The Causes of Depression
What Causes Depression? Genetic Factors in Depression
There is a long history of uncertainty in the field of mental health about whether mental illness, especially depression, is psychogenic or biogenic, that is, whether the cause is psychological or biological. Today, mental health professionals agree that, for most mental illnesses, it is difficult to pinpoint any one cause and that multiple factors play a role. But for severe cases of depression, it is agreed that a strong biological component is involved, and that the illness can be brought on with little or no apparent precipitating environmental stressor.
According to integrated models of disease,2 the symptoms/signs, severity and duration, and outcome of any disease are the product of complex interactions among multiple factors: biological (inherited vulnerability, malfunctioning bodily organs or systems or disease agents such as viruses), psychological (level of stress, learned coping skills, negative thinking habits, unpleasant or traumatic experiences), and sociocultural (social support, family environment, cultural stigmas towards a disease). In fact, a sickness of any kind, even a physical ailment, is the result of social and psychological factors, to some degree. For example, exposure to a virus isn’t necessarily enough to make one sick. One’s predisposition to illness is influenced not only by genetic makeup but also the status of one’s immune system, which can be affected by stress. The level of stress in a person’s life will be influenced by social circumstances, such as the presence or absence of love and support from family and friends, or stigma towards people with a particular illness, such as depression or AIDS. Individuals coping with chronic illness are particularly vulnerable to the impact of these social stresses.
Cross-cultural research provides some interesting insight into how important love and support from others can be for the prevention of depression even under circumstances we might assume would inevitably bring on a depressive episode. In Western society, it is widely believed that the death of a loved one is such a traumatic event that depression, even if transient, would be a normal consequence for the bereaved. But among the Kaluli tribe in New Guinea, anthropologists found this did not happen. The tribe would offer a member who lost a loved one such strong social support that depression did not occur.
Physiology is also a factor in depression and other mental disorders. Abnormal levels of the neurotransmitters norepinephrine and serotonin and other chemicals that play an important role in pleasure and moods are closely linked with depression.3 Research indicates that depression may also be associated with abnormalities in some structures of the brain.4 How the brain’s neurotransmitters and brain structures respond to stress and depression is not fully understood. It is still unclear if changes in brain chemistry and structure are what cause mental disorders, or if those changes are simply a reaction to environmental factors.
In the end, it is probably safe to say that the cause of a depressive disorder in any person is a unique combination of a person’s genetics, health status (especially of the brain), history of relationships, repertoire of learned coping skills, and the psychosocial and cultural environment. What science does understand about brain function and depression makes it possible to influence neurotransmitter activity in the brain with medication and thus bring relief for many cases of depression.
Research shows us that there is a strong familial component to depression, or as some might say, it seems to “run in the family.” That is, children of parents with depressive disorders are more likely to develop depression than are children whose parents who are not depressed. Some of this effect can be explained by the fact that depressed parents behave in ways that “teach” their children to become vulnerable to depression, but studies of identical twins demonstrate that genetics plays an important role. When the influence of learning from depressed parents is removed, as with identical twins who were separated at birth and reared by different sets of parents, the twins whose natural parents were depressed were more likely to develop depression than are those whose natural parents were not depressed. Identical twins reared apart, who share the same genes but different experiences, will develop depression at a similar rate. If one twin develops depression, the other does also 40% to 80% of the time (rates vary according to researchers’ differing diagnostic criteria).
The fact that the rate is not 100% shows that life experiences, i.e. learning, are also determinants of depression. Remember the diathesis-stress and integrative models of illness? Both theoretical frameworks take into account possible differences between identical twins such as learned coping skills, family environment or other factors that may either protect against depression or precipitate it, regardless of genetic makeup. Neurotransmitter Malfunction: A Biological Cause of Depression?
Every thought, image, or perception that humans experience is mediated by the brain. Each mental event has a biochemical counterpart in the brain; the mind can’t exist without the brain. No matter what events may have led up to it, a depressive episode will always have a neurobiological component. There will be disruptions of neurons and neurotransmitters (especially serotonin [5HT] and norepinephrine [NE], based on our current understanding), which are the chemical substances that send electrical signals between neurons.3,6
This abnormality in brain function is not entirely understood by neuroscientists, and there are many theories about what actually malfunctions on the cellular level when someone experiences depression. We know that some of the neurotransmitters that seem to be involved in depression are also responsible for important functions known to be impaired by depression, such as sleep, appetite, attention, concentration and emotion.3,6,7,8
We also know that, while some individuals may be more innately vulnerable to abnormal brain function, most anyone can develop such problems given a sufficient combination of unfortunate circumstances.
The most convincing evidence we now have for the biological cause of depression comes from research into the functions of serotonin and norepinephrine, both of which are in a class of neurotransmitters known as the monoamines. Studies during the 1950s that tested drug treatments for high blood pressure and tuberculosis tipped off scientists that these two neurotransmitters might play a role in regulation of mood. One study tested the drug reserpine (known to deplete monoamine levels in the brain) for treatment of high blood pressure. Fifteen percent of the patients on the drug developed severe depression. In another study, doctors found that treating tuberculosis with a drug that slowed the breakdown of monoamines also improved moods in some patients. From these two studies, it was concluded that low levels of monoamines were the cause of depression. This led to the introduction of the first pharmaceutical drugs to treat depression, monoamine oxidase inhibitors, which work by maintaining normal brain levels of monoamines.
The theory that abnormally low levels of monoamine neurotransmitters, specifi cally serotonin and norepinephrine, are the underlying cause of depressed mood is supported by the fact that depression can be controlled by medications that increase the availability of serotonin and norepinephrine. Also consistent with this model are observations that the illicit drugs cocaine and amphetamine raise norepinephrine and serotonin levels and that both these substances produce shortterm, mood-elevating and stimulating effects.
Scientists are still piecing together the evidence to fully understand how monoamine-elevating substances affect mood. In the case of the illicit drugs, the effects on mood are immediate but short-term and can have permanently damaging effects, whereas the pharmaceuticals work much more gradually. Antidepressant medications do restore monoamine neurotransmitters levels to normal within hours, but it generally takes several weeks before positive changes in mood are evident. One of many possible explanations is that the medications work by increasing the number of monoamine receptors to a level that mood is improved. This increase in monoamine receptors takes time, typically several weeks. These types of uncertainties in the biochemical imbalance model point out the complexity of the systems involved and how much more research is needed.
It may be that individuals with depression don’t all suffer from the same kind of neurotransmitter dysfunction. One person may have a problem with a serotonin defi cit; another may have a problem with a norepinephrine defi cit. According to a leading theory, dysregulation of mood may result from more than a simple defi cit of a neurotransmitter, but a malfunction of the entire system that maintains the synthesis and release of neurotransmitters and the neural pathways that transmit them.7,10
As changes occur in the brain, including those induced by stress, the neurotransmitters fail to adequately respond. As a result, imbalances occur, either in the level of serotonin and/or norepinephrine.
The differences in neurotransmitters involved in depression for different individuals would explain why people behave differently when depressed. A serotonin defi cit would be more likely to cause sleep and appetite changes, since the areas of the brain that regulate sleep and appetite are known to be more affected by serotonin. Similarly, a norepinephrine defi cit may result in fatigue, since areas of the brain regions regulating energy level are affected by norepinephrine.
The brain has ways of trying to resolve the problems due to neurotransmitter deficits. For example, neurobiologists have detected an increase in the number of receptor sites in the brain, when serotonin is abnormally low. It appears that the brain is trying to do what it can to pick up all the serotonin available to it. back to top Brain Structures Involved in Depression
Researchers have identified these areas of the brain that are particularly dependent on serotonin and therefore may play a role in the triggering of a depressive mood when serotonin is low: Amygdala11,12
– an almond-shaped structure deep within the brain, which is believed to be involved in depression because it has a role in regulating rage, aggression and sexual behavior, all of which can be affected by depression. Hypothalamus
– is believed to also play a role in depression because it uses serotonin and regulates appetite, sleep, libido (sexual interest), the fight-flight response, and the capacity to experience pleasure – all of which are often reduced in someone who is depressed. The hypothalamus also regulates hormone secretions within the body, so if serotonin in the hypothalamus is depleted, hormone levels could also be affected. Abnormal hormone levels originating in the hypothalamus are not uncommon for women who have just given birth or for individuals under extreme stress. (See the section on stress and the hypothalamicpituitary-adrenal axis).
Imaging technology such as MRI (magnetic resonance imaging) and PET (positron emission tomography) make it possible to study changes in brain structure and funtion in relation to emotional response. According to this type of research, other areas of the brain that may be implicated in depression are: Hippocampus
– a critical structure for memory that is reduced in size in some individuals who are depressed.13 Cingulate cortex
, the temporal lobe
and the left prefrontal area – all play an important role in the regulation of positive emotions, awareness of mood state, and in memory and concentration.11,14,15,16 Raphe nucleus and locus coeruleus
(parts of the brain stem) – sites for the manufacture of serotonin and norepinephrine, respectively.3,17 Depression and Stress17,18
As we will see in Lesson Four, there is a strong connection between stress and depression through the body’s steroid hormone system, the Hypothalamic-Pituitary-Adrenal (HPA) axis, which is involved in the fight-flight response to stress. Stress and depression are believed to be related because they have common elements (some of the same neurotransmitters, brain areas, and symptoms).
Although it is known that a malfunctioning HPA axis is associated with depression, it isn’t clear which causes the other or if both are a result of some other process. Because it is affected by the HPA axis, serotonin, one of the primary neurotransmitters involved with regulation of pleasure and mood, is also implicated in stress and depression.
When the HPA axis works normally, stress causes the fight-flight response to be evoked throughout the body via the sympathetic nervous system. Many bodily changes occur. The adrenal glands, which sit atop the kidneys, secrete norepinephrine. As a result, heart rate goes up, blood vessels dilate, and blood pressure increases, preparing a person for fight or flight. The hypothalamus releases corticotropin releasing factor (CRF), which causes the pituitary gland to release adrenocorticotrophic hormone (ACTH) into the bloodstream. The ACTH travels to the adrenal glands, triggering the release of cortisol. Cortisol, a steroid with powerful effects, is necessary at moderate levels for a variety of bodily functions. However, elevated cortisol over time can be damaging. To keep this from happening, the hypothalamus, by a process called a feedback loop, ordinarily monitors the cortisol level in the blood. If it is too high, it will decrease the release of CRF until the cortisol level returns to normal.
Problems arise when chronic levels of high stress cause the HPA axis to “work overtime,” causing the hypothalamus to habituate to elevated cortisol. The feedback loop stops doing its job so that cortisol remains at an abnormally high and unhealthy level. When this happens, a person may become vulnerable to depression.
Some researchers believe that excessive cortisol, which builds up in the body, may be toxic to cells that produce serotonin or use it for nerve signal transmission.19,20
If serotonin-dependent brain tissue becomes damaged, brain structures that regulate mood don’t work as well. This may be why a person under chronically high stress is prone to depression. Some antidepressants can help normalize the hypothalamus’ feedback loop by lowering the amount of cortisol that is released from the adrenal gland. Psychological Factors in Depression
The way we perceive process and react to daily events significantly affects our moods and even physiological reactions.21
From childhood, we gradually develop habitual attitudes or ways of thinking about ourselves, other people, and the world, which psychologists call “explanatory styles.” Research has found that most people who are depressed have a pessimistic explanatory style.22
Because these unhealthy patterns of thinking are so ingrained, they are almost automatic and instantaneous. This makes it hard to recognize negative thought patterns or see their connection to bad moods.
Cognitive psychologist Martin E. P. Seligman, PhD, who with his colleagues developed the concept of explanatory style23
, identified its three dimensions:
■ Personalization – Internal-External: Do things happen to you because of things within you (intelligence, hard work) or outside of you (luck, other people interfering with you)?
■ Permanence – Temporary-Permanent: Are things the way they are only temporarily and can be changed, or are they not capable of being changed, no matter what?
■ Pervasiveness – Specific-Universal: When something happens, is it always this way, or only just in this one instance?
The most pessimistic explanatory style is one that attributes positive events to external, temporary and specific causes, and negative events to internal, permanent, and universal causes. For example, a pessimist might see a perfect test score as a one-time fl uke, or dumb luck or an easy test, rather than proof of one’s own abilities. On the other hand, the pessimist might react to a bad grade by thinking: “I blew it on the test because I am stupid. I’ll always fail because I am stupid! It won’t change!! Everything I do is wrong!!!” In contrast, the optimist minimizes the significance of a specific negative event and might blame a bad grade on someone or something else, rather than oneself:
“The teacher gave a really hard test” or “I was sick that day.” Failure does not spell doom for the future but is just an isolated incident. In other words, an optimist compartmentalizes life’s upsets, whereas a pessimist reacts by generalizing a single disappointment into the future and all areas of one’s life. It is the “I never do anything right” syndrome, or catastrophic thinking – a kind of negative thought pattern known as a cognitive distortion.
There is some disagreement among mental health researchers about what role cognitive distortions actually play in the development of depression. Some researchers contend that distorted cognitions are what cause depression. Others point to evidence that seems to support the idea that, at least in cases of severe depression, the disruption in mood is first and the cognitive distortions arise from that. Whatever their origin, it is apparent that distorted, pessimistic types of thinking are closely associated with depression. Current research shows that a type of psychotherapy called cognitive behavioral therapy (CBT) can successfully treat most types of depression without the use of drugs.24,25,26
With CBT, depressed persons learn to replace excessively negative thoughts with more realistic and positive ways of thinking about themselves, the world, and others.
So how does a non-medication treatment help resolve depression, if neurochemistry is the basis for the disorder? It isn’t clear. We have a good idea how antidepressant medications change neurochemistry, thereby resolving depression, but we don’t really understand how this type of psychotherapy works. Apparently, something about the cognitive therapy, which teaches patients to modify pessimistic thought patterns, somehow changes the brain’s neurochemistry in a way similar to antidepressant medication. Perhaps practice at thinking accurately and positively about life helps prune away those old neural circuits, promoting the growth and development of neural circuits that are more adaptive. Or, maybe the psychotherapy helps improve the person’s ability to deal successfully with stress, thus lowering the person’s vulnerability to depression. Quality research over time will help us to better understand how it all works. back to top Environmental/Social Factors in Depression
Stress of any type can make us more vulnerable to developing negative moods. Over time, if the stress becomes too great or stays with us for long periods, we may become depressed. It doesn’t matter what the stressor is. It could be stress encountered on the job, in school, or in family relationships. The stress could be due to financial problems, lack of social support or living in poverty or in a noisy or crime-ridden area. Research has clearly shown that living in a stressful environment can eventually led to a depressive episode18, 27
even without an apparent triggering event.
There is much scientific evidence to indicate that stress can also directly affect one’s physical health. For example, stress can weaken one’s immune function. In one well-known study, medical students had blood drawn before taking an exam and afterwards to measure levels of immune-response cells to assess immune system function.28
The post-exam measures were significantly lower, apparently due to the stress of taking the exam. This may explain why we sometimes get sick after a period of high stress: Our body’s ability to fight off infections has been compromised by the stress. Thus, stress can have many harmful consequences, both psychologically and physically. Society, Culture and Mental Health29
With relative ease, most adolescents can describe how society or elements of their culture can contribute to stress in their lives. From the messages and influences in popular media (movies, TV, radio, and print), parents and family history, to peer cliques at school, church, and employment, society and culture profoundly shape how we feel and think about ourselves. Many research studies indicate that the impact of society and culture can contribute to our resistance or vulnerability to stress, depression and other mental disorders. Understanding how societal and cultural forces can make one susceptible to stress and mental illness is the focus of specialized research within sociology and psychology. Sociology is defined as the scientific study of society, social institutions, and social relationships and how these social structures affect individual behavior.
The prevalence of mental illness (i.e. how often it occurs in a population) is affected by certain so-called “social structures” such as race, ethnicity, religion, and social class, which in turn define our culture. Culture refers to patterns of thought, behavior, values and feelings that are characteristic of a social, racial or ethnic group (e.g., children who play on a sports team, a women’s civic organization, members of a religion, an Amish community, African-Americans, or Hispanics) within a larger society.
Attitudes, beliefs, values and standards for normal behavior (called “norms”) within a society are aspects of culture. All of these cultural aspects play a role in an individual’s self identity, which in turn, can either be a determinant of psychological well-being or distress. Whether we recognize it or not, each of us is affected to some degree by many cultural factors by which we are defined, in most cases not by our own choosing. For instance, discuss with students which of the following characteristics play a role in their identity and mental well-being.
- Marital status
- Body type
- Minority/majority group status
- Disability status
- Family structure
- National origin
- Political affiliation/ideology
- Generational status
- Geographic origin
- Immigration status
- Socioeconomic status
- Language & cultural barriers
- Sexual orientation
- Residence: urban or rural
Using race as an example, national and international epidemiological studies have revealed that the prevalence of all mental disorders is similar between minorities and whites, yet there may be differences when considering specific illnesses such as depression. For example, recent survey research has shown that African Americans may be less likely to suffer from depression than non-Hispanic whites. Race significantly impacts mental well being through differences in health care between whites and racial minorities. The body of current research indicates that racial minority groups are less likely to use mental health services and they receive poorer quality mental health care when they do access services. This contributes to a higher level of unmet mental health needs in minority communities.29
One’s culture can even influence how the symptoms of a mental disorder like depression are expressed, as well as how likely a depressed person would recognize the problem, seek help, and what types of help they might seek. The “Mental Health: Culture, Race, and Ethnicity” Supplement to the Surgeon General’s Report on Mental Health details much of the research that supports a causative relationship between society, culture and depression.
“Cultural and social context weigh more heavily in causation of depression. In the same international studies cited above, prevalence rates for major depression varied from 2 to 19 percent across countries. Family and molecular biology studies also indicate less heritability for major depression than for bipolar disorder and schizophrenia. Taken together, the evidence points to social and cultural factors, including exposure to poverty and violence, playing a greater role in the onset of major depression. In this context, it is important to note that poverty, violence, and other stressful social environments are not unique to any part of the globe, nor are the symptoms and manifestations they produce. However, factors often linked to race or ethnicity, such as socioeconomic status or country of origin, can increase the likelihood of exposure to these types of stressors.”29
More than a decade of research has also demonstrated that certain cultural factors can act as protective factors for persons at risk of depression or other mental health problems. For instance, having a strong religious faith or spirituality has been linked to an improved sense of well being and life satisfaction. Additional protective factors related to social structures or culture include an individual’s sense of social competence and connectedness to others, commitment to schools/ education, and the availability of health and social services. All of these factors are associated with mental health promotion and illness prevention. While the body of research is still evolving and more study is needed, other examples abound that suggest connections between social and/or cultural subgroups and various mental health issues. Students who choose to research the effects of social and cultural differences on mental health, especially in light of the tremendous cultural diversity in the United States, will be at the cutting edge of the mental health field for the next generation.
Social stratification refers to unequal access to resources, power, autonomy, and status across social groups.30
In the United States, the most widely recognized systems of social inequality are based on race/ethnicity, social class and gender. According to current social science research, stratification can have a bearing on the mental well being of individuals through the effects of poverty, segregation and isolation, prejudice and stigma, and limited opportunity. Social scientists have identified two ways that the effects of inequality can heighten vulnerability of stress in the individual of lower economic status. Inability to meet basic material needs simply makes life distressing and harder to endure, especially if poverty is chronic. Social evaluation, or how persons of differing economic classes perceive inequalities, can also be a source of stress and diminished psychological well being by negative self comparisons to others. 30
A sense of failure can take the form of aggression towards others or self-blame.
Although individuals living in poverty are more at risk for developing mental illness, stresses directly related to our consumer-driven, profit-oriented society affect people on all levels of society to some degree. Acquisition of material things in pursuit of the American Dream has resulted in Americans working more than they did 20 or 30 years ago, according to Harvard University economist Julia Schor.31
In most families, both parents work, and in some, teenagers hold down jobs to contribute to the family income. Still, the gap between rich and poor in the United States continues to widen, and 38 percent of all children 27 million children – live in low-income families (family earnings at 200% of the federal poverty line or below).32
Researchers have found that poverty threatens psychological health of children because they are more likely to experience the following stresses29
■ Parents with unstable employment (especially true of women and non-whites)
■ Living or working in a noxious or hazardous environment
■ Marital problems
■ Parent-child conflicts
■ Parental incarceration
■ Poor nutrition and inadequate stimulation (affecting neurological development and school performance)
■ Poorer general health
■ Lack of culturally meaningful experiences and resources
■ Lack of positive social networks and other means for coping with life’s difficulties
The segregation and isolation related to living in a economically deprived, dangerous neighborhood have been found to be significantly associated with increased mental illness (most notably Post-Traumatic Stress Disorder, PTSD) and relationship problems for children and adolescents. Researchers theorize that risk factors such as a lack of social cohesion, or connectedness, among persons living in unsafe areas feeds a sense of suspicion and mistrust and the belief that events are outside one’s control, which can give rise to futility, self-doubt and depression.30
In areas of high adult unemployment and isolation from the mainstream culture, a collective sense of helplessness can be pervasive. Some sociologists have used the term “culture of poverty” to describe this type of pervasive phenomenon. Culture of poverty can be defined as a self-perpetuating complex of escapism, impulse gratification, despair, and resignation – an adaptation and reaction of the poor to the marginal position in a class-stratified, highly individuated, capitalistic society. For a young person growing up in that kind of negative environment, “success stories” of optimistic cognitive styles and positive lifestyles may be few.
The effects of poverty and race on mental health also vary with urban or rural living. Poor whites who live in rural areas have been found to have poorer mental health than urban whites, whereas poor blacks in rural areas fare better than urban blacks.30
Researchers attribute these differences to how segregation and isolation, tough life conditions, and prejudice impose greater stresses for the urban black and the rural white. In general, the prevalence of mental illness for ethnic minorities rises with decreasing proportion in a community population (the fewer there are of one’s cultural/ethnic group, the more likely one will become mentally ill). However, as this section has shown, depression is due to many interrelated factors including the over-representation of minorities in high-risk populations that have unmet mental health needs.31
Prejudice and stigma refer to practices, beliefs or attitudes that discriminate against members of a particular status group. While these concepts will be explored fully in Lesson Eight, it is important to note that researchers have found that experiences of racial discrimination or sexist prejudice are stressors that can contribute to mental health problems or mental illness, but all of that depends on the capacity to resist on the part of the targeted individual. That is, if an individual or family possesses certain protective factors such as high intelligence, social connectedness, a supportive relationship with parents, or, as mentioned earlier, a strong sense of faith or spirituality, these factors may mitigate the degree of illness or problems. back to top Interaction of Multiple Factors in Depression
Remember the bidirectionality and integrative models from Lesson Two? What these theoretical frameworks tell us is that biological and psychological, social and cultural factors can have an impact on each other. There is a growing body of scientific evidence validating the idea that the developing brain is somewhat “plastic” and subject to environmental influences.
Research has found that neural circuits in an infant’s brain are either impaired or nurtured by the quality of his or her home life.6,8,33,34
The brain of a baby raised in an abusive, chronically stressful home will be saturated by excess neurotransmitters associated with the stress response. This can affect the infant’s brain development and make the baby much more vulnerable to stress, anxiety and other negative mood states than one with the same genes and health status, but is reared in a peaceful, loving and stable home. These changes during early neurological development can have lasting effects, leading to behavioral problems and greater susceptibility to stress and anxiety-related problems. References
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The Adverse Effects of Chemical Treatment of Depression in Children
The intent of this article is to present to the field doctor the story of growing usage and adverse effects of newer types of antidepressants (selective serotonin reuptake inhibitors, or SSRIs) among children and adults. This is not an attempt to discourage entirely the use of antidepressants by children, but rather, to provide the family chiropractor information that may shed light on the growing concerns held by many in other health care branches.
On January 3, 2003, the Bloomberg News reported that Eli Lilly had been given approval from the Food and Drug Administration (FDA) to release its antidepressant, Prozac (fluoxetine) for treating children and adolescents with depression (major depressive disorder) and obsessive-compulsive disorder (OCD). Prozac was approved for patients 7-17 years of age, although the manufacturer planned not to promote the pill for children. Prozac once was the world's top-selling depression treatment, with annual sales of more than $2 billion dollars.1
After many reports and hearings, on March 22, 2004, the FDA issued a Public Health Advisory regarding the new generation of antidepressants (Prozac, Zoloft, Celexa, Luvox, Paxil and Lexapro), including Wellbutrin, Effexor, Remeron and Serzone. The FDA warned that these antidepressants may contribute to suicide among children and adults for a small few; however, the warning came short of concluding that they were a cause of suicide.
What may not have received as much attention are the other known side-effects of these antidepressants, which include:
* panic attacks;
* hypomania; and
* akathisia (severe restlessness).
It should be further noted that these antidepressants and their induced behaviors, listed above, are identical to those of methamphetamine, cocaine and PCP, all chemicals known to cause violence and aggression. Both the new antidepressants and old stimulants alter the neurotransmitter in the brain called serotonin.2-5 Another added concern to the usage of antidepressants is that the behavior of "mania" often escalates to violence when the person is aggravated. A manic individual can also go into a crash stage of depression or suicidal behavior.
On March 22, 2004, the FDA issued a caution to physicians, their patients and families, urging them to "closely monitor both adults and children with depression, especially at the beginning of treatment, or when the dosages are changed with either an increase or decrease of dose." The FDA also asked the manufacturers to change the labels of 10 drugs to include stronger cautions and warnings about monitoring patients for worsening of depression and the signs of suicidal behavior.6 The FDA has made the new label and cautions available on its Web site: www.fda. gov/cder/drug/antidepressants/ defaults.htm.
Peter Breggin, MD - a psychiatrist, medical expert and author - has been a watchdog regarding the underreporting of side-effects of antidepressants and Ritalin when used on children. His books, The Antidepressant Fact Book, Brain-Disabling Treatments in Psychiatry and Talking Back to Prozac, reveal his decade-long journey to uncover the hidden truths and often tragic outcomes involving children taking these prescription drugs.3-5
Dr. Breggin has recommended that the U.S. follow Great Britain in banning the use of most of these drugs by children. Regarding the new FDA committee suggestion of "black warning labeling" of all antidepressants, Dr. Breggin suggests that he would rather see that the specific drugs be labeled. His concern is that if all antidepressants receive the black label, this would water down the overall impact on the sales of SSRIs, which would positively benefit the drug industry.
Dr. Breggin further suggests that if the FDA is not willing to ban SSRIs drugs, then the FDA should label these drugs a "contraindication" in children. At least a contraindication would be an alert not to prescribe these medications to children. (To stay current with Dr. Breggin's articles and his public safety concerns, periodically check his Web site, www.breggin.com.)
Parents should also be cautious when removing their child too quickly from antidepressants. Withdrawal reactions may take days or weeks; a physician should closely monitor this process. A side-note to the reader is that many antidepressants are prescribed at medically supervised weight-loss clinics and are often used not only on the obese adult, but the adolescent.
Although the family chiropractor does not treat depression, many parents may want to discuss this concern and their child's struggle with this problem. Parents often do not know what direction to take or what alternative choices exist. Further, many parents lack all the information (previously stated side-effects) necessary to make such a critical decision regarding their child.
Dr. Breggin would suggest, "Those struggling with severe depression essentially are feeling profound hopelessness and despair that can be addressed by a variety of psychotherapeutic, educational, and spiritual or religious interventions."
Family chiropractors should keep themselves current regarding the trends of usage of antidepressants by children and the public safety concerns of these drugs, and direct parents to related Web sites, research studies, books and resources. Even developing a network of other health professionals who would approach the child in a noninvasive manner is suggested.
And last, but not least, never underestimate the powerful influence of an upper cervical adjustment. Although studies are warranted in this area, many who perform specific chiropractic adjustive techniques to the upper cervical spine hear of improvement in many of the children's behavioral issues.
This article is available online at www.chiroweb.com/columnist/ anrig. You may also leave a comment or ask a question at her "Talk Back" forum at the same location.
1. www.nytimes.com/ 2003/ 01/04/business/04PROZ.html?ex =1103950800&en=b2b5.
2. "The Proven Dangers of Antidepressants." www.breggin.com.
3. Breggin P. Brain-Disabling Treatments in Psychiatry. Springer Publishing, 1997.
4. Breggin P. The Antidepressant Fact Book. Preseus, 2002.
5. Breggin P and Breggin G. Talking Back to Prozac. St. Martin's Press, 1994.
6. www.fda.gov/bbs/topics/ ANSWERS/2004/ANS01283.html.