The Bright Side of Being Blue



AH, DEPRESSION, always good for a sad holiday topic. But there are other approaches, such as why almost everyone these days seems to be taking an anti-depressant.  Or, the role of antibiotics and other drugs in contributing to depression.

But the best may be a recent study focusing on “the bright side of being blue” — the actual title of a research paper touting “analytical rumination — a type of distraction-resistant thinking that is characteristic of depression.

(Note: Analytic rumination, holiday blues and whatever is being treated in people who function well on anti-depressants are all a far cry from the acute or chronic depression that cripples its sufferers.)

The startling rise in anti-depressant use — from almost 7% of Americans in 1999 to about 13% in 2012, according to statistics from the NHANES (National Health and Nutrition Examination Survey) of 37,959 adults over age 20 — is causing an outcry by some but not all of the medical profession.

Among women in their 40s and 50s, one in four now takes an antidepressant medication, according to a Johns Hopkins study on more than 5,000 patients who had received a diagnosis of depression within the previous 12 months.  The study’s conclusion, which criticized overprescription of the drugs: two thirds of the 5,000 did not meet the criteria for “major depressive episode” as described by the Diagnostic and Statistical Manual of Mental Disorders (DSM), the New York Times reported.

On the other hand, “Listening to Prozac” author Peter Kramer points out: “a reliable finding is that antidepressants work for chronic and recurrent mild depression, the condition called dysthymia.  More than half of patients on medicine get better, compared to less than a third taking a placebo.”

“Maybe what antidepressants need, these days, is a defender,” writes Maura Kelly in a 2012 Atlantic article (in which the Kramer quote appears).  Kelly points out that while non-pharmaceutical treatments are often recommended for depression, good therapy can be expensive, and following an exercise regimen is difficult for people who have trouble getting out of bed.  “In some cases — like mine,” she writes, “years of therapy don’t solve the problem, and neither does daily exercise.”

“The bottom line is that these medications often relieve the patient’s suffering,” Houston psychiatrist John Oldham, then-president of the American Psychiatric Association, wrote in a letter to the New York Times.

Another defender, Dr. Howard Forman, medical director at Montefiore Medical Center in the Bronx, has pointed out that “while psychotherapy is another option to helping people obtain better mental health…cost, availability of experts and time demands” are the main reasons people may turn to antidepressants instead.”

Another reason for rising numbers of people taking these drugs is that 25 to 60 percent of anti-depressants are prescribed for off-label uses, including anxiety, addiction, eating disorders, insomnia, pain, panic disorder, fibromyalgia, OCD and symptoms related to both PMS and menopause.  Less common reasons: arthritis, migraine, panic disorder, PSTD and fainting.

The blame on antibiotics for the increasing prescription of antidepressants comes from research on the gut-brain connection: disruption of the healthy balance of bacteria in the gut by antibiotics can produce brain chemicals linked to depression.  A Tel Aviv University study looking at health records of more than a million British patients from 1995 to 2013 found one course of antibiotics boosted the risk of depression by about one quarter; while between two and five courses raised the risk by nearly half, according to the Daily Mail.

Besides antibiotics, a host of other drugs with depression as a side-effect include barbiturates and benzodiazepines (for anxiety, insomnia, etc.), beta-blockers and calcium-channel blockers (for high blood pressure and heart problems), opioids (for pain), statins (for high cholesterol) and acyclovir (for shingles and herpes).

The analytic rumination theory comes from research published in PLOS ONE, the peer-reviewed, open-access journal, based on a 20-question test given to almost 600 subjects at McMaster University.  “We are seeing more evidence that depression can be a necessary and beneficial adaptation to dealing with major, complex issues that defy easy understanding,” McMaster professor Paul Andrews told Science Daily.

The study concluded that depression may arise when the mind concentrates involuntarily on a complex issue to the point where it allocates resources to analyzing the problem at hand, leading to disruptions in eating, sleeping and social interaction associated with depression.  With this understanding, said researcher Skye Barbic, “instead of discussing the disease as a ‘bad thing,’ clinicians maybe be able to help patients have insight about the potential adaptive purposes of their thinking.”

As always, it’s a question of finding the balance.  For many people, antidepressants can make a difference.

— Mary Carpenter
Mary Carpenter is MyLittleBird’s well-being editor. See more of Mary’s posts here

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