Depression medication – Evidence and usefulness

Depression medication has been widely prescribed since the early days of Prozac (Fluoxetine) and the discovery that depression can be helped by taking a pill. A new study shows that in reality, only those who suffer from severe depression may actually benefit from taking the meds though.

Depression is commonly seen in addiction treatment so I think the topic is relevant for us. But before I explain the details, a little review of depression medication would be useful.

A review of depression medication

The type of medication has gone through some major changes, starting with TCAs and MAOIs and ending up at SSRIs and SNRIs. MAOIs blocked an enzyme from breaking down Serotonin, which increased the levels of this emotion-enhancing neurotransmitter (MDMA, or ecstasy effects Serotonin as well). SSRIs and SNRIs block the recycling of serotonin (SSRI means Selective Serotonin Reuptake Inhibitor) and a broader group of neurotransmitters (SNRI = Serotonin Norepinephrine Reuptake Inhibitor).

The problem with MAOIs was that their side effects were often worse than the depression the patients were suffering. The same side effect problems were also common with TCAs (tricyclic antidepressants) because of the numerous effects they had on many systems in the brain.

MAOIs and TCAs are essentially gone from the U.S. market but are still prescribed in other countries to some extent. SSRIs and NSRIs are the most common drugs for depression treatment here, but there are still major differences between different specific pills.

New study results – Pills good for severe depression

This new meta-analysis (a combined analysis of a bunch of older papers), seems to show that Tofranil (a TCA) and Paxil (a SSRI) are only more effective than a placebo sugar-pill in patients who suffer from severe depression. The problem is that most people who are prescribed anti-depressants today suffer from mild or moderate depression. This brings into question the wide use of the drugs.

It even seems possible that the reason side effects are worse than the depression for some patients is because the depression itself was simply not that severe in the first place and would have been better helped by the use of psychotherapy without medications.

Some limitations of the study

It’s important to realize that this study looked only at two different medications, both of which are known to have a significant problem with negative side-effects. Future studies will most likely cover more of what’s available and since depression and addiction are so closely associated, you can count on me revisiting this again!

Citation:

Jay C. Fournier; Robert J. DeRubeis; Steven D. Hollon; Sona Dimidjian; Jay D. Amsterdam; Richard C. Shelton; Jan Fawcett (2010). Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-analysis. JAMA, 303(1):47-53.

It’s in your genes: The connection between addiction and other disorders

I think it’s common knowledge that children are more likely to develop a psychiatric disorder when one of their parents is diagnosed with one. Just in case it isn’t, as much as 80% of the likelihood that a person will develop a mental health disorder is genetically determined.

The genetics of mental health and addiction

The thing is, some studies have shown that children are more likely to get any disorder, while other have shown that a child is most likely to get a similar disorder to the parents. Granted, for things like anxiety, and depression, knowing which of the two answers is correct may not matter much (though for some parents it does). But when it comes to substance-abuse, parents want to know whether they should take special precautions, which is especially true if addiction runs in the family or if any psychological disorders are common.

A recent study tried to answer that question while focusing on anxiety, conduct disorder, depression, and substance use [1]. The researchers’ reasons for choosing these four disorders had to do with repeated findings about the association between them [2].

The results showed that if both parents displayed generalized anxiety disorder their children were more likely to suffer from anxiety and depressive disorder [1]. It was also revealed that parental substance use was associated with an increased risk of conduct disorders in offspring.

In general, these results indicate that the heritability is not super-specific. However, it seems that while substance abuse and things like depression and anxiety are related, parents transmit disorders in a relatively specific way. So, if you’re worried about your children having substance abuse problems, I’d look more toward family history of those or impulse and attention problem, not depression and anxiety.

Citations:

1. Johnson, J.G., Cohen, P., Kasen, S., & Brook, J. S. (2008) Parental Concordance and Offspring Risk for Anxiety, Conduct, Depressive, and Substance Use Disorder, Psychopathology, 41: 124-128.

2. Merikangas, K.R., Dierker, L. C., & Szatmari, P. (1998) Psychopathology Among Offspring of Parents with Substance Abuse and/or Anxiety Disorder: A High-risk Study, Journal of Child Psychology and Psychiatry, 39: 711-720.

Alcohol, benzos, and opiates – Withdrawal that might kill you

Along with teaching and telling stories, part of my goal here at All About Addiction is to get important information out to those who can benefit from it.

Most drug users who quit drug use “cold turkey” have to go through withdrawal of some sort. Withdrawal is never comfortable, but sometimes it can actually be dangerous. The list below outlines some drugs that should NEVER be quit suddenly without medical supervision. This is the reason why some rehab treatment is preceded by a medical detox period lasting anywhere from 2 days to a week or more.

Which withdrawals can actually kill?

  1. Alcohol – Yes, after long term use, withdrawal from alcohol can kill. Alcohol withdrawal syndrome can take on mild, moderate, or severe forms. If while withdrawing from alcohol a person develops a fever, extreme nausea, diarrhea, or DT (delirium tremens), they need to be rushed to see a doctor as soon as possible. In fact, alcohol withdrawal after heavy, chronic use is best managed under the care of a doctor or a professional medical detox unit. By using medications that relieve withdrawal symptoms, these professionals can essentially eliminate any of these risks.
  2. Benzodiazepines – Benzos were introduced as a replacement to barbiturates that were causing common overdose cases, many of which resulted in death. Nevertheless, withdrawal from extended use of benzodiaepines can kill. Whether Xanax (alprazolam), Ativan (lorazepam), Valium (diazepam) or other variations, long term use of Benzodiazepines requires medical supervision to be completed successfully with minimal side-effects and risk to the patient. Normally, the withdrawal process is managed by slowly reducing the dose and transferring the patient from a slow acting, to a long acting, form of the drug. Still, full resolution of benzodiazepine withdrawal syndrome can take up to 6 months (or even longer).
  3. Opiates – Many people are surprised to learn that in most cases, withdrawal from many opiates is not deadly. Still there are some very important exceptions. Methadone, a long-acting opiate often prescribed as a replacement for heroin can cause death during withdrawal if it’s consumed in high enough doses for a long enough period. The debate of whether the state should be prescribing something like this should be saved for a later date. It is one of the better ways of getting people off of heroin, though obviously, all it does is replace dependence on one substance with another, more manageable one. Also, some of the recently popular methods of rapid-detox from heroin addiction can themselves cause death, and many other negative side-effects. Overall, I would recommend checking in with a physician and conducting opiate withdrawal in a controlled setting. Withdrawal under Suboxone or Subutex can be far less horrific.

Much of the danger in withdrawal from all of these drugs has to do with the body’s response to the extreme changes in the chemical processes going on in the brain and the rest of the body. Alcohol, Benzos, and Opiates interference with the GABA system, the body’s most common downregulator.

Withdrawal from these drugs is like trying to turn the heat up in a cold house with a broken thermostat and an out of control heater – It won’t always lead to disaster, but it’s a bad idea.

The withdrawal danger summary

That’s pretty much it. “Cold Turkey” withdrawal from cocaine, marijuana, crystal meth, ecstasy, GHB (never mix GHB with alcohol though!!!), and many other recreationally used drugs will not lead to death in the vast majority of cases. While it may make you uncomfortable, and you may feel moody, constipated, dehydrated, hungry or nauseous, and a whole slew of other symptoms, the chances of someone actually dying from withdrawal are very small.

If you have any more specific questions regarding your case though, don’t shy from asking me!

Beyond my addiction: Allowing myself to be proud of my achievements

This is a more personal post than I’m used to writing, but I think the thoughts in it are shared by many addicts, so I’d like to share it. I originally posted it on my personal blog:

It’s sad, but for the most part, I focus on the things I haven’t yet done and not on what I’ve already accomplished.

When I think about it for a few seconds, it’s staggering just how much I’ve managed to do in my 32 years here:

  • I spent my first 14 years having a wonderful childhood
  • I only let my obsessions during those years take over sometimes
  • I moved to a new country and made myself at home again
  • I dug myself out of a severe depression episode
  • I made it through college somehow in a haze of drinking and drug use
  • I moved myself out to Los Angeles without knowing a soul and made a life there
  • I’ve run a recording studio, a record label, and made my own music
  • I’ve DJ’d and put out two records
  • I’ve broken my leg and learned how to walk again
  • I held my head high through a brutal court case
  • I made my way through rehab, overcoming my addiction to crystal meth
  • I made it through months in jail
  • I’ve managed to stay drug free since those two events
  • I’ve gotten myself back into school
  • I received two Master’s degrees with endless honors and awards
  • I’m steps away from finishing my PhD
  • I’ve secured a book deal to publish my memoir/lessons from addiction (still struggling with the writing of that one)
  • I’ve published more than 10 articles, 2 book chapters, and given dozens of presentations at national and international addiction conferences
  • I found the love of my life and am working hard to make my damaged ego last through a real relationship

I often take these things for granted, but it’s good to write them down. It lets me know just how grateful I should be for even being here, let alone standing upright and proud.

I’m lucky.

Emotional eating: A possible connection for food addicts

More cake please!!! The supposedly wondeful face of sugar addiction...

Co authored by: Jamie Felzer

Do you ever stuff yourself beyond capacity because you are depressed, feeling inadequate or self conscious?

Are you a perfectionist with difficulty expressing and realizing your feelings, instead turning to food to take out your frustrations?

If so, you may be linking strong emotions and eating- taking your inability to effectively portray feelings and transforming them into feasts of food. This is a problem often experienced by food addicts.

Typically, when under stress or any other strong negative emotion, people tend to lose their appetite.  Instead, those who eat emotionally have an increased appetite and an inability to gauge their eating as it relates to their physical state. Emotional eating does not necessarily involve binge eating, but instead, describes eating associated with particular feelings.

Researchers recently found that high amounts of emotional eating occurred when participants experienced anger, anxiety or depression. Emotional eating was a big factor for those with restrictive types of eating disorders (aka anorexia not bulimia or binging).  However emotional eating occurred often with those who desperately wanted to become thin but still had a tendency to eat according to their emotions.

This leads to eating without actually being hungry but to fill other voids.  Emotional eating involves many ups and downs of eating and those who engage in eating in this manner need help determining what behaviors are healthy and how to work on mind over matter as the saying goes.

Although the majority of cases involved people eating in response to negative emotions some people reported eating comfort foods in response to positive feelings as well.  As stated in Addiction Inbox “In an unconscious effort to raise brain levels of serotonin and dopamine, drug users often discover that doughnuts, cakes, ice cream, soft drinks, and other sugar foods can lessen withdrawal symptoms” which is why many people chose to eat in hopes of combating these strong emotions.

The same pattern of eating can happen for non-users as well, but being aware is the first step to recovery.

Citation:

Courbasson, Rizea, and Weiskopf , (2008). Emotional Eating among Individuals with Concurrent Eating and Substance Use Disorders. Journal of Mental Health and Addiction.