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?
- 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.
- 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.
- 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.
- 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!
David Edelberg, MD