Antidepressants: Is the beam of light less bright than it looks?

Exams, work or personal problems, imprisonment, international conflicts, economic problems… One could say that life has been difficult in recent years. All of these issues can lead us to feel sad, which is normal in stressful circumstances.

However, if discouragement persists, usually accompanied by fatigue and lack of motivation, among other manifestations, and interferes with daily activities, it may be a sign of depression.

Unfortunately, this disorder has been growing at an alarming rate in recent years. Who does not know someone in their environment who has the above symptoms. The global covid-19 crisis has only worsened the outlook, with an estimated 25% of the world’s population suffering from covid-19 related disorders.

Faced with such a situation, and regardless of the type of depression, most seek a cure in the form of antidepressants in the hope of getting out of this pit of suffering. In fact, its consumption has increased by more than 30% in the last 5 years and by 10% since the pandemic.

Efficacy and limitations of antidepressants

And how do these pills cheer us up? Well, while there are many types of antidepressants, the most commonly prescribed are selective serotonin reuptake inhibitors (SSRIs). They, in order to understand us, allow serotonin, commonly known as the hormone of happiness, to act longer.

However, the expected results are not always achieved. Recent studies show that in general they are effective only in 40-60% of cases.

In this sense, a systematic review article has recently been published – a very valuable tool that allows us to closely examine the existing results in a particular area. In addition to reporting that SSRIs have traditionally been the main treatment, he concludes that they have only had a positive effect in some patients. In other words, they are not as effective as promised.

But be careful, the question is not whether they are worth it or not, but who the 40-60% are. This means that a deeper analysis of the results that we already have is needed to find out what the patients they actually help are like, given their condition.

Lack of attention to the treatment of depression

Although there are seven different families of serotonin receptors in the brain, simplifying depression to this pathway is reductionist. To begin with, this disorder manifests itself through many subtypes (major depression, seasonal depression, anxiety depression…) and the associated symptoms number in the hundreds.

In addition, these symptoms are not exclusively associated with mood states, many of them are associated with other processes. Among them, weight changes, pain in different parts of the body, problems with the intestines or heart, etc.

This alone should be more than enough to prove that depression is far more complex than we have assumed over the years. In fact, this is supported by recent studies that link depression to many other biological mechanisms besides serotonin, such as changes in the generation of new neurons or the condition of the bacteria in our gut.

That being said, treating such a variety of symptoms and subtypes with one magical remedy seems unrealistic.

Moving towards more personalized medicine

This type of research opens the door to the possibility of finding more personalized treatment for patients. Better knowledge of the participants might allow them to be classified based on their symptoms or other types of variables. For example: genetics, lifestyle, age, presence of other diseases, presence or absence of cognitive problems, etc.

In turn, this may inspire new research that will start from this base and improve diagnosis, policy development, and therefore treatment, including psychological therapy. And not only that: identifying variables can help us better understand the origins of these complex disorders, taking one step further in their prevention.

Everyday weapon against depression

In recent years, there have been many studies confirming the positive impact of a healthy lifestyle on mood.

Far from being empty and typical advice, a good diet helps us have good gut health, which seems to be increasingly related to our mental health. Exercise allows us to lubricate all our motor and metabolic systems by flushing out toxins, preventing inflammation, and releasing substances like endorphins that improve mood.

It is also important to sleep enough hours, which allows us to do cleaning in our brain and correct memory. This is also facilitated by cognitive stimulation, such as learning languages ​​or music.

Finally, maintaining a healthy and satisfying relationship with our activities and with the people around us helps improve beneficial brain pathways such as the so-called reward circuits.

All this is useful not only for patients with mental disorders, but for everyone as a preventive measure. Until we develop an effective therapeutic strategy that combines medication and psychological therapy, it is worth remembering these tips, which also help us maintain good overall health. In short, for now let’s press the buttona healthy lifestyle is a ray of hope available to everyone.

Maria Inmaculada Infantes Lopez, PhD student, researcher on stress-induced depression, University of Malaga; Carmen Pedraza Benítez, professor of psychobiology, University of Malaga and Margarita Perez Martin, professor of physiology and neurology, University of Malaga

This article was originally published on The Conversation. Read the original.