Avoiding Antidepressants: A Provocative Clinical Study

Swallowing prescription drugs is our new reality. You, as patients, confront endless magazine, web, and TV ads from Big Pharma. I see these same ads tweaked gently to encourage me, the prescriber. But beyond what we all see, I get a lot more.

My mailbox is crammed with Big Pharma junk. My office waiting room is a containment area of smiling ex-cheerleaders and their drug samples. I brush away drug ad pop-ups as I struggle to read online medical journal articles, half of which are about drugs. Via snail mail, stacks of “prescribing opportunity” letters arrive from your insurance companies, complete with software to scan your medical records and your pharmacy refill habits to create some reason for me to prescribe something new for you.

To Big Pharma, the ideal drug is one you’re on for the remainder of your incarnation. Every company prays it will be the one to develop the new blood pressure med, the latest drug for diabetes, cholesterol, or depression, each trying to corner a disease market like the Hunt brothers tried with silver in 1980.

As an aside, you’ve read how doctors complain about working with electronic medical records (EMRs). But despite the moaning, doctors agree that EMRs make renewing prescriptions very easy and efficient.

Too easy, in fact.

So that when a busy multi-physician practice uses a nurse practitioner or physician assistant (who may not know you at all) to OK the hundreds of refill requests pouring in every day, it takes about five seconds to hit that button and refill your med for another year. Little wonder global spending on prescription drugs has passed $1.2 trillion.

With cradle-to-grave pharmaceuticals, all of us–patients and doctors alike–begin to believe the pill-for-every-ill cliché. So I was jolted a bit when I recently read that something completely harmless and non-medical was actually superior to a prescription drug for clinical depression.

Let there be light
You know already that light box therapy can benefit seasonal affective disorder (SAD). During dark months, your brain’s serotonin production drops, rendering you susceptible to depression, obsessive thinking, poor sleep (or excessive sleep), and so forth. To boost serotonin, you could take an antidepressant like Prozac or any of a dozen others and struggle through the winter. You could also winter in Costa Rica. Or skip the med and the hotel bills and be in the vicinity of a full-spectrum light box every day, which triggers your internal serotonin production. The price of light boxes has finally dropped and we stock a good one in our apothecary.

But here’s the real news. A study from the Department of Psychiatry at the University of British Columbia reported the results of a trial using a light box for clinical depression regardless of the season. The results were surprising.

They gathered 122 patients who had been diagnosed with untreated, moderately severe depression, patients who would normally be started on antidepressants. These 122 were divided in four groups:

  • Group One: Medication only (Prozac/fluoxetine).
  • Group Two: Full-spectrum light box only (30 minutes daily).
  • Group Three: Light box and medication.
  • Group Four: Placebo (sugar pill and a fake light box).

The patients were tracked for a total of eight weeks and their improvement or lack thereof was based on MADRS (Montgomery-Ashton Depression Rating Scale) scoring. MADRS is a way psychologists and psychiatrists can assign numerical values to the extent or your depression and, later, to your response to treatment. Although MADRS was created for professionals, you can see what the test is like by clicking here.

After eight weeks and comparing the before-and-after MADRS scores, there was significant improvement in two of the four groups:

  • Best result: Light box + medication.
  • Second best: Light box only.
  • Third/fourth: Not much improvement in either the antidepressant-only group OR the sugar pill/fake light box group.

You’ve read that correctly. Not only did using a light box beat out taking an antidepressant, but taking an antidepressant was no better than taking a sugar pill and sitting in front of a fake light box! 

Michael Terman, PhD, a Columbia University psychiatry professor who was not part of the investigation team, commented on the study. “The major surprise was the failure of a standard dose of fluoxetine (Prozac) to beat out the placebo while the light therapy showed a large effect within four weeks.”

You might wonder what the results would have been if they’d used a different antidepressant. The answer: when antidepressants are used against each other (Prozac vs. Paxil vs. Zoloft, etc), they all come out pretty much the same.

What should you, personally, do with this study?

  1. If you’ve never taken an antidepressant and your doctor is suggesting you give one a try, tell her about the study and try the light box instead. If you want to add an antidepressant to the light box treatment, that’s your choice. However, instead of the drug I suggest St. John’s wort (450 mg twice daily) and 5HTP (100 mg at bedtime). This combination has been proven to be as effective as a small dose (25 mg) of Zoloft.
  1. If you once used antidepressants and think you might need to restart them, try the light box and the St. John’s wort/5HTP combination instead.
  1. If you’re feeling some of the symptoms of depression (glance at the MADRS link above), try the light box and the St. John’s wort/5HTP combination first.
  1. If you’re currently taking antidepressants and want to get off them, discuss this with your doctor. Although using a light box while tapering off antidepressants has not been studied in a clinical trial, very likely the light box will take the edge off any uncomfortable withdrawal sensations you might feel.

It has been rumored that when a doctor avoids prescribing a drug, or a patient safely gets off one, a little bell will ring and an angel gets her wings. You’ve got to listen very carefully. Ah! There it goes!

Be well,
David Edelberg, MD

Posted in A, Blog, Case Studies, Knowledge Base, Mental Health Tagged with: , , , , , ,
11 comments on “Avoiding Antidepressants: A Provocative Clinical Study
  1. Colin Cody says:

    The result of the study is not surprising because the Serotonin Deficiency Hypothesis is baseless.

    http://kellybroganmd.com/depression-serotonin/

  2. Jo Peer-Haas says:

    I would use a light box if I needed Paxil, etc., but the kind of antidepressant I respond to works on both sides of the brain instead of just one, like the Zoloft-related varieties. (Am I getting that right? SSRI vs. SSNRI?) I take Effexor or Cymbalta for my anxiety/depression. Clinical depression runs in my family; I’m 59 myself. I dislike being on these meds, but I’ve tried herbs and other meds and that’s what works. I also have a therapist. I’m glad to hear about the light box results, though. Thank you.

  3. Ingrid says:

    Hi, I will try a (Full Spec) light lamp, but I have been experiencing low grade to sometimes deep depression, for many months now and not only in the winter months. I got my North Shore Health System IL. Pharmaco genetics gene test back that shows that I am a “fast Metabolizer’ of Serotonin meds. So they have not been much help. I suffer from FM / IBS / IC/ insomnia/ Tinnitus/ etc. My diet is quite clean (FODMAPs) as I believe most is caused by Glyphosate destroying the Shikimate pathways of my gut bacteria. Isn’t it true that until I get my gut on track, the depression will persist. Any tips besides typical pre and probiotics?

  4. Constans Dina Karamitsanis-Taha says:

    What an excellent write up Dr. Edelberg!!!! I VALUE Doctor’s that give “practical medicine” over medication!!! I believe this topic to be a Huge issue for highly sensitive people and in today’s society I imagine, we are plenty, as stimulus is 10 fold and growing! Our children will NEED these practices, as medication will be “killing us off”, sort of speak, literally, financially, or figuratively!!! Thank you for sharing!!!

    P.S. What would be your write up on PMS DYSPHORIA???

  5. Lisa W. says:

    It looks like there are a range of lightbox prices, many in the $60 range on Amazon. What sets the one carried at the Apothecary apart?

  6. Dr. R says:

    Lisa W. The less expensive units are smaller and not as bright. You can contact our Natural Apothecary staff for more details. 773-296-6700 or apothecary@wholehealthchicago.com

  7. Dr E says:

    Hi Ingrid
    You might try a very specific probiotic Lactobacillus helveticus (sold as Pro BioMood) which has been shown to help depression and anxiety

  8. Regina Sargent says:

    Dr. E.
    THE pro biomood contains xylitol, which I get severe migraines from.
    Could you recommend another brand to get the correct probiotic you are suggesting.

    I am very medication sensitive and have tried several SSRI and recently A tricyclic, which I had a profound negative reaction to, on a very small dose.
    I had an appt. To see the Nurse practitioner at Whole Health, but had to cancel.
    I am interested in the lightbox and any other natural things I can take for anxiety and Depression.
    I was on Zoloft for almost 14 years. And can no longer take it.
    If there is anyway to see you. I would so appreciate that. Soon.
    I have RSD reflex sympathetic dystrophy fibromyalgia, slow immune response to healing. Inflammation problems.
    Anxiety and Depression
    When I call, they want to schedule me with NP, because I have BC/BS and Medicare due, to my Disability. BC/BS is primary….my husband carries through work.
    I havent had much luck with chinese herbs or flower essences .
    Please consider writing me with any suggestions.
    Lightbox and probiotics
    I can do, if no Xylitol.
    I would like to see you.
    It has been a very rough year.
    I am scheduled for a Holistic MD closer and am.looking at neurotransmitter testing.
    Is that worth my while.
    I can consider supplements.
    I am sensitive to L Theanine found in 5HTP
    but, considering taking 1/2the dose.
    Thank you for your information time and committment
    Kindest Regards,
    Regina

  9. Dr E says:

    Hi Regina
    The Product Florassist Mood by Life Extension does not contain xylitol. Here’s a link
    http://www.iherb.com/Life-Extension-Florassist-Mood-60-Capsules/68441?gclid=Cj0KEQiAhNnCBRCqkP6bvOjz_IwBEiQAMn_TMbWuz29z6Em7YsJsSvxrRHh4EnPQhIDiPhB_kEHpiXAaAnVn8P8HAQ

    Dose is one capsule twice a day. These, plus a lightbox, may be helpful

  10. Regina Sargent says:

    Dr. E
    Thank you, for another probiotic product name.
    Do you think the neurotransmitter testing
    Is helpful at all?
    I will ask for MTHFR
    Testing.
    I have tried so many things. I appreciate your feedback.
    Thank you
    Regina

  11. Leah says:

    Another great alternative to prevent depression is vitamin therapy. The most scientific and comprehensive book I’ve found was written by Dr. William Walsh (http://www.walshinstitute.org/nutrient-power.html). The Mood Cure is a great DIY resource (http://www.moodcure.com) as well as Depression Free, Naturally (http://joanmathewslarson.com/HRC_2006/Depression_06/DepressionFree_TheBook.htm). I incorporated what I learned from these three books into a supplement regimen that cured my depression in a matter of weeks. It was far more effective than taking Zoloft 10 years ago, and without side effects.

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