Depression and Antidepressant Medications


Biobalance healthcast episode 231 depression and Antidepressant medications biobalance health cast features conversations about positive aging your hosts are dr. Kathy Maupin medical director of biobalance health and a leading expert in treating symptoms of aging and Brett Newcomb a licensed professional counselor Welcome to the biobalance healthcast, I’m Brett Newcomb and this is dr. Kathy Maupin. And today we’re going to be talking about depression and antidepressants antidepressants is it’s sort of a global phrase that applies to a group of medicines that are Continuing to evolve and they’re used to treat a lot of different things. I mean we depression is a big word And it means a lot of things to a lot of people and then as a counsellor I can tell you that treating people with chronic depression or clinical depression It’s difficult on many levels in part because it’s not visible, you know If you’re walking around with a with a cast on your leg and hobbling People have compassion. They see you. They open doors for you. Whatever if you’re walking around depressed after a very short period of time Even the people that love you are like suck it up or get on with it, you know damn, it gets you where’s your energy to do something look and That’s a natural reaction difficult difficult depressions even suicidal depressions. They They’re battered by that and it accelerates and exacerbates the issues that they struggle with so Depression as a treatable illness is a complex compound problem. It’s almost always comorbid You almost always have depression with anxiety or panic attacks. Once the press is the other but they’re both there So the antidepressant drugs There there are four classes of them that have evolved so far The the first was what we call the MAOI inhibitors mono amine oxidase inhibitors the second Evolution was a group of drugs called tricyclics, which was like in the 60s The third was a group of drugs called SSRIs selective serotonin reuptake inhibitors That’s the 18th news and the fourth is selective neuro tonin reuptake And the way they all are believe that to work is it’s a Way to help the brain not Reabsorb it well in the brain is full of all these nerve endings and millions and millions of thousands of nerve endings that are the create what we call synaptic cleft the nerves look kind of like a String with a Y on each end this point at each other and there’s an electrochemical impulses that makes this nerve spasm and it shakes loose little chemicals that flow out into a solution and those drift around in the solution and then become reabsorbed on the other side that Causes that balance to change and that impulse to kick it’s a chemical communication between the two nerves and that chemical. Yeah It’s usually serotonin sometimes dopamine shall findeth norepinephrine so that cool that solution that they swim in Is the critical ingredient and all of these drugs operate in different ways on different I mean What am I I don’t know what you’re thinking but the but the nerves all use different neuro Transmitters which is what we call them. But once that fluids out there, yes, then the nerve that Developed that that secreted the fluid picks it back up, right? Okay, so it reabsorb it up to so that’s called reuptake. So when we talk about SSRIs that’s selective serotonin reuptake inhibitors, so that means it’s these two nerves are bathed in the neurotransmitter longer before it’s Retaken up. So you’re producing the serotonin or the dopamine or the norepinephrine and these certain? Specifically serotonin and they serotonin uptake rehab inhibitors, but it stays there longer so it gives you more elevation of more volume of those things that you have the better you feel And it’s really hard to get that balance inside the brain because there’s no delet direct delivery Method for putting the chemicals in the brain, right? So they have to give you thoughts or pills your body has something called the blood-brain barrier, right? so between your blood and the brain There’s a barrier and you have to and there’s only specific things that can actually transmit from your blood to your brain It’s why you don’t get a brain infection every time you have septicemia or an infection throughout your body It protects us, but we can’t deliver Drugs there except we’re delivering something to make the serotonin. Stay there longer Yes, so we’re not delivering serotonin, right? And so they use these drugs They’re called antidepressant drugs, but they use them for things like panic attacks PTSD and Rexie of bulimia. That’s the things the Parkinson’s PMS PMS Yeah, so you may be taking an antidepressant and you do the research and find out Oh my god standard, press I’m not depressed But but there’s a whole cluster of things that they throw these drugs at and they have concerns about side effects and You brought to me an article from a medical journal, which you read for entertainment all these medical terms all these medicines I mean to talk you about. Yeah, I know I know I need to read this is the American Journal of thing the American Journal of Psychiatry. Yeah, that’s like reading for Sunday. Yeah So but you came to me with this article which led us to have this discussion about antidepressants And and why they choose what they choose what the balances are what the issues are. So the article is about antidepressants in older adults people The average age was 70 in this study because often times We get more and more depressed as we get older because we kind of run out of neurotransmitters. Well This the the serotonin reuptake inhibitors and the other antidepressants Don’t work quite as well as we get older they so they are looking for something that makes them work better So they’ve added an amphetamine called Sorry meth Bennett methylphenidate, which is what we use for a DD. They’ve added that to The antidepressant and they found that it bumps it it makes it work better in people who are older Speech them up. It’s it will it speeds them up? But it also makes our serotonin Increase and their norepinephrine which makes their mood better Yeah, but if you think about it You remember in the 70s when all all the mothers except my mother on the block was they were all taking? Diet pills well diet pills are amphetamines. And so they were they keep you focused they make you work hard They keep they stimulate norepinephrine in your brain and they have a mood elevating effect. Now, these are not not Against the law these are prescribed by a doctor, but we’ve used a lot of them then just like we now use a lot of Antidepressants, but they have the benefit of also Decreasing your appetite. So most of the women in the 70s that were my mother’s age were skinny as they were taking this But they were always happy. It’s kind of a Stepford wife thing. But so we’re doing the same thing now. We’re giving everybody Antidepressants for everything and unfortunately, it doesn’t make you thinning it makes you gain weight So that’s not always a good one of the SATA tech issues with most of those types of antidepressant All for clusters is weight gain But but if you’re if you’re older and your antidepressant doesn’t work anymore and your doctor switching you between antidepressants This is this is awesome. And I’ve seen a lot more patients coming in with a low dose of an amphetamine with their Antidepressant to help bump it so that it works better for mood It also helps you with weight, but also it also just makes it work in people who it doesn’t work for inch anymore So that was what the article was about That was that made me feel better because I’ve been doing this with patients a long time using a very benign Time-release diet pill to add to their antidepressant so that it would work better for them and they aren’t all elderly either Made them help help them focus gave them energy if and that’s what I did prior to doing hormones I don’t have to do it quite so so much anymore now that I can give testosterone Mm-hmm, but we’re going to go through the different types of antidepressants. Okay, because the article itself is just if it’s not working then try methylphenidate or some other or Some other and I don’t want to go through the list of amphetamines But they are there other ATD type drugs instead of but in addition technicians balancing effect with the drugs talking about mao inhibitors They were the first class of drugs that were evolved for treatment of depression, but there were concerns about mao inhibitors email wise because there were thought to be Lethal problems regarding food consumption Yeah, there’s a lot of foods you can’t eat and I mean a lot of fish a lot of restrictive things. You can’t take wine Dark heavy with red wines, right? You can’t Jesus a lot of nuts All that’s all nuts. You can’t have any nuts in any chocolate Right you took chiming chocolate, you know, I’m pretty restricted No wine, I mean that’s that’s really restrictive and then people would cheat and then they get sick yes, they didn’t die or they didn’t know there was wine in something or you know like a If you had a salad dressing, you know, I mean or aged balsamic vinegar. Yes, some of that would be pretty something that you could not do if you had a mono, I mean so in doing research for this conversation, we were looking into that and the Research data is now starting to break Mao is down into two clusters Mao Mao Mao B. They’re using primarily for Parkinson’s symptoms But the Mao B’s don’t have the same food and diet restrictions and let’s say that extremely high dose You could be taking those and you wouldn’t have the worry about if you ate some cheese or had a glass of wine But as we were looking we weren’t able to find any specific Mao be on the market for general consumption Well, there is there is for Parkinson’s but we couldn’t find it for as an antidepressant So it must not be I mean I didn’t go to the FDA website yet, but it must not be approved But it could be used off-label If you were if the only thing you could take for depression was an MAOI Then you could ask for one of the Parkinson’s drugs off-label. It’s it it works It’s just not approved by the FDA yet for depression So that’s something that’s that That would be helpful. If that was you know, it’s a if that’s what you’re taking that’s the only thing that works so Usually if you’re on that nothing else is working, right? So tricyclics There’s a lot of tricyclics out. There. We we use it for chronic pain amitriptyline is one of them I see a lot of people on it for sleep pain Relaxation at night before they go to sleep Because they get anxious so you use that bit that makes women gain weight. I don’t know about men I don’t have very many men on it, but But in general it makes women gain weight even at a low dose So that’s never helpful for depression because well that makes us more depressed when we’re gaining weight So that’s the second Yeah, so I’m taking something that depresses me for my depression right and and all of these mess with your sex drive With your sex drive all of them Goes away which again for me is inherently depressive Yeah, of course, it would be we all like the the high that we get from the oxytocin that we get from having sex Hey, and if we aren’t getting those chemicals start up on our brain, then we’re not getting that high Oh, man, there’s a sense of loss and there’s damage to the relationship and so and so We’re talking about antidepressants But which a very thin line just like water bugs dampen. That’s all you need not be I mean, it’s never a good idea to go off your antidepressants cold turkey, so we are not Suggesting anything like this. We’re just giving you enough information So you can talk to your doctor about it and change doesn’t change types chains change something if you’re not how that’s a good point that we probably should expand a minute that when you take a new antidepressant they will tell you to be patient that it takes between 11 and 13 days for your metabolism to Reset itself in response to the Senate repressive. So they’re Picking at a cluster of things. We will try this for you. I’ve had success with teenagers taking this drug looking at our 11 box appendix on Prozac But older people I don’t want to get a project to only give something else to so there’s because the doctors have raised yeah, because the Baxter increases norepinephrine if you have high blood pressure that might be a problem. I mean, you know, there’s there’s there are Specific qualities for each antidepressant so they’re not just going. Oh, we’re just gonna flip you around to some antidepressant They have a reason that they’re changing. Yeah, but it feels to the patient like they may be playing roulette, but we’re not Yeah, I take Nord L for three weeks and I don’t feel any better so then they said we have to wait a week to get all the gnar deal out of your system and then we’ll try your Prozac. It’s a very difficult thing to find the right anti-venom so it may be four or five months out if I’m a complicated case before I’m gonna feel any better by discovering the right drop and That causes people to say oh and depressors don’t work for me I can’t take them which is another good reason to add and then offend me because they work right away. Yes, I mean They work right away while you’re waiting for the antidepressants and start I mean, it’s very possible that that might be approved for other people that are older in the future we should do a podcast about taking or returning all of your medicines because people have this this Magical thinking idea about keeping medicines in the medicine cabinet when they no longer take them. You know, they don’t take the full dose there and oppresses or they get changed, you know, you changed me from benadryl to Something else. I put it in the medicine cabinet Eventually, I may throw it away. It gets into the system. It gets into the groundwater it gets into the cattle You know me all these there are concerns about Managing medicines that people don’t use and that’s a podcast for another day But especially with things like Ana depressant something you don’t want those. Oh You’ve got some and you’re teenagers acting funny should just give him one, you know, you know, well, that’s an absolute no-no these things Yeah, these are no and you can’t go off of them patients will say well. Yes Yeah, after a month appellate their moods back up because they’ve got their hormones back Oh, I just stopped that and then I felt terrible. So it must be the pellets I’m like, yeah, he just cold turkey dogs wellbutrin or or one of one of the ones that requires some weaning We do that to two children ahead AED when I’m was on Flex teen one of them was horn That’s okay But different different time differently and they ran out of prescription for the one so they just gave one of the other kids pills Yes, I know There is a reason that we choose a specific Medication like this for specific people. Yeah, and we look at your whole. I mean you should have all of your medical history textbook at all, which is All four years, right and then he started having heart issues as response to so they transferred him to a different drug Copeland We doesn’t have those issues But they may saturate on focalin at some point And they will have to transfer to another I mean it is possible that you have to change from from one Medication to another over time, but he was growing up too. So as he was growing up his his neurotransmitters were changing So he didn’t he just didn’t have the same response to that drug as he did to the focalin But one of the things that you should remember also before before anything Before you get on an antidepressant unless it’s an emergency is that there are medical conditions that cause depression that should be ruled out before you start an antidepressant unless you’re suicidal and that is hypothyroidism and Hypothyroidism causes depression people are very depressed on low thigh when they have low thyroid So if you have a goiter or a thickness in your neck And your hair is falling out and you’re constipated and you have no eyebrows out here and you’re depressed That’s most likely thyroid and not just a depression like not making enough of the hormone in your brain You’re not making enough of the thyroid which stimulates the hormone in the brain. So that’s one tweet So chemical imbalance in the brain, right? It causes the same problem as depression It’s just that what’s the source and do you want to treat the initial problem? Which is thyroid or do you want to treat the symptom which is depression, right? So the second thing is low testosterone and that usually occurs but not always in Women over 40 men over 50, but I’m sure I’m seeing a lot of men in their 40s with low testosterone It’s starting to creep down to the 44. That’s terrible. I’m so sad that that’s happening But a lot of men who are younger are getting this as well, so if that’s the case Then you need to replace the testosterone in the best manner that you can I mean there are prescriptions for men For testosterone none for women, so we have to go to the compounding pharmacies for testosterone for women But replacing it improves your mood. Mm-hmm. That is that’s an excellent Antidepressant if that’s the reason you’re depressed you should treat the treat the problem and not the symptom low cortisol, which is What everybody calls adrenal fatigue? That it causes depression. You don’t have enough cortisol, then you can get very depressed and very well, usually you’re very fatigued like feel like you just got rung rung out like you’re just a rag that just got Just wrung out and you have no energy left. That’s adrenal fatigue that can cause it as well So that has to be treated before you go on the antidepressants and lastly low growth hormone which I think is what’s going on with some of these older patients because I Treat test I treat low growth hormone with testosterone because it stimulates growth hormone So it doesn’t naturally without any side effects of high growth hormones such a politically explosive Constant in today’s marketplace is to give people growth hormones, right? So I’m not giving them growth hormone I’m giving them testosterone which stimulates growth hormone yet there But when you get older that doesn’t work your pituitary doesn’t keep making growth hormone because you’re taking testosterone So oftentimes somebody over 70 might need to take. Mm-hmm anything else So that they’re not depressed and they still have to keep their muscle mass and they still can think so They may have to take testosterone and a stimulant stimulation Medication called Sur m’ling which is not growth hormone Right, but it is compounded and you can take it sublingual layer as a shot and that stimulates growth hormone And that’s usually when for my patients are all in testosterone So that’s usually when the testosterone no longer is making growth hormone work McKenney. I have a concern about that because what not saying that everybody needs specialist for everything but Medicating the elderly is an art form and assigning their often Their metabolism slow down so radically that a standard dosage for most grownups Is it metabolized in the same way so balancing dosages for the elderly? It was why? I don’t really want to play doctor anymore. I can’t do those things You don’t have it You know I’m talking about when I was a kid, how do you say you won’t play doctor Oh that but learning from you the things that you do you have to know that you have to worry about the up to juggle It’s way more complex than I would ever want to go. I’m amazed that anybody wants to do it But and I said that find somebody wants to do it really well. Yes well All of these things are medical things It should be ruled out before you get an antidepressant hand it to you because if you don’t rule this out Then you’re just treating the symptom You’re not treating the cause and then there’s gonna be other things especially if you’re middle-aged and it’s it’s easy Because in middle age there are lots of life changes children grow up and leave home people get divorced Retirements staring you in the face major changes in your life. All those things can cause depression too But so can your thyroid being out of balance? So can your testosterone being a lot of those things have variants being flooded? absolutely, and so again You need to find a good doctor who will go through this process and take the time To look at what’s going on in your life and going on with you to find the right answer for you. There’s some psychiatrists It’ll go through all these hormone levels as well But when they put you on an antidepressant or on an amphetamine, so it’s not just primary care. It’s just just Endocrinology or somebody like me which is age management. So it’s not just That type of doctor that does it’s like if some psychiatrists are really great at nutrition. They’re really great at at Ruling out other illnesses before they treat so you could pursue that Before before or while you’re on an antidepressant to help you treat the the cause of the depression. Sometimes it’s just That’s you don’t have enough serotonin. Just like any lack of hormone You just don’t make enough It has nothing to do with anything else Right and it may not have to do with your life or like my favorite statement that I hear all the time is My life is perfect. I don’t know why I feel so bad. Yeah, so I mean if you have a perfect life, thank God. Yeah But if that’s the case then if that depression is being treated That could just be a genetic inherent depression or it could be your hormones I hear in counseling that they they shouldn’t have these bad feelings because their life is so good, right? Everything’s so fine You know that they give like Skyy comparative grief, you know your husband died But my dog died and I’m feeling terrible, you know, there’s no sugar out there. You can’t do comparative grief Well, it’s not your pain is your thing. Exactly. Nobody’s you can’t compare one grief to another I mean everybody has their own so getting treatment in because a lot of general practitioners and family doctors will give antidepressants based on Fluctuating symptoms to somebody’s life if I’m going through a divorce I may get a low-level dosage of an oppressor from my regular doctor and They do that, but they don’t die They don’t prescribe and what we call clinical levels of these antidepressants when you start to get into more serious need states then they’re gonna refer you to a psychiatrist or somebody that specializes in Knowing enough about these players everybody dangerous prescribes these serotonin Reuptake inhibitors because they have so few side effects Well, but one of the shots is for adolescents and children There’s potential suicidality, right so which is not a reason not to give it to them But it’s a reason to monitor them. They know what you’re I was really talking about adults Okay, you know adults. I mean often times people I mean almost everybody who comes to my office is on an antidepressant for has been on one who story one reason Repeated teachers lounge one time I was doing a faculty consultation on classroom discipline and the teachers were all sitting around having a conversation and one of them suddenly slapped herself in the head and said, oh my god, I forgot to take my Prozac and five teachers over there person said you want one of my Oh Great that’s yeah. Well, that was the panacea. Yeah Yeah, everybody had like, you know, they moved away from valium in the 60s It started going into that’s what that’s what led into that That’s so glad to Prozac. But you know, they went from the amphetamines to the SSRIs too, so we don’t we’ve changed how we treat things but But the problem remains the same depression is a problem and I can see it in people. Yes I look at I look at somebody’s eyes and if their eyes don’t reflect back at me, that’s depression I mean, it’s not dry eyes. It’s larger into the lights The lights aren’t shining back and so it’s funny to be able to now recognize that in people It’s not when they’re treated. It’s it’s when they’re not treated. It’s when their depression is untreated. So there are treatments they vary and type and dosage and causation it’s not always just because there are things going on in your life that that you’re depressed about can be that but it can Also be because you have medical conditions that have led to chemical imbalances in the brain that mean that you are chemically depressed and and We find patients that struggle with being able to admit. You know, I’m a man. I’m supposed to be tough I’m not supposed to be depressed. That’s a wuss. You know, I’ll fight my way through it You can’t necessarily do that or you can’t ignore it either. I mean really you’re like your quality of life decreases Drastically and the quality of your your family lives decrease if you’re depressed It really does spread through the whole family unit or whoever you’re living with and what led us to this conversation today was an opportunity based on research that we have found to remind people that sometimes as you age the Antidepressant is not the only solution you need the antidepressant You also need some other additive drug them typically in the speed category the Infinity category to find the right balance of Stimulating energy while you wait on the mood to come back and it’s like a chemistry set. You need a good doctor Who knows what they’re doing and who will work with you and take time with you to treat your symptom and get you better They need them all the time after it comes back. They leave them on there that means because they find that it’s much more effective Sour as always. Thank you for listening. Thank you Email your questions or comments to podcast at biobalancehealth.com You can find the biobalance healthcast on iTunes and on YouTube for more information about bioidentical hormone pellet therapy and other reverse aging solutions visit biobalancehealth.com or call 300-499 3 0 9 6 3 You can find dr. Maupin on twitter at dr. Kathy Maupin and on facebook at facebook.com Slash biobalance health find Brett Newcomb at brettnewcomb.com

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