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Depressant treatments: Should we use drugs to treat mild depression…

- - - - Anecdotal reports have suggested that the long-term use of selective serotonin reuptake inhibitors (SSRIs) may be associated with significant weight gain, sexual dysfunction, drug interactions, and discontinuation symptoms.
  - - - For instance, while antidepressants are modestly effective in reducing depressive symptoms, they increase the brain’s susceptibility to future episodes after they have been discontinued. . In fact, antidepressants cause neuronal damage and mature neurons to revert to an immature state, both of which may explain why antidepressants also cause neurons to undergo apoptosis (programmed death). Antidepressants can also cause developmental problems, they have adverse effects on sexual and romantic life, and they increase the risk of hyponatremia (low sodium in the blood plasma), bleeding, stroke, and death in the elderly. Our review supports the conclusion that antidepressants generally do more harm than good by disrupting a number of adaptive processes regulated by serotonin.
- - - - Unless prescribing patterns change, any benefits from increasing access to antidepressants for those with severe depression will be accompanied by significant harms due to inappropriate prescribing in conditions, such as mild depression, where antidepressants are not indicated
    - - t has been suggested that the rise in antidepressant usage among adults coincides with the introduction of selective serotonin reuptake inhibitors (SSRIs), perceived as advantageous over the older tricyclic antidepressants (TCAs) because of enhanced safety and more tolerable side effect profiles
      - Overuse was estimated at 20%, with the majority concentrated in newer-generation antidepressants
- - - - Both drugs and CBT caused similar change in the brain (caudate nuceus). CBT for patients with MDD increases metabolism in the hippocampus and doral cingulate and decrease in the dorsal, ventral and medial frontal cortex
        Top-dpwn regulation of hyperexcitable limbic structure by the prefrontal control system drugs like SSRI 5-HT receptor binding is not reversed
    - - Findings in depression, where both decreases and increases in prefrontal metabolism after treatment and considerable differences between pharmacological and psychological interventions were reported, seem still too heterogeneous to allow for an integrative account, but point to important differences between the mechanisms through which these interventions attain their clinical effects.
    - - CBT increased gray matter volume in the lateral prefrontal cortex
  - - - CBT was somewhat superior to antidepressants in the treatment of adult depression.Dobson (1989) conducted the
        first meta-analysis on this topic and found CT to be superior to untreated controls, wait list, pharmacotherapy,
        behavior therapy, and a heterogeneous group other therapies.Outcomes for CBT and
        interpersonal therapy were generally equivalent (Elkin et al., 1989), although CBT did not fare as well as IPT or
        antidepressant medication among the more severely depressed patients in this study(Olfson & Klerman, 1993). Gloaguen et al. (1998) found that CBT was significantly better than antidepressant
        medication More recently, however, a major high-quality controlled
        trial comparing CT with a commonly prescribed serotonin reuptake inhibitor (paroxetine) found that cognitive
        therapy was equally effective for the initial treatment of moderate to severe major depression (DeRubeis et al.,
        2005). There is some evidence
        that the combination of psychotherapy and antidepressant medication leads to significantly better outcomes with
        severely depressed patients (Thase et al., 1997).s. On average, only 29.5% of CBT patients relapsed versus 60% of patients treated with antidepressants.Gloaguen et al. (1998)DeRubeis and Crits-Cristoph (1998), in their review of treatment efficacy, obtained highly
        similar figures by averaging 1-year relapse rates across three large-scale clinical trials, finding a substantial difference
        between CT (26%) and pharmacotherapy (64%)..