There has been a growing body of research regarding the tendency for some antidepressants to have a paradoxical effect, leading to hormonal imbalances and a worsening of their symptoms. Much of the research has pointed to selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant that has shown to shut down the brain’s production of serotonin, the neurohormone they were designed to be preventing the body from losing. Despite antidepressants being the most widely prescribed mental health medication in the U.S., the Journal of the American Medical Association has reported that SSRIS may put people at an elevated risk of suicide attempts in the first nine days of treatment.
Published online in the journal Trends in Cognitive Sciences, the authors sought to investigate why some people experience paradoxical effects with depression medications in addition to ways that new classes of drugs could treat the disorder. The authors found that during the initial two week grace period that the body requires for antidepressants to take effect, the drug actually aggravated depressive symptoms in women and men in the test group. They found that the reason lies in a recently discovered dual signal that serotonin neurons transmit, responsible for the release of glutamate in addition to serotonin.
“While the serotonergic component is immediately amplified following SSRI administration, the glutamate component is acutely suppressed and is only normalized after several days of drug treatment. These differential time courses may help to explain the paradox of acute versus chronic SSRI effects,” said Adrian Fischer of Otto-von-Guericke University in Germany, lead author of the study.
While the serotonin component of the dual signal has been linked to motivation, glutamate has been linked to pleasure and learning. Experts believe that a better understanding of serotonin neurons’ dual signal and their various responses to drug treatment may help resolve some of the paradoxes observed with SSRIs, leading to more accurate and fast acting antidepressants. Although the exact mechanisms in which SSRIs affect the dual signal are still being investigated, the authors believe that it provides insight on why SSRIs need a two-week delay to show any effects while drugs that target glutamate receptors have an almost instant onset.
Alternative approaches to antidepressants
Currently, there are no antidepressants that carry zero risk of depression or suicidal ideation. Since the FDA approval process usually takes about a decade on average, the medical field is still a ways away from releasing a truly risk-free class of depression drugs. However, there is a growing body of research suggesting that alternative forms of treatment, such as telemedicine-based care, is able to minimize side effects from SSRIs.
Published in the journal Psychiatric Services in Advance, the researchers analyzed data from over 190 patients who enrolled in a comparative-effectiveness trial from 2007 to 2009. The test group, which was mostly Caucasian women (over 80 percent), was followed for nearly two years while they received telemedicine-based collaborative care from their primary care provider as well as off-site care via telephone from a nurse care manager, telepharmacist or telepsychologist/telepsychiatrist. After being interviewed about their antidepressant treatment and the severity of their depression over a period of a year and a half, the results not only showed that the patients who had received teletherapy suffered from significantly fewer side effects than the control group, but the risk of side effects increased with the number of antidepressants prescribed as well.
At Sovereign’s Chandler center, we place an emphasis on cutting edge, holistic approaches to the treatment of depression and other issues in women in addition to our hallmark of addiction, dual diagnosis and mental health treatment. If you would like more information, feel free to contact us today.
Written by Chase Beckwith, Sovereign Health Group writer
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