The surprise answer is that in many cases they are equally effective.
Antidepressants have been used for decades and billions of dollars have been spent on these drugs, but they are surprisingly ineffective. The difference between the drug effect and a placebo (or sugar pill) is almost undetectable except in the most severe cases of depression. Placebos themselves are surprisingly effective – when a person expects to get better, sometimes that is all that’s needed to help the mind heal itself.
The US Centers for Disease Control and Prevention report that the rate of suicide has increased by 30% since 1999. At the same time, the use of antidepressants has increased by 65%. This suggests the drugs are not great at preventing suicide. In addition, some of these drugs have a “black box” warning, the highest level that can be applied to a drug. It warns doctors to monitor patients for new suicidal thoughts that may occur shortly after beginning therapy.
Statistics show that more people are on long-term financial assistance due to mental illness than before these drugs were introduced in the 1950s. One analysis suggests that the drugs may actually block a full recovery, even though symptoms appear to improve in the short term. Studies have found that more patients who used non-drug therapies had recovered and returned to work after one to two years of treatment compared to those who took medications.
At an educational session many years ago, the speaker told us that mental illnesses were a result of a chemical imbalance in the brain. Depression was caused by too little serotonin or norepinephrine. They explained that antidepressants re-balanced these chemicals (called neurotransmitters), by increasing the available amount of the ones believed to be low in depression. I often explained this to patients when I counselled them about their medication in my pharmacy.
However, newer studies have shown that the brain changes how it functions to accommodate for the effect of the drug. When the patient tries to stop the medication, it takes a while for the brain to return to normal. This manifests as a return of the mental illness, sometimes more severe than it was before. This has often been interpreted as a need to continue treatment, rather than a withdrawal effect of the medication. As a result, sometimes patients are kept on treatment for many years.
The longer the person has been taking the medication, the longer it can take for brain function to return to normal. This can make it very difficult to stop the medication. It is recommended to taper the dose gradually when attempting to discontinue treatment to reduce withdrawal effects.
As well, antidepressants have side effects that range from weight gain to erectile dysfunction. The small benefit these drugs provide needs to be weighed against the side effects they cause.
So, do studies show that alternative “natural therapies” work for depression?
The answer is yes! Good quality scientific studies are available to support some of these non-drug treatments:
Exercise
A 2007 study at Duke University Medical Center in North Carolina found that 30 minutes of walking or jogging three times a week was more effective than an antidepressant or placebo. (Psychosomatic Medicine, Sept 2007, 69(7), p. 587-96)
A review (or “meta-analysis”) of studies that included exercise and antidepressant medications in 2016 confirmed the effectiveness of exercise. (Journal of Affective Disorders, 15 Sept 2016, vol.202, p.67-86)
Bright light therapy
Bright light (10,000 Lux, 30-60 minutes daily first thing in the morning) attempts to duplicate the effect of being in sunshine. A review of studies showed significant effect, with the largest study showing an effect approximately equal to antidepressants when added to medication. Of course, spending time in actual sunshine could be expected to give the same beneficial effect.
Mediterranean diet
While less studied, a small Australian study, the “SMILES Trial” suggests a Mediterranean Diet that includes local unprocessed foods may work better than antidepressants. After 12 weeks on the diet, 32% experienced remission compared to only 8% of those who received only social support.
Cognitive behavioural therapy (CBT)
Cognitive Behaviour Therapy, or CBT, is a non-drug, “talk” therapy used to treat psychological illness. It aims to help people understand their thoughts and feelings, and what makes them feel positive, anxious or depressed. It helps people to identify the problems that are troubling them and find different ways to think and behave to manage their feelings.
The evidence for benefit from CBT is indisputable. It is as effective as antidepressants but, unlike medication, the effect continues after the therapy is completed. The other plus is that a person can’t overdose on a bottle of “therapy”, unlike antidepressants…
So, if you get the “blues” this winter, talk to your doctor. But, before they take out the prescription pad, be sure to ask whether non-drug therapies might be appropriate for you. While you may benefit from medication, or a combination of medication and non-drug therapy, it’s worthwhile discussing your options first.
Of course, considering the positive effect of exercise, sunshine, a healthy diet and discussing ways to deal with problems effectively with someone you trust, perhaps these are things we should all be doing every day anyway to keep our bodies and our minds healthy!
References:
Why Natural Depression Therapies are Better Than Pills, Dr. Matt Strauss (Pharmacy Practice Journal)
