstracts, but a general estimate is that 5% to 15% will get worse,

some much much worse. Some supplements have actually made me feel

suicidal, when they were supposed to improve mood. Same with some

meds.

In the mood stabilizer category, lamictal wins hands down for

depression. Unfortunately not for everyone. But sometimes depakote or

lithium work too. The scientific data on lithium don't seem to pan

out in real life. Fish oils, ones especially high in EPA, show good

promise and results with a lot of people. Taurine and magnesium are

decent mood stabilizers, though they can ironically sometimes make

people more depressed. As can anything actually.

All meds have suicide risk warnings. I suspect if herbs and

supplements were regulated, many of them would too.

Medications are much more complicated than we know. We all assume

SSRIs increase serotonin. So why does one work and another not?

Studies have shown that each medication has its own fingerprint of

doing a lot of other things, such as turning certain genes up or

down, on or off, affecting cortisol one way or the other, influencing

immunity, on and on. That's why armchair quarterbacking is difficult.

It is not as simple as serotonin, GABA, dopamine, etc.

Trying to match supplements to a particular symptom cluster is a good

start and makes sense. In the end though, it really is trial and

error. So often I have seen it, over and over, where people who found

near cures did so with supplements or meds that made no sense for

their condition. So if the seemingly appropriate stuff doesn't work,

keep trying other stuff, even if it seems like a weird choice.

Supplements plus medications open the doors to greater potential than

either alone, in my opinion. Too much focus on one or the other

prolongs suffering and limits potential life enhancement. Side

effects occur with both. Some people have intense side effects with

supplements but not certain meds, and for others it is the other way

around. Sometmes supplements just don't have the potency to do what

is needed, or their biochemical pathway is screwed up. Supporting

them can help that, while a med can circumvent it from a different

angle.

These opinions are intended to widen the scope of our decision making

processes combating chronic illness. No matter what the case, two

good rules of thumb are: 1)Go low and slow; 2)Take the minimum dose

that is effective.

[Guest guest]

I appreciate that you have taken the time to write up your views on

depression treatments. I included your post with others in the

" member's posts " file in the links section. I keep this file so that

we will hopefully be able to find some of these posts later. There

are, of course, many useful posts that I miss.

J

>

> Andy has offered some excellent ideas for treating depression. With

> longtime experience on this topic I wanted to offer some thoughts.

> These are not intended to support or refute Andy's ideas, but rather

> to paint a bigger picture so that all avenues may be considered in

> perspective.

>

>

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