Antidepressants

I’m not surprised when a patient tells me she doesn’t want to take antidepressants.They make some people gain weight, and some lose their interest in sex or find it more difficult to have an orgasm. Others just don’t want to take a drug that mucks with their brains. So my interest was piqued by a recent article in The Wall Street Journal that discussed a “backlash against antidepressants sparked by concerns about their safety, efficacy, and side effects [that] is helping drive patients to alternative methods.”

Given what I do for a living (check the byline), my own bias is in the direction of therapies that have been rigorously tested for safety and effectiveness. However, for patients who can’t, won’t, or simply prefer not to go with conventional medicine, a prudent trial of an alternative therapy, like acupuncture or valerian, might be worth considering. But are these alternative approaches truly effective? That’s a tough question, and it depends on what you mean by “effective.”

For a drug to be effective it should work better than a placebo, but in most drug studies the placebo itself often has a measurable success rate—often around 20 percent. Thus, even if an alternative therapy is no more effective than a placebo, you’re still left with a one in five chance of feeling better at the end of the day. For some people, even this 20 percent chance of feeling better is worth it.

So As Not To Stress

Nobody likes stress. Not only can it cause sleepless nights and irritable days, we all suspect, at some level, that it can’t be good for our health. Now we can add another reason to reduce the stress in our lives: It may impair our thinking when we’re older, adding tarnish to the luster of our golden years.
A recent study in the journal Neurology concludes that people who experience chronic psychological distress, such as anxiety or depression, are up to 40 percent more likely to develop mild cognitive impairment (MCI) than people not prone to distress. What is MCI? Well, it’s not dementia, but it does represent a measurable decline in thinking ability and may affect more than 15 percent of the older population. Now before you stress out about being stressed out, take a deep breath and keep reading.
In this study, more than 1,000 older people without any cognitive impairment were evaluated for their tendency to experience distress. This group was then assessed annually (for up to 12 years) for signs of MCI.

The study found that psychological distress did not appear to correlate with age, education, or gender. (It’s nice to know that stress is such an egalitarian problem.) But people with higher distress scores tended to have more depressive symptoms. And those participants with the highest distress score (in the top 10 percent) were 42 percent more likely to develop MCI than people with the lowest scores.
Is all this new? Well, not exactly. People who are prone to chronic distress have been shown to be more likely to develop Alzheimer’s disease. They also are more likely to have their thinking decline at a faster rate.
What this study doesn’t tell us is how chronic distress leads to the development of MCI. The authors of the study have some ideas: Perhaps being prone to chronic distress is one of the earliest signs of having MCI. I find this idea less than appealing, because it suggests that the horse is already out of the barn when it comes to chronic distress and the development of MCI. Fortunately, the authors believe there is a more likely explanation.
Their leading theory is that stress has adverse effects on the parts of our brains that help us form and keep memories. They point out that there is evidence that stress has been shown to reduce our ability to form memories, and that severe stress—like post-traumatic stress disorder—may cause changes in the memory-forming parts of the brain. I find this a far more appealing theory, as it’s based on studies of how our brains work and gives us a chance to "turn things around" by dealing with chronic distress in a positive way.
So for now, let’s focus on what we do know: that reducing the stress in our lives is good for lots of reasons. First off we’re happier, as are the people around us. It’s good for our complexions, probably good for our hearts, and maybe even good for our brains. Don’t sweat the small stuff and don’t let the small niggles become big problems. Whether you exercise, meditate, talk to a therapist, or just spend time on the beach, managing stress is a great investment in your short-term and long-term health.