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Health Protocols

Depression

Conventional Medical Approaches – Challenges and Benefits

As mentioned earlier, mainstream medicine typically relies on antidepressants as first-line treatment for depression.4 However, in many cases, this first-line treatment is meant with failure. The result is a diagnosis of “treatment-resistant depression,” and, if severe enough, more drastic measures will be undertaken in attempt to alleviate depressive symptoms. Instead of addressing the multiple other potential contributors to depression mentioned in the protocol, conventional physicians opt to appease treatment-resistant depression with procedures like electroconvulsive therapy, which happens to cause memory loss.

Sadly, though research has given rise to promising new modalities for relieving depression, such as transcranial magnetic stimulation, mainstream medicine has yet to advance past the archaic model of psychiatric medicine that has been in place for decades.

This section of the protocol will discuss typical conventional treatment options and also introduce some promising new techniques that are quickly gaining the attention of patient-minded clinicians.

Medications Typically Used to Treat Depression

Several classes of medications may be employed to treat depression; depending on the patient’s symptoms and history medications from the following classes are typically utilized.

Most antidepressant medications work by altering signaling within the brain. They do so by manipulating the level of neurotransmitters in the synaptic junction, the finite space between two neurons in which signaling molecules are released and reabsorbed to facilitate neuronal communication.

While antidepressants may temporarily improve mood, they do so in a way that is somewhat artificial and unlikely to be effective for an extended time. There is disturbing evidence that some antidepressants may cause the brain to adapt to their presence, requiring increasing dosage and leading to withdrawal symptoms upon cessation.

Moreover, an underrecognized condition known as antidepressant discontinuation syndrome may arise in as many as 20% of patients upon abrupt discontinuation of an antidepressant medication. This phenomenon is likely the result of the brain having adapted to the medication, and now being deprived of it, malfunctions for a time until it can readapt to the lack of the drug. Symptoms of antidepressant discontinuation syndrome include flu-like symptoms, insomnia, nausea, hyperactivity, and sensory disturbances, among others.76

1. Selective serotonin reuptake inhibitors (SSRIs) are one of the most popular class of antidepressants. Fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft) are all SSRIs. They tend to have the fewest side effects of antidepressant drugs. Primary side effects are decreased sexual desire and delayed orgasm. Other side effects—digestive symptoms, headaches, insomnia and anxiousness—often decrease over time.77

2.Serotonin and norepinephrine reuptake inhibitors (SNRIs) include duloxetine (Cymbalta), venlafaxine (Effexor), and desvenlafaxine (Pristiq). The side effects for these medications are similar to those of SSRIs.

3. Atypical antidepressants are norepinephrine and dopamine reuptake inhibitors (NDRIs) such as bupropion (Wellbutrin), trazadone (Desyrel), and mirtazapine (Remeron). They have a different mechanism of action and side-effect profile than other antidepressants. For example, NDRIs generally do not cause sexual dysfunction as a side effect; however, they can increase blood pressure and risk of a seizure. Other minor effects include loss of appetite, headaches, dry mouth, nervousness, anxiety, stomach pain, constipation, insomnia, and more.

4. Older antidepressants include the tricyclic antidepressants amitriptyline, amoxapine, desipramine (Norpramin), doxepin, imipramine (Tofranil), nortriptyline (Pamelor), protptyline (Vivactil), trimiptyline (Surmontil); and the monoamine oxidase inhibitors (MAOIs) tranylcypromine (Parnate) and phenelzine (Nardil). Doctors do not use these medications frequently because they tend to have more frequent and severe side effects. For example, tricyclic antidepressants can cause an abnormal heart rhythm and drowsiness. MAOIs can increase the risk of severe reactions to foods, drinks and other medications, as well as significantly increase blood pressure, which may lead to a heart attack or stroke. Other side effects of both these classes of medication include constipation, headaches, anxiety, and dry mouth.

Electroconvulsive Therapy

A long-standing treatment still used in conventional medicine is electroconvulsive therapy, or ECT. It is most often reserved for people with suicidal ideation, psychotic depression, or those who have not responded to other treatments. It is reportedly effective in up to 90% of patients, which is why it is still available,78 although it is important to question the extent of the benefit and how long the effects last.

ECT is associated with short-term memory loss, and it appears that some aspects of memory may be affected for an extended time.79 Moreover, ECT may negatively influence other realms of cognition unrelated to memory; in fact, one group of reviewers stated that “…clinicians should take the non-memory cognitive effects of ECT into account, and patients should be informed of their existence before they sign consent for ECT.80

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