Posted 04/07/2014
The statistics are simply staggering. The National Institutes of Health estimates that more than 20 million people in the US, roughly 10% of the population, have depression, defined as a recurring major depressive disorder, a constant state of depression (dysthymia), or bipolar disorder. Officially, these three are called mood disorders, considered separate from anxiety disorders such as generalized anxiety, panic attacks, social anxiety, post-traumatic stress disorders, obsessive-compulsive disorders, and phobias. Anxiety disorders affect another 40 million Americans.
Add them together and you get a stunning 60 million people, or roughly 28% of the US population. The DSM-IV separates mood disorders from anxiety disorders because the treatments are different. Although both are helped by counseling, the techniques used for depression and those for anxiety differ considerably. Both are also helped by some of the same medications. Antidepressants were originally FDA-approved only for depression until years later they were found helpful for anxiety. On the other hand, anti-anxiety meds, like clonazepam, can be harmful for a depressed patient unless he or she has a mixed anxiety-depressive disorder.
These numbers certainly match pharmaceutical industry data. At this moment, roughly 10% of Americans 11 and older are taking an antidepressant, either with or without an anti-anxiety med (for anxiety) or a mood stabilizer (for bipolar disorder). Among new patients at WholeHealth Chicago, a majority report having taken one or more antidepressant or anti-anxiety meds at some time in their lives. Many have been taking them for years, the original prescribing physician long forgotten, the drug on automatic renewal, apparently for the remainder of their incarnation. As you might expect, health insurance companies are especially fond of this scenario. If you remain nice and placid on a generic drug for years, you won’t be bothering them about paying for the more costly talk therapy.
Some of these medicated/formerly medicated patients were once in talk therapy, which they grade like Yelp reviews from “wonderful” and “life changing” to “useless–my therapist needed more help than I did.” Helpful or not, many of these same patients continued taking their medications long after they stopped talk therapy, talking to their therapist (who as a non-MD could not by law change their prescriptions) on an as-needed basis. Once medicated, these patients had been advised to see their prescribing doctor every few months, usually a ten-minute visit invariably ending with “I think you should stay on your meds.” In other words, there was no encouragement to get off the meds or try any other approach.
Another group of patients come to WholeHealth Chicago for the first time either self-diagnosing their depression or with an unfilled antidepressant prescription in their pocket or purse. They’ve never liked any medication and are reluctant to start taking one that could affect how they think, be a problem stopping, or have side effects. They want to know if there might be something else.
Oh yes, let’s not forget the side effects of antidepressants, which for most patients are downplayed when they first receive a prescription, the “so many side effects, so little time” phenomenon. Doctor visits are often short, while the list of side effects can be very very long, like the drug commercials you see on TV, happy people walking along a riverbank while a grim list of side effects is read in hushed tones with the speed of a cattle auctioneer.
The three most common side effects of the SSRI antidepressants (like Celexa and Zoloft) are personality change (“I feel numb,” “I became a zombie,” “I’m not crying anymore, but I’m not laughing either”), weight gain (suddenly I gained 25 pounds), and loss of interest in sex (or inability to achieve orgasm). Meds that target norepinephrine, the SNRIs, toss in nausea (“Only in 25%,” said a cheery drug rep), Cymbalta renamed Cymbarfta by many users. Just about all wreak havoc when you go off them, a smorgasbord of symptoms euphemistically termed “drug discontinuation syndrome” (withdrawal, which is what’s actually going on, is such a harsh word) in which waves of depression hit you while fireworks, called “brain zaps” by victims, explode in your head. You can go off these meds but you have to go slowly.
Acupuncture, an alternative to juicing your brain chemicals
For decades articles about the effectiveness of acupuncture in treating depression and anxiety have appeared in Chinese medical journals, but it’s been just in the last few years that English-language journals have followed suit. The largest of the controlled studies in the West was recently published in England, appearing in late 2013. Researchers gathered from 27 primary care practices a total of 755 patients who had been diagnosed with moderate to severe depression. Of these, 69% were on antidepressants at the start of the study but remained depressed. A little more than one third of the 755 started a 12-week course of acupuncture, the same number started talk therapy, and the remainder stayed the course, dutifully taking their meds if they were on them. No medications were added or removed throughout the study.
By the end of 12 weeks, the acupuncture group reported the greatest improvement. However, six months later, the talk therapy group caught up. And, interestingly, a full year later all three groups reported the same degree of improvement, reflecting the idea that depressive episodes will eventually clear up no matter what you do. What the study did show is that using acupuncture, your depression will improve faster.
How acupuncture actually works for depression (and like anxiety as well) may be explained in this scholarly article published in China two months ago. Working with lab animals, neurophysiologists discovered that certain acupuncture points increased the brain’s production of norepinephrine and serotonin, the very same neurotransmitters activated by prescription antidepressants. Unlike medications, however, which cause rapid rises of neurotransmitters (this can be quite uncomfortable), the increase with acupuncture was slow but steady.
What’s best for you?
Every patient is different, and thus sweeping generalizations aren’t in order. However, if you struggle with depression, you’re medication averse (either as a philosophical issue or because of a bad experience), and you’re currently not taking medication I’d suggest this combination:
- Work with a psychologist or psychiatrist familiar with alternative therapies who doesn’t look like a deer in the headlights when you mention acupuncture or herbs.
- Start taking St. John’s wort (450 mg twice daily) with 5HTP (100 mg at bedtime) to gently increase your brain’s serotonin. A British Medical Journal article estimates this combination to be as effective as 25 mg of Zoloft (sertraline), but without the side effects.
- Meet with an acupuncturist who’s familiar with treating depression. All three of our WholeHealth Chicago acupuncturists–Mari Stecker, Cindy Kudelka, and Helen Streitlemeier–have considerable experience with this.
Patients often ask if acupuncture for depression is covered by their insurance. The answer is probably not. When insurance does cover acupuncture, it’s usually for physical pain only. Never having experienced any form of emotional pain themselves, to an insurance company your psychic pain does not exist.
This Health Tip gives me a perfect opportunity to introduce for the first time Marisa Serrato, MD, who’s joining WholeHealth Chicago later this month. Dr. Serrato is one of a handful of board-certified psychiatrists in the US who is also board certified in integrative medicine.
She’s already met with our staff and spoken at length with our psychologists, Dr. Janet Chandler and Dr. Meghan Roekle, who, like me, are extremely excited about working with a psychiatrist who’s familiar with the language of alternative medicine.
More to follow, and be well,
David Edelberg, MD