Depressed mood has many psychological and biological causes. Some people are born with genetic factors that significantly increase their risk of developing severe depressed mood. Known medical causes of depression include thyroid disease, heart problems and anemia. When an underlying medical problem is treated depressed mood often gets better. Chronic stress, over-work or sleep deprivation can lead to depressed mood. Some prescription medications can cause or worsen depressed mood including drugs used to control high blood pressure and many others. Symptoms of depressed mood can be mild, moderate or severe depending on how much distress they cause and to what extent they interfere with your ability to function at work, in school or in a relationship.
Some people hear voices or develop delusional beliefs when they are severely depressed. They may not be able to distinguish between reality and fantasy however this does not mean they are ‘crazy.’ Psychotic symptoms generally go away when severe depressed mood improves with treatment. Individuals who experience mood changes that alternate between feelings of depression and euphoria or an irritable mood have bipolar disorder. It is important to understand whether your problem is depression, bipolar disorder or another mental health problem before starting any new treatment because different medications and alternative treatments are used for different mental health problems and taking the wrong treatment can potentially worsen your symptoms.
Limitations of prescription antidepressants
Several independent analyses have concluded that most trials of antidepressants sponsored by pharmaceutical companies fail to show significant response differences between conventional antidepressants and placebos. There is on-going debate over the validity of antidepressant trial designs, and it has been suggested that standardized research methods bias outcomes in favor of antidepressants. In United States and West European countries more than two thirds of depressed patients never receive adequate treatment with conventional antidepressants due to inadequate screening by physicians and under-reporting by patients. Over half of all patients who use conventional antidepressants are not treated by psychiatrists and have never been formally diagnosed with depression. Of those who are diagnosed and receive recommended doses of conventional antidepressants, between 40% and 70% fail to respond. The issue of non-response to conventional antidepressants is complicated by reports of overall worsening of depressed mood with long-term treatment. Approximately one half of individuals who fully recover from an episode of severe depressed mood relapse within two years regardless of whether they are taking a conventional antidepressant. Approximately one third of patients who stop taking conventional antidepressants after responding to them subsequently fail to respond to the same antidepressant when it is resumed.
Systematic reviews of studies on treatment-refractory depression found little evidence to support conventional pharmacological treatments (including combined drug regimens) or psychological treatments of treatment-refractory depression. “Treatment resistant” patients are twice as likely to be hospitalized, have more outpatient visits, and use more psychotropic drugs compared to patients who respond to conventional antidepressants.
Prescription antidepressants may have limited efficacy because they do not address impairments in neuroplasticity or neurogenesis that may underlie chronic depression. These findings suggest that future antidepressant agents with neurotrophic or neuroprotective effects may be more effective than currently available drugs that target specific neurotransmitters but do not stimulate synaptic growth or reduce nerve cell loss or atrophy believed to be associated with chronic depressed mood. The high cost of prescription drugs has become an important issue for many patients who take antidepressants. In this context it is significant that the cost-effectiveness of more expensive SSRIs and SNRIs is equivalent to that of the older inexpensive tricyclic antidepressants.
Non-medication approaches used to treat depressed mood
The limited effectiveness of available mainstream treatments of depression invites serious consideration of non-medication approaches. Natural supplements used to treat depressed mood include certain vitamins, minerals, herbals, amino acids and essential fatty acids. Depressed individuals may respond better to antidepressant medications when they are combined with certain natural supplements including folate and omega-3 essential fatty acids. St. John’s wort (Hypericum perforatum) is an effective treatment of moderate depressed mood but is much less effective for more severe depressed mood. The omega-3 essential fatty acid called EPA in particular may have beneficial effects against depressed mood when taken alone or in combination with conventional antidepressants. Extensive research has been done on S-adenosyl-methionine (SAMe) for depressed mood and have concluded that SAMe is as effective as prescription antidepressants. 5-HTP is a naturally occurring amino acid found in many foods and is the immediate precursor of serotonin that may be safely combined with prescription antidepressants increasing their effectiveness.
In addition to natural supplements there is considerable evidence for antidepressant effects of regular exercise. Early morning bright light exposure often reduces the severity of depressive mood symptoms. Depressed persons who exercise or use bright light therapy while taking an antidepressant may also improve faster than persons who use either approach alone. Exposure to high-density negative ions may be as effective for depressed mood as early morning bright light exposure. Emerging findings suggest that a specialized biofeedback approach that ‘shapes’ the brain’s electrical activity in the context of a computer game (i.e. EEG biofeedback) may have beneficial antidepressant effects. Other non-medication approaches that have beneficial antidepressant effects include acupuncture, music therapy, meditation, and yoga.
If you are struggling with depression, taking a medication that isn’t helping you feel better, experiencing adverse effects, or you simply can’t afford to continue taking an antidepressant that is helping, you will benefit from my book Depression: The Integrative Mental Health Solution. In the book I provide practical information about a variety of safe, effective and affordable non-medication alternatives that will help you feel and function better such as herbals, vitamins and other natural supplements, whole body approaches, meditation and mind-body practices, and energy therapies.
Depression: The Integrative Mental Health Solution will help you
• Understand depression better
• Take inventory of your symptoms
• Learn about a variety of non-medication approaches for treating depression
• Develop a customized treatment plan that makes sense for you
• Re-evaluate your treatment plan and make changes if your initial plan doesn’t work
Click here to preview or buy my book.