Anti-Depression medications – One size does not fit all!

In today’s world ‘stress’ has become a common household phenomenon. Professional, social, economic and personal issues drive people to unimaginable level of stress and the outcome is that 1 in 4 people are afflicted with depression (Mental health statistics, UK). True, happiness is a state of mind but it is also a fact that people have different intrinsic capacities to deal with stressful conditions and not many can cope with a chronic onslaught of ‘stressful’ conditions!

We have come a long way in the field of psychiatry since the time when lithium used to be prescribed for ‘treating’ mental disorders like depression. The older tricyclic antidepressants (Doxepin, Imipramime etc.) have been superseded by the newer SSRIs (Selective Serotonin reuptake inhibitors), SSREs (Selective serotonin reuptake enhancers), atypical antidepressants (Bupropion) and the MAOIs (Monoamine oxidase inhibitors). It would look as if we have a good arsenal to fight this menace. 

But if one scratches the surface, one would realize that in many cases these medications are the problem and not the solution. The side effects of these ‘newer’ class of drugs range from the ‘manageable’ nausea, dry mouth, weight gain/loss to the dangerous cases of increased suicidal tendencies and anxiety. The problem is that still the theories behind the probable cause of depression revolve around the differential levels of neurotransmitters (Serotonin, dopamine) in depressed patients. Although, many scientific reports have validated these claims but doubts persist. To top the level of confusion, both classes of drugs such as SSRIs and SSREs which target the neurotransmitter serotonin level (one increases its level and the other decreases it) have been shown to alleviate symptoms of depression!

Also, unlike other modern medicines, antidepressants take longer time to show their effects (if at all). We do not understand why this is so though there are theories that suggest that the medicines can lead to modifications at the genomic level and hence the time-delay of their action! Psychiatrists themselves try and experiment with different class of medicines to see the best fit for their patients. But in doing so not only crucial time is lost, there are  issues leading to patient compliance and severe side effects and even death (suicide).

The need of the hour is therefore to use modern genomic data to predict the outcome of these medications before embarking on the prescription. As 'mind' is unique to every individual, this is a fit case where the newer field of 'personalized medicine' should kick in with all its technology in its arsenal.We have already started doing the same for oncology drugs with newer drugs being accompanied by companion diagnostic tests. Also, the drug companies need to be more transparent with their data of the side effects of anti-depressants as it has been found of late that many pharma companies did not divulge the true nature of the side effects and later the drugs had a serious ramifications on the patients’ health and many of them were either withdrawn or were forced to have ‘black box’ label warnings!

Mental illness - an appalling state of affairs

Depression is a simple word but has a devastating meaning. It is a disease which ruins not only the individual but also affects the entire family. Particularly in today’s day and life when stress (both professional and personal) is slowly gripping the society, cases of depression have been skyrocketing.  Talking about mental illness however, has been a taboo in our society. People afflicted with such diseases are socially boycotted. It is time when people, government realized the impact such an ailment has on the society. Western countries are a shade better when it comes to the acceptance of mental ailment and availability of healthcare workers, psycho analysts and psychiatrists to deal with such issues. But it is in an appalling state in our country.

The area of research and treatment in this field is also fraught with naivety and is not very advanced. Even there are no credible biomarkers to diagnose such ailments; it solely depends on the profiling done by the psychiatrist. We still do not know the mechanism of action of some of the drugs and doubts persist about their effectiveness as therapies. Patients even avoid taking these drugs as they are unsure of the possible ‘side-effects’ of these molecules. Yes, research on brain is a very difficult proposition, yes; it requires cutting edge technologies probably in the edge of what science can offer today and yes we are years if not probably decades away from a ‘cure’ to most of these ailments. But having said that, are we spending enough in this field? Are the pharma companies/Governments doing enough? Of course the cash cows for the industry remains cancer, diabetes etc. but if do not look deeper into the problem and increase funding and research into this field then the cost of dealing with the outcome would be dangerously high!