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"Hope Is a Very Good Thing, Maybe the Best of things": What is the active Ingredient in Antidepressant medication.

9/28/2014

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I do like movies! I like them most for the quotes that are just waiting to pop up when I read an article in medicine. Today’s quote came from the Shawshank Redemption. Andy was talking to Red sitting in the prison exercise yard trying to get across why Andy was not going crazy while doing life for a crime he did not commit. Andy had hope that grew from the fact that he was digging a tunnel out of prison! 

The quote applies to a new research study that tells us something that many have been thinking for a long time. The active ingredient in today’s crop of antidepressant medications appears to be hope. The study was done at the UCLA Medical School and examined whether or not patient attitude toward the treatment made a difference in the outcome. [i]

The study divided individuals into three groups one of which would receive a placebo pill (looks exactly like the real thing but does not contain the active drug) and a second which would receive the medication. The third group did not receive medication but did get supportive care.  Then they questioned the participants as to whether or not they believed the medicine was going to work. 

Those who reported that they believed the medication would be effective improved. They improved whether they received the placebo or the real drug.  And, the difference between the groups was not large. Both treatment groups did better than those who only received supportive care. I suppose the equation would look like faith plus hope equals effectiveness.

In the words of the researchers, "Supportive interaction with the subject helped them get better, and antidepressant therapy helped them get better, but I think our key finding was that patients' belief in the effectiveness of medication was a unique factor that contributed to them getting well. So belief in the power or effectiveness of the medication may be a contributor to placebo responses in the treatment of depression."[ii]

There are lots of directions to take these results. The lack of a large benefit in taking the active drug makes one wonder if the potential for side effects would be worth the risk. But I think there is more to be had in looking at how faith can help those who are depressed. As the writer of Hebrews said, “Now faith is the assurance of things hoped for, the conviction of things not seen.” (Heb 11:1)

If nothing more than faith in the effectiveness of a placebo can result in people who are depressed improving, what might happen if they had something or someone real in which to believe?

 


[i] Patient Expectations Largely Dictate Antidepressant Response, Medscape News @ Medscape.com Pam Harrison September 15, 2014.

[ii] Ibid.

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Chemical Imbalances & Depression: A Theory Falls victim to New Research

9/1/2014

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Chemical Imbalances & Depression: A Theory Falls victim to New Research

There is interesting news in the field of medical research for depression. [i]I am always grateful when medical researchers take another look at a significant problem in life when the current answers don’t seem to work well. This is so true of depression. People do struggle with real sadness today and the answers that medicine offers are just not working as well as hoped.

Research in the past decade has told us that the most popular medicines we have for depression do not work very well for up to 80% of the people who take them.[ii] There is a growing sense that the diagnosis of depression is made too often. It is also a concern that normal sadness over loss is being confused with the disease depression.[iii]

Today, most all of us know or have heard about chemical imbalances and how they are supposed to cause depression. Most of us have heard about serotonin and how a low level of it in our brains can cause us to be depressed. We have seen the commercials on television for medications that are supposed to correct the deficit. But, new research would indicate that the chemical serotonin may have little or nothing to do with depression at all.

Researchers at the Wayne State University School of Medicine noticed that 60 to 70 percent of patients who take the serotonin reuptake inhibitor antidepressants will still feel depressed. And so they devised a research project that would look again at the role serotonin and chemical imbalances play in depression. What they found indicated that serotonin may not be a major factor in depression.[iv]

Keep mind that the study was done on mice. They were found to have a gene that resulted in them making very little serotonin in their brains.  And no you do not need to remind me that we are men and not mice. J But, these mice with little brain serotonin did not display a depression-like behavior pattern under normal circumstances. When they were subjected to the same kinds of situations that caused behavior that looked like depression in animals, these mice responded just like normal mice that had normal levels of serotonin. Most of the genetically serotonin deficient mice did not respond to the SSRI antidepressants in the same way normal mice did with changes in their “depression-like” behavior.  

The conclusions from the study were that it is likely that serotonin may not be a large factor in depression. In essence the chemical imbalance/ serotonin deficiency theory of depression is most likely wrong. While this is not great news for those who are invested heavily in the production and sale of the current crop of antidepressants, it is good news for patients.  

The reason it is great news is the last line in the article. “These results could dramatically alter how the search for new antidepressants moves forward in the future, the researchers conclude.” In other words, science is moving on to look for a better way to explain why some struggle with sadness. The outcome could be a better understanding of the cause at the brain cell level of the disordered sadness part of depression today.

This could result in laboratory testing and brain scanning that would allow us to make a better diagnosis. And, that could lead to more effective treatment. This study opens the door for researchers to resume looking for a real explanation for the disordered sadness of depression.

When we understand the change in the human brain or body that causes depression two things could happen. The diagnosis of depression will become far more accurate reducing the numbers of people over-diagnosed.  And, a better treatment could be found for those who suffer with severe, disordered sadness.  

For the 90% of patients today with normal sadness over loss, accurate testing could help them avoid from being treated with medicine intended for the treatment of disease. Having a test that says the patient does not have depression would help doctors encourage patients to seek care that fit their problem such as counseling.  And that is where Biblical counseling can offer great hope.

 


[i] American Chemical Society. "Serotonin deficiency? Study throws into question long-held belief about depression." ScienceDaily. ScienceDaily, 27 August 2014. <www.sciencedaily.com/releases/2014/08/140827111946.htm>.

[ii]Charles Hodges M.D., Good Mood Bad Mood.  Shepherd Press, Wapwallopen, PA. p48-49.

 [iii]Ibid, p68-69.  

 [iv] Mariana Angoa-Pérez, Michael J. Kane, Denise I. Briggs, Nieves Herrera-Mundo, Catherine E. Sykes, Dina M. Francescutti, Donald M. Kuhn. Mice Genetically Depleted of Brain Serotonin Do Not Display a Depression-like Behavioral Phenotype. ACS Chemical Neuroscience, 2014; 140812102725008 DOI: 10.1021/cn500096g

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    Charles D Hodges Jr. MD
    I have been counseling people with mood problems and other family issues  for 25 years.  

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