It was interesting to hear today the Royal College of Psychiatrists calling on the National Institute for Health and Care Excellence (NICE) to update its advice on antidepressant withdrawal with a policy statement that highlights the risk to some people of severe and long-lasting withdrawal effects from antidepressants, and the associated risks of over prescribing. My professional body UKCP has been part of a collaborative campaign to get NICE to change its adult depression guideline and that treatment choices must include a range of evidence-based talking therapies which, in many parts of the country are sadly lacking. Getting the Royal College of Psychiatrists onboard as part of this campaign is a big step forward.
Having better access to proven talking therapies is crucial (or if PTSD is part of the problem EMDR is very successful in dealing with trauma) rather than an immediate reliance on pills. Antidepressants are often prescribed by medics on the assumption of serotonin deficiency. Therefore, it is reasoned, that the drugs help to rebalance a brain and may result in increased levels of brain-derived neurotrophic factor (BDNF). However, another view is that the drugs actually boost a thing called neurogenesis (the process by which nervous system cells, known as neurons, are produced by neural stem cells) which also helps to boost serotonin and it is this that is actually responsible for the feel good factor.
So what, you may say? The pills boost neurogenesis, so what is the problem, if all roads lead to Rome? The trouble is, the drugs come with potentially massive side effects, such as loss of libido, gaining weight and feeling a bit vacant which can in themselves also be depressing. The withdrawal is the unpleasant outcome of the homeostatic down regulation of serotonin receptors which stop making their own in the presence of the drug. Research suggests that this is why the longer you’re on them, the harder they are to come off and there can be long term reduced efficacy of our own natural receptors.
It is far better to boost neurogenesis organically, but that is not typically a quick win. Eating healthily and undertaking regular high impact exercise can boost neurogenesis as well as engaging in mindfulness and meditation. Boosting neurogenesis, though, requires some heavy lifting on the part of someone feeling depressed in order to feel better and to transform their life whereas a pill can feel like an instant solution. GPs are often in a difficult position. They have limited consultation time with patients and patients may be insistent on wanting to be prescribed medication for their depression.
If you are suffering from depression it is important to note that a mental health professional needs to be medically qualified in order to prescribe medication.
There are many psychiatrists who strongly object to the notion that severe depression can be cured with exercise, meditation and healthy eating alone. Obviously the more severe the depression is then an antidepressant might be needed and should carry no stigma. In cases of severe depression, it can feel difficult to engage with anything at all. Exercise and nutrition may form a part of the solution to managing depression on a daily basis, but might struggle to solve the overall issues of clinical depression. Whilst a change of lifestyle, particularly exercise, might be proven to help mild depression, and may help with moderate depression, the medication may be able help a sufferer to get to a stage where they can begin to help themselves. Severe depression can be extremely disabling. It is also important to understand why someone became depressed in the first place. Sometimes there might not be any clear reason, and in such cases it is very likely that a chemical imbalance could be treated with diet and exercise, with CBT or drug treatment at first. But some people are depressed because of things they are unable to change – other health problems or disability, bereavement, family problems, poor housing, loss of career, loss of meaning in life and so on. Helping with the depression may help them to deal with their other problems, but if someone has become too disabled to live independently or has lost a loved family member, suggesting that they improve their diet and boost their physical health regime might fall on deaf ears.
See also
My interview with Brant Cortright on neurogenesis diet and lifestyle