Antidepressants: What We Know and Don't Know
Antidepressants and You
Antidepressant use is on the rise, with numbers estimating anywhere from 12.7% to 14.7% of adults currently taking one. But did you know that from a functional medicine perspective, they are not the only answer to a happier, healthier life?
Antidepressants target serotonin and other neurotransmitters by increasing their production. Although no one is entirely sure how they work, we do know that serotonin is created in the gut (actually in the intestine). Your gut bacteria manufacture about 95% of the body's supply of serotonin, which influences both mood and GI activity.
But there are other ways to increase serotonin.
Low serotonin can be the result of many factors, including nutrient synthesis. In addition to iron, serotonin synthesis requires P-5-P (pyridoxal-5-phosphate) - an active form of B-6, niacin, methyl B-12, methyl folate and magnesium.
Guess who is often deficient in these cofactors?
Many Americans, because of poor diet.
What are the causes of low serotonin?
Other causes of low serotonin can be:
Age-related health and brain changes
Lack of exposure to natural light
Lack of physical activity
In another study, researchers have found exercise to be just as effective as antidepressants for some people. Alternative therapies like talk therapy, art therapy, and mindfulness are all effective for both anxiety and depression.
The Placebo Effect
Some antidepressants increase serotonin levels, some decrease it, and some have no effect at all on serotonin. Nevertheless, they all show the same therapeutic benefit. Even the small statistical difference between antidepressants and placebos may be an enhanced placebo effect.
Instead of curing depression, popular antidepressants may induce a biological vulnerability making people more likely to become depressed in the future.
Antidepressants can have a negative effect on your health.
Ongoing use of SSRIs can deplete the body of serotonin. Like most systems, the body has override mechanisms in the nervous systems that counter abnormal action.
In this case, the brain naturally secretes enzymes that break down excess neurotransmitters left in our synapses (both serotonin and dopamine).
Thus, extended use of SSRIs can eventually cause neurotransmitter depletion or a worsening of the situation it was trying to address.
The gut is in charge!
Serotonin and drugs that target serotonin, such as antidepressants, can also have a major effect on the gut's microbiota, which are the 100 trillion or so bacteria and other microbes that live in the human body's intestines.
Antidepressants can fundamentally impact and reduce the richness of our gut microbiota and can reduce the amount of certain types of bacteria. So while your antidepressant may be helping your mood, there are long term effects researchers are not totally sure of yet.
I’m not against medication, but I’m all for using as little as possible, for as short of an amount of time as necessary.
This is why functional medicine coaches like myself are amazing for supporting you as you before tapering off your antidepressant with nutrition and lifestyle changes.
Tapering Off Your Antidepressant
One thing of certainty is that antidepressants are very often stopped too suddenly. Currently, many doctors suggest one month to completely come off of an antidepressant.
However, in their paper published in March of 2019 in the Lancet Psychiatry, the authors argued that any responsible withdrawal regimen should have the patient tapering off medication over MONTHS or even YEARS, depending on the individual.
More than half (56%) of people who attempt to come off antidepressants experience
withdrawal effects. Nearly half (46%) of people experiencing withdrawal effects describe them as severe.
And these are just reported - they might not include people who believe their symptoms are recurrence, rather than withdrawal symptoms. It is not uncommon for the withdrawal effects to last for several weeks or months.
For many people, because their withdrawal syndromes might be mistaken for recurrence, this leads to long-term unnecessary medication.
The acronym FINISH summarizes the symptoms of antidepressant discontinuation syndrome or the side effects from withdrawal: