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Thursday, July 7, 2011

Antidepressants, Serotonin, You and Me

Just wait a minute! Don't take that pill just yet! So you were at your primary care clinician's office getting your annual check up and you mention to your practitioner that you've been "out of sorts, kind of depressed, not myself." And before you know it, without further investigating your feelings, your clinician hands you a prescription for paxil or prozac or celexa or lexapro or zoloft or luvox. All these medications are antidepressants and known as SSRIs (Selective Serotonin Reuptake Inhibitors). Sounds fancy right? Sounds like a sure bet for happiness right? Well let's do a little more investigation.

Dr. Axelrod won the Nobel prize in 1970 for his research that led to the development of the SSRIs. The discovery of serotonin was a very cool thing because psychiatry became hopeful that they could now "cure" depression. Psychiatry thought they would be accepted as a legitimate arm of medicine because depression was actually a "medical illness," a "deficiency of serotonin." So quickly, the pharmaceutical companies got to work developing the SSRIs, medications that affect serotonin. The SSRIs simpy put, inhibit the reuptake of serotonin, thus allowing a build up of the serotonin.

Serotonin is in your blood. It works in your central nervous system. Serotonin affects mood, emotion, sleep, and appetite. But guess what...90% of your serotonin supply is in your digestive tract and in your blood platelets!  So when we look at the side effects of the SSRIs, we can understand it.

The side effects from too much serotonin include insomnia, rash, muscle pain, bleeding, sweating, anxiety, and GI distress like nausea, diarrhea, vomiting, upset stomach. Well these make sense now that we know that serotonin works in the belly and works in the brain on mood, emotion, sleep, and appetite! In other words...too much serotonin can make you sweat, can make you anxious, can make you bleed, can make you have diarrhea, nausea, vomiting. And...the most annoying side effect...decreased sexual interest, desire, and performance.

There's a cool study that found migraine patients have a higher sex drive. Hmmm...you say?? Yup, it's true! People who suffer from migraines have low levels of serotonin. And people with low levels of serotonin have normal or higher than normal sex drives. So if you increase your levels of serotonin with an SSRI, you will decrease your sex drive!  I bet your primary care clinician didn't explain that to you!

Well all the hype about serotonin seems to only be good news for some of the people some of the time. Some people don't need more serotonin and some people can't tolerate having increased serotonin.  

So what should you do if you feel depressed? Should you try an SSRI? Well you should definitely try meeting with a psychiatric nurse practitioner. Because there just isn't a magic happy pill out there. And what may work for one person, may not work for another. Do you think low levels of serotonin cause depression or does depression cause low levels of serotonin?  I sure don't know! But what I do know, is that when I meet with a client, together, we take the time and seriously examine all aspects of your health, your activities of daily living...what makes you tick.  Sometimes the SSRIs work and sometimes they don't. Well how is that possible? If all those science and doctor dudes said serotonin is the thing that makes people depressed...why doesn't it work all the time for all the depressed people? Because maybe you have a dopamine issue. Or maybe you have a specific life event that's caused you emotional difficulties. Or maybe you have a norepinephrine issue. So maybe depression isn't just a serotonin problem.

Dr. Axelrod gave us a good start.  But I think each person is unique and has very specific reasons and chemistry's and histories... that together, may cause mood disorders. So be good to yourself, don't just take that prescription from your primary care clinician, ask for a referral to a psychiatric nurse practitioner and explore what's really going on in your mind and body.