DEPRESSION, STRESS AND THE AMERICAN DREAM
By the time she was twenty-one years old, Siomara Melina had been taking drugs for depression for six years. “At one point, I was given Buspar,” Melina explains, referring to the trade name for buspirone, a drug with more than 160 listed possible side effects.1 “It’s supposed be like an anti-anxiety drug but is more like a tranquilizer. I was also on clonazepam for my anxiety, Wellbutrin for an antidepressant, trazodone for sleep, and then my doctor put me on Lyrica, which is an anti-seizure medicine. I would try something and tell them it wasn’t working, and doctors would be like, ‘Okay, let’s try Zoloft, let’s try Dexedrine.’ They just give you the hardest drug to try to kind of fix you. A lot of doctors don’t really listen. It’s frustrating because these things make you feel sick.”
Neither Melina nor her mother, who live in Victoria, British Columbia, in Canada, had a clear idea of whether they were getting the right medical advice, but they felt desperate. “I was young and took what the doctor gave me,” Melina says. “I was really depressed and having anxiety attacks at school, and I was self-harming a lot, and my mom noticed and took me to the doctor where I was put on my first med. It was Prozac. There were no positive effects. I was hungrier. I was sleeping in class and tired all the time. I was numb and dragging myself along a life I hated.”
Financial successes and health failures
Prozac, also known generically as fluoxetine, is one of the most successful antidepressant products of all time, so it makes sense that Melina’s doctor wanted to start her out on that drug. Discovered by Eli Lilly in 1972, Prozac has been prescribed to more than 54 million people around the world. Since its patent ended in 1999, sales of generic versions have increased by 65 percent in the US alone.2
It is widely thought that these little blue pills cheer us up because they give our brains what it has been sorely missing: a dose of happiness. Depression is a serious issue, and happiness is serious business. Globally, 11 percent of the adult population has suffered from depression at some point in their lives, and that number rises to an average of 16 percent in the United States.3
In fact, Americans consume more than 80 percent of the world’s prescription antidepressants, and that number has continued to rise by about 4 percent per year.4 The depression business is expected to generate revenue of $16.8 billion for drug companies by the end of 2020 in the US alone.5 On a global basis, 17.4 percent of our collective human years are lived with disabling mental disorders like depression.
That’s too long to wait for happiness, health and the American Dream.
We can blame drug companies for the rise of antidepressant product use, but the bottom line is that depression is very difficult to treat. Most psychiatrists suggest that many of their patients are not able to physically tolerate the side effects of the most common drugs, such as fluoxetine; they do not respond adequately to treatment; or they suffer from a decreased response to these drugs over time.
This is because depression isn’t caused by just one thing. When we face stressful life situations, or when we don’t have an outlet for our pain, like a close friend ready and willing to talk things through, or when we don’t know how to solve difficult problems like unemployment, depression can come on suddenly. This means that most doctors find it difficult to actively help patients who are sad and can’t functionally cope with life.
What is depression, really? It’s a product of both mental and physical stress. This means that depression is not just about being sad: it’s associated with how we think and how we move our bodies, as well as with mood symptoms. In basic terms, when we experience stress, our bodies shut down core functions to decrease the energy we use.
Depression leads to inflammation, diseases such as diabetes, premature aging and other physical problems. This is because we burn fewer calories and we retain both fuel and fluids. Our minds are affected because our whole nervous systems are affected. People who are depressed are likely to sleep more, move less and process food poorly. It’s a process of gradual stagnation of both the body and the mind.
On a chemical level, when a person is deeply affected by this kind of strain, their brain can overuse certain hormones. The two main hormones that are affected are serotonin and adrenalin, which are part of our nervous system. These hormones help us react to challenges, rev up our systems, fight our foes and eventually calm down and relax. When our storage of serotonin and adrenalin goes down, we can’t easily replace it. This means that depression happens again and again, as the body struggles to increase its resources to face future stress. Depression can increase because of environmental factors such as where we live, the weather patterns we face such as a lack of sunlight in winter, and other life factors such as raising children. All of these issues can spark the same effects within the brain.
Here’s where medications like Prozac come in. As the first major antidepressant on the market, the marketing of Prozac taught doctors that it was necessary to increase the brain’s supply of serotonin. Serotonin is what creates feelings of comfort in our bodies. Drugs like Prozac are officially called selective serotonin reuptake inhibitors (SSRIs). They create pathways to increase our serotonin use. The theory was that the more serotonin the body has, the happier the person.
The problem with this theory is that it can’t be proven.
Depression is not a lack of chemical happiness; in fact, experiments on the human brain have since shown that the reverse is true. If we artificially lower someone’s serotonin level, they don’t become depressed. Lower serotonin levels don’t even make their mental health symptoms worse.
Recent research has shown that while serotonin has a role in helping to build pathways in the brain when we are young, and it can help keep brain cells healthy, it’s not responsible for making us happy when we’re stressed. When we’re physically stressed out from the flu, or dealing with external factors like morning traffic, an impatient boss or an impending divorce, serotonin does nothing. What serotonin does, instead, is make sure that our brain cells do not die off when we need them the most.6
“The best way to think about depression is as a mild nervous system disease,” suggests Ronald Duman, a professor of psychiatry and pharmacology at Yale University. “Your brain cells atrophy, just like in other diseases. The only difference with depression is that it’s reversible. The brain can recover. The mental illness occurs when these stress mechanisms in the brain spiral out of control.”7
How does the brain recover? Science is only beginning to figure that out, but serotonin is not the answer that doctors thought it was going to be. As Dr. Duman explains, SSRIs like Prozac are just a Band-Aid solution. Depression is actually a sign that we have to make changes in our lives because our bodies are literally shutting down. Depression is asking us to develop what doctors call synaptic plasticity: the ability to shift direction when life’s not working quite right. It’s our job to teach ourselves how to feel better, slowly and steadily.
Prozac and other drugs can help to ensure that the brain is equipped to make these changes, but the reality is that SSRIs can cause other problems at the same time. Patients on these drugs are affected by what doctors call “Prozac lag,” which is how long it takes for SSRIs to have an effect. This delay causes danger to people who are clinically depressed.
SSRIs themselves are also dangerous. The side effects of SSRIs can be as serious as suicide and seeing and hearing things that aren’t there. There are also physical risks: weight loss, inflammation, intestinal and sexual dysfunction, dizziness and vision problems, and the list goes on. The body doesn’t know what to do with the extra serotonin, and therefore it actively tries to get rid of it in every way possible.
We can change our minds
Americans often believe that these challenges are hardwired in our genetic makeup and that they are not going to change, but that isn’t true either. Siomara Melina, like other mental health patients, was told by doctors that her depression was never going to go away and that she should expect a lifelong reliance on medical care and drugs.
But research shows that genetics only plays a small role in our mental health. In fact, more than 92 percent of how we feel is affected by lifestyle choices and learned daily habits.8 Research shows that we can only achieve the goal of truly long-term positive mental health through physical exercise, therapy and diet changes. We have to take charge of our own lives. Essentially we have to shift the triggers that lead to stress in the first place, not just take a single pill.
The challenge, as Dr. Duman explains, is that our care system isn’t set up to help us take charge. Doctors have very little time and very little knowledge about the impact of the drugs that they are prescribing in the first place. Doctors are also given the incentive to prescribe new SSRIs by drug companies that use welltrained salespeople, few of whom have any medical background, to hand out free samples every month.
Here’s the other thing you need to know. Doctors prescribe us these drugs because it’s the easiest way to make a patient satisfied. When we have a prescription in our hands, we believe that we will be well. This is because we live in a health care system that teaches us that we can buy a solution to every problem.
When it comes to our health, too many of us presume that the doctor knows best and that we actually can fix something in our bodies as quickly as we change a tire. Even if you know that there are better solutions than those presented in a five-minute chat with your doctor once a year, and that it’s possible to make healthier choices, that’s not the reality of our health care system. We want it to be easy to find happiness and achieve wellness, and taking a pill that fixes the chemicals in our brains makes things very easy indeed.
This means that Americans take mental health drugs for granted. In other countries, different solutions are prioritized by doctors. Don’t get me wrong. Our doctors are some of the besttrained medical caregivers in the world. But American doctors treat depression in a very different way from others.
If you were a German doctor diagnosing moderate depression like the kind Melina has, you would be more likely to treat her with St. John’s wort than Prozac. St. John’s wort is a plant medicine with no side effects. Sixty-six million Germans, or the equivalent to more than 80 percent of all people with depression, have been treated with this medication since the mid-1990s.9 It’s a $2 billion industry there. Germany surveys the safety of these plant medicines and how they work so that consumers have a clear picture of what they do. This makes it easy for manufacturers to market products, as well as for doctors to have confidence in their use and for insurance companies to cover drug costs for patients.
In the Middle East, saffron (literally the same saffron that may be in your spice cabinet, except in a concentrated form) is used to treat depression. Researchers have shown, through strict drug trials, that saffron reduces blood pressure, anxiety and depression, and it can even be used to decrease the size of cancer tumors.10 Saffron has been shown in study after study to be as effective as other drugs prescribed for depression, even when directly compared to Prozac.
But compared to St. John’s wort and saffron, CBD is even more effective.
There are 22,000 published studies about CBD and how it helps with all mental illnesses including depression. Half of this research has taken place within the past ten years, which means that we are just beginning to show what it can do. In studies on adults, CBD treatment has been shown to reduce depression in as little as three weeks.
And here’s what’s most important. Unlike any other solution being marketed today by drug or plant medicine companies, CBD actively helps our brains and our bodies recover from depression. It decreases brain cell death in the same way as Prozac, but it also increases the amount of oxygen in our brains, nervous systems and cells. This means that the nutrients we take into our bodies can actually get to where they need to go so that we can be healthy again.
All of this shows us that something needs to change in how we, and our doctors, think about depression. Studies show that plant medicines are more effective in treating depression than SSRIs. The problem is that, as Melina explains, doctors don’t want their patients to try out plant medicine solutions because it challenges the way they’re used to working.
In Melina’s case, she insisted on trying CBD, because she couldn’t live with the side effects of SSRIs any longer. “With these things, you can’t come off it right away. I just want to stop taking it, but you can’t. You have to find the right time and do it really slowly. You can die. I could have seizures and die by just stopping the drugs without a doctor’s supervision.”
Like many Americans seeking a better solution, Melina turned to her own internet research, as well as a number of legal CBD dispensaries, to find the right dosage for her. With this research, she was able to finally gain her doctor’s support for her new CBDbased mental health care plan.
Drug by drug, Melina replaced her doctor’s prescriptions with CBD.
“Getting off clonazepam was so, so hard. I was so depressed, way more than before. I just knew I could not have it and I just used it as a crutch. I also felt nauseous, had headaches, stomach cramps and that happened for about a month. And then the mental aspect of it continued for about a month. It was just the worst depression. What got me through it was a lot of support from family and friends and knowing it would not go on forever. That once I was off, I’d be off.”
CBD has made it possible for her to eliminate eight different daily drug prescriptions over the course of the past eighteen months.
Americans need healthy skepticism about the mental health care system. We need to educate ourselves on what will serve us best. Plant medicines such as CBD, St. John’s wort and saffron have been available for generations, but the American public doesn’t know much about them, at least not compared to how much we know about drugs like Prozac. Only a tiny fraction of us actually do our own research. Patients report that many health professionals today lack the clinical skills of listening, of being helpful and hopeful and of letting them know that healing is possible, but patients themselves don’t take the lead and look at how they can make a positive impact on their own health.
All of this means that there are many people who resign themselves to a lifetime diagnosis of depression.
Something has to shift.
Our current health care standards are based on old information. In order to move toward positive mental health, we have to demand a different standard than the one we have relied on. We can’t be apathetic any longer. With this default behavior, we will continue to miss out on the benefits of plant medicines that will lead us to long-term wellness.
What we need is a new way of thinking about depression. We need to create healthy lives for ourselves every day through our choices to live better and more fully aware of our opportunities to become our best selves. Americans can’t continue to rely on hope that a five-minute miracle cure is our best option. If the pursuit of happiness is a right of American citizenship, then so is being healthy enough to be happy in the first place.
Health-promoting habits have to come first in our lives, starting with self-education and self-care. We need to take responsibility for our health by increasing access to new proactive tools to wellness. We can find the right combination of support systems for our minds and bodies.
1. [Interview with Siomara Melina.]↩
2. [Wong, D.T., Perry, K.W., & Bymaster, F.P. (2005). The discovery of fluoxetine hydrochloride (Prozac). Nature Reviews Drug Discovery, 4(9), 764.]↩
3. [McGrath, J.J., Saha, S., Al-Hamzawi, A.O., Alonso, J., Andrade, L., Borges, G. , . . . & Fayyad, J. (2016). Age of onset and lifetime projected risk of psychotic experiences: cross-national data from the World Mental Health Survey. Schizophrenia Bulletin, 42(4), 933–941.]↩
4. [Wedman-St. Louis, B. (2018). Cannabis: A Clinician’s Guide. Boca Raton, FL: CRC Press]↩
5. [Welch, A. (2016). Study reveals how many US adults are taking psychiatric drugs. CBS News. Retrieved from https://www.cbsnews.com/news/psychiatric-drugs-study-reveals-widespread-use-women-men/]↩
6. [Castrén, E., Võikar, V., & Rantamäki, T. (2007). Role of neurotrophic factors in depression. Current Opinion in Pharmacology, 7(1), 18–21.]↩
7. [Yale University. (2012, August 12). How stress and depression can shrink the brain. ScienceDaily. Retrieved from www.sciencedaily.com/releases/2012/08/120812151659.htm]↩
8. [Yale University.]↩
9. [Linde, K., Ramirez, G., Mulrow, C.D., Pauls, A., Weidenhammer, W. & Melchart, D. (1996). St. John’s wort for depression—an overview and meta-analysis of randomised clinical trials. BMJ, 313(7052), 253–258; Miyawaki, E. (1998, May). Listening to St. John’s wort. The Atlantic. Retrieved from https://www.theatlantic.com/magazine/archive/1998/05/listening-to-st-johns-wort/377108/]↩
10. [Moshiri, M., Vahabzadeh, M. & Hosseinzadeh, H. (2014). Clinical applications of
saffron (Crocus sativus) and its constituents: a review. Drug Research, 64, 1–9.]↩