All this medicating has me downright depressed


The more I think about the number of people taking anti-depressants -- government statistics show one in 10 Americans older than 12 take them -- the more depressed I become.

Not because people are trying to do something for depressive episodes that affect their ability to work, sleep, eat or enjoy once-pleasurable activities. That's a good thing. It's dumb, not to mention dangerous, to suffer in silence.

But it's also dangerous to assume that the only way to turn your life around is through anti-depressants, where clinicians say the common side effects are sexual problems, constipation, diarrhea, dizziness, dry mouth, headache, nausea, shakiness, daytime sleepiness, trouble sleeping and weight gain.

That millions of Americans pop pills in hopes of brightening their dispositions is particularly distressing when researchers say that exercise is often as good, if not better, than antidepressants.

Oh, by the way, doctors say the common side effects of regular exercise aren't too awful, including reduction of the risk of high blood pressure, colon cancer, Alzheimer's disease, diabetes and breast cancer.

Dr. Ole Thienhaus, who recently left as chairman of the psychiatry department at the University of Nevada School of Medicine for a similar post at the University of Arizona, said clinicians have long known inactivity poses as great a health risk as smoking, contributing to a long list of problems, including cardiovascular disease, cancer, and depression.

How exercise benefits those with depression isn't fully understood, but it is known that it increases the production of "feel good" chemicals produced in the brain, including dopamine, serotonin, norepinephrine and endorphins.

Thienhaus, who stresses that some people with depression benefit most from counseling or medication or exercise or even all three, says studies show medication best helps those with severe symptoms, such as suicidal thoughts.

He believes the first prescription for depression many people could benefit from is exercise.

That prescription is based on the kind of scientific evidence published in 2007 by psychologist James Blumenthal and his research team at Duke University. They randomly assigned 202 individuals diagnosed with major depressive disorder, to one of four treatment approaches: group exercise, home-based exercise, antidepressant medication, or a placebo.

The exercise had previously sedentary individuals engaging in three 45-minute walking sessions each week.

After 16 weeks, researchers found all three treatment options more effective than placebo and that remission rates among the exercisers were not statistically different from remission rates among the pill-poppers.

So why the 400 percent increase in antidepressant use in the last 20 years?

"The pharmaceutical companies have a huge budget for marketing their medications while researchers don't have the money to advertise exercise as the thing to do," said Michelle Caro, a clinical psychologist at the University of Nevada, Las Vegas. "Market forces impact medicine. People see something advertised as an easy fix for a problem they're having and they ask their doctor for it."

And it's easy to give patients what they ask for, Thienhaus said, when you're a harried primary care physician -- most people don't go to shrink for mental health problems -- who only has 10 minutes per patient, not enough time to analyze anyone.

Though exercise's benefits have been publicized, pharmaceutical companies don't worry about melancholic Americans forgoing anti-depressants in favor of walking.

"Pfizer (the drug company) gave us free Zoloft (an anti-depressant) for studies over the years that all show exercise is just as effective as drugs for depression," Duke researcher Benson Hoffman said. "They don't see what we've found as competition."

Now that's really depressing.

Paul Harasim is the medical reporter for the Las Vegas Review-Journal. His column appears Mondays. Harasim can be reached at pharasim@reviewjournal. com or 702-387-2908.

 

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