effectiveness of antidepressant
Are antidepressants effective?
The History of Antidepressants
The topic of antidepressants frequently resurfaces in public discourse. Today, nearly ten percent of the adult global population uses antidepressants, which have become extremely common, especially in predominantly Western societies. The history of antidepressants, particularly their globalization, began in the 1950s. Before this, opioids like methamphetamine were used to energize patients affected by what is now a widespread disorder. These early antidepressants had numerous and very unpleasant side effects, like what is found in modern substances like MDMA, commonly encountered in student life and parties. Similarly, cocaine was often used in various therapeutic applications, including for depression, anxiety, mood disorders, and chronic fatigue. It even reached a point where it was advertised for alleviating the daily boredom of housewives under fifty.
It was in the 1950s that the first antidepressant molecules emerged, coinciding with the explosion of assembly line work and the advent of modern life. This development in societal evolution was closely linked with the introduction and widespread use of antidepressants in everyday life. In the 1970s, antidepressants gained further momentum with the introduction of a new molecule: Fluoxetine, marketed as Prozac. Since then, there have been few optimizations or significant research developments in antidepressants, emblematic of a society sometimes consuming these pills as a magical solution to the dark forest of depression.
How Antidepressants Work
Although there are several classes of antidepressant molecules, they primarily focus on the concentration of serotonin in the body. Serotonin, a neurotransmitter produced 95% in the intestines, plays an important role in transmitting information between neuron synapses. Originating in the intestines and deployed throughout the body, its mere 1% presence in the brain has a significant impact on mood regulation and the sense of happiness. This is why most antidepressants target this crucial molecule for our well-being.
When a person is depressed, imagine their nervous system is in shock. This shock disrupts the entire nervous system, affecting the use and recovery of neurotransmitters and inhibiting the efficiency of nerve impulses. That's why molecules like Fluoxetine focus on the issue of serotonin being reabsorbed too quickly, preventing the drop in happiness sensation. It allows serotonin to remain longer in the synaptic gap. Fluoxetine is part of the SSRI (Selective Serotonin Reuptake Inhibitor) class, preventing serotonin from being reabsorbed by the synapses, extending the duration of the nerve impulse, and promoting neuronal exchanges.
Differences Across the World
One might assume that antidepressants are universally prevalent, but their distribution is quite different from what one might expect. Antidepressants are predominantly used in Western countries, while they are almost nonexistent in Asia and Africa. This discrepancy is due to two main factors:
Firstly, the cultural and traditional practices of these continents have not fully embraced modern medication. Preferring natural medicine, some Asian countries have a medical history dating back over three thousand years. The medical paradigm shift of the 1950s and the explosion of pharmaceutical companies had little impact on these regions. Ironically, these are the continents where most Western medicines are produced, yet they are hardly consumed there.
Secondly, the dietary and behavioral habits of these continents differ fundamentally from those in most Western countries. High fish consumption, strong family connections, and a predominantly positive attitude contribute significantly to real well-being and fewer depressive episodes.
Accepting Modern Society
While the introduction of antidepressants was seen as a major advancement in Western countries, it's important to question the exact role of these medications. Comparing Western countries with Eastern and African nations, one might wonder if antidepressants are simply masking the effects of modern society (work rhythms, family disconnection, loss of identity, etc.). Shouldn't we rather address the fundamental problems generated by modern societies instead of focusing on the deleterious effects they have on their populations? The question is open, and it's worth considering given the colossal profits generated by the global pharmaceutical industry and the rapid deployment of antidepressants worldwide.
Usage (Not So) Virtuous
It's clear that antidepressants can provide support during a depressive episode. However, I remain cautious about the dosage, duration, and context of prescribing such medication. Despite their potential temporary support, I am skeptical about the effects and goals of long-term antidepressant use.
Many have heard stories of individuals on antidepressants experiencing disconnection from reality, emotional management issues, headaches, vomiting, loss of balance, etc. The purpose of taking antidepressants is to aid during a period of depression, alongside psychotherapy. How can this approach be effective if these molecules disconnect you from reality and cause numerous side effects? How can you find yourself and know what's good for you if you're not yourself and feel unwell? It's paradoxical.
Consequently, many people on antidepressants have been taking them for years, even decades. This persistent medication use, even with psychotherapy, should prompt healthcare professionals to reflect. Antidepressants might be beneficial in certain mild depression cases within a favorable context, but it's not uncommon to encounter individuals who have been medicated for years without psychological progress or follow-up.
Natural Alternatives
Beyond traditional antidepressants, natural alternatives exist. St. John's Wort, classified as an SSRI like Fluoxetine, is widely used in Germany, often preferred over Prozac for treating depression. In France, it's available without a prescription for up to 15 days of self-administered use.
A notable study in 2010 by Dr. François Lespérance revealed the benefits of Omega-3 on major depression without anxiety disorders. This study, involving 432 men and women, showed equal efficacy between Fluoxetine and fish oil containing 1050mg of EPA Omega-3, suggesting why populations with higher fish consumption might experience less depression.
Can We Naturally Heal from Depression?
Reflecting on the role of diet in depression is crucial. From serotonin synthesis in the intestines to fish consumption, depression could be a result of dietary imbalances. Traditionally, the sequence is thought to be traumatic events > depression > sleep problems > dietary and digestive disturbances. However, it might be the reverse. Increasing evidence suggests that dietary imbalances and disruptions in gut flora might largely cause depression.
To conclude, I recommend a fascinating short video by Dr. Bruno Donatini, a gastroenterologist, hepatologist, oncologist, immunologist, and osteopath, discussing this intriguing subject.
