How Come They're Happy and I'm Not? (34 page)

In addition to identifying whether or not you or a loved one is suffering from depression, it is also important to be aware of the warning signs of suicide, so you are forewarned and can act to prevent this tragedy from happening if the signs begin to manifest. A family history of suicide or a previous suicide attempt places one at increased risk of suicide. In addition, the warning signs of suicide are:
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• feelings of hopelessness, worthlessness, anguish, or desperation
  
• withdrawal from people and activities
  
• preoccupation with death or morbid subjects
  
• sudden mood improvement or increased activity after a period of depression
  
• increase in risk-taking behaviors
  
• buying a gun
  
• putting affairs in order
  
• thinking, talking, or writing about a plan for committing suicide
  

If you think that you or someone you know is in danger of attempting suicide, call your doctor or a suicide hotline or get help from another qualified source. Know that there is help and, though it may be difficult to ask for it, a life may depend upon it.

References to depression (melancholia) as a medical condition date back to Greece in the fourth century
B.C
., with the writings of Hippocrates, the “father of medicine.” In ancient Greece, melancholy came to be considered an excess of black bile, one of the four humors of the body (blood, black bile, yellow bile, and phlegm) believed to regulate health. As black bile was also considered the driving force in creativity, melancholy had a positive association with the creative temperament. By pointing out the many poets, artists, politicians, Greek heroes, and philosophers, including Plato and Socrates, who were of a melancholic nature, Aristotle perpetuated a positive view of the condition that continued for centuries.
³³

As melancholy began to be viewed as a condition to cure, in the late fourth century, various methods, including bloodletting, were used to eliminate the excess black bile from the body. This approach lasted into the 1800s, when the humoral theory fell out of favor.
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In the late 1800s and early 1900s, the German physician Emil Kraepelin studied and documented mental illnesses, providing the foundation for modern psychiatry. Its focus on diagnosis and classification comes from Dr. Kraepelin.
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The belief that psychological factors were the cause of depression arose from the work of Sigmund Freud and began to gain cachet in the American medical establishment in the 1920s.
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The advent of antidepressant medications in the 1950s transformed the psychiatric field, shifting the focus of the causality of mental illness from psychological to biochemical, and turning the profession into a pharmaceutical industry. The idea that psychological factors may contribute to depression has not been completely dismissed, but the small percentage of money devoted to psychotherapeutic treatment in the total amount expended in the treatment of depression shows where the overwhelming emphasis lies.

The current conventional medical view is that depression is a brain disorder caused by a deficiency in neurotransmitters, the
brain's chemical messengers that enable communication between cells. While there are many different kinds of neurotransmitters, the primary ones involved in the regulation of mood are serotonin, dopamine, epinephrine/norepinephrine, GABA (gamma-aminobutyric acid), and L-glutamate.

Contrary to popular belief, serotonin is not found only in the brain. In fact, only 5 percent of the body's supply is in the brain, with 95 percent distributed throughout the body and involved in many functions.
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Serotonin is similarly distributed throughout the brain, where it is “the single largest brain system known.”
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In addition to influencing mood, serotonin is involved in the regulation of sleep and pain, to name but a few of its numerous activities.

Dopamine has a role in controlling sex drive, memory retrieval, and muscles, in addition to mood. GABA operates to stop excess nerve stimulation, thereby exerting a calming effect on the brain. Two important functions of L-glutamate involve memory and the curbing of chronic stress response and excess secretion of the adrenal “stress” hormone cortisol. Epinephrine (also known as adrenaline) and norepinephrine are hormones produced by the adrenal gland. Epinephrine is involved in the stress response and the physiology of fear and anxiety; an excess has been implicated in some anxiety disorders. Norepinephrine is similar to epinephrine and is the form of adrenaline found in the brain;
³⁹
interference with norepinephrine metabolism at certain brain sites has been linked to affective disorders.
⁴⁰

Serotonin, dopamine, and norepinephrine are monoamines (they are derived from amino acids) colloquially known as the “feel good” neurotransmitters.
⁴¹
As such, they are the target of antidepressant drug action. Prozac, Paxil, Zoloft, Luvox, and Effexor are what is known as SSRIs, selective serotonin re-uptake inhibitors. They block the natural reabsorption of serotonin by brain cells, which boosts the level of available serotonin. SSRIs are relatively new arrivals on the antidepressant scene; Prozac was introduced on the market in 1987.

Earlier categories of antidepressant drugs are tricyclics and monoamine oxidase inhibitors (MAOIs). Tricyclics such as Elavil,
Adapin, and Endep inhibit serotonin re-uptake, but block norepinephrine re-uptake as well; thus, they are less selective than SSRIs. MAOIs such as Nardil and Parnate act by inhibiting a certain MAO enzyme that breaks down monoamines; the outcome is more available neurotransmitters.
⁴²

The theory that neurotransmitter deficiency causes depression is known as the “biogenic amine” hypothesis. While the model recognizes that imbalances in amino acids (neurotransmitter precursors) produce the deficiency, amino acid supplementation is not the conventional medical solution. “These amino acids have proven to be effective natural antidepressants,” states Michael T. Murray, N.D., author of
Natural Alternatives to Prozac.
⁴³

Despite this, the focus of conventional treatment is expensive pharmaceuticals. “Perhaps the main reason [the biogenic amine] model is so popular is that it is a better fit for drug therapy,” notes Dr. Murray.
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Contrary to popular belief, the newer, more expensive antidepressants—Prozac, Zoloft, and Paxil—are no more effective than the older antidepressant drugs, according to a report issued by researchers for the U.S. Agency for Health Care Policy and Research and the U.S. Department of Health and Human Services. Not only that, but research has not established that any drug produces better results than psychotherapy as a treatment for depression, the report reveals.
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Antidepressant drugs are problematic for a number of other reasons as well. It is sufficient for the purposes of this book to cite only two. First, the adverse effects (euphemistically known as side effects) of antidepressants can range from uncomfortable to untenable, although some people who take the drugs experience no side effects. With Prozac, for example, adverse effects include nausea, headache, anxiety and nervousness, insomnia, drowsiness, diarrhea, dry mouth, loss of appetite, sweating and tremor, and rash.
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Flattened or dulled feelings and sexual dysfunction are common effects of taking SSRIs. In addition, the anxiety and agitation induced by SSRIs can result in patients increasing their use of alcohol and other substances for calming purposes.
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More serious, there has been very little research on the longterm effects of taking SSRIs. It is known, however, that they can produce neurological disorders, and permanent brain damage is a danger.
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Second, and perhaps most important, antidepressants do nothing to address the deeper causes of depression. Why are the amino acids and neurotransmitters out of balance? What caused that to happen? What are the other factors involved in the depression of this particular individual?
Chapter 2
looks at the many causes of depression, which can serve as a starting point for answering these questions.