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By Andrea Cannas

DATE

October 24, 2023

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Side effects: how to optimise anti-depressant therapy

How are antidepressants used?

Antidepressants are a family of drugs primarily indicated for depression. They are also commonly prescribed for chronic pain, anxiety, panic disorder, cigarette addiction, obsessive-compulsive disorder, obesity and premenstrual depression. The main 4 categories include:

  1. Monoamine Oxidase Inhibitors (MAOIs)
  2. Tricyclic Antidepressants
  3. Selective Serotonin Reuptake Inhibitors (SSRIs)
  4. Miscellaneous Antidepressants


How can I complement antidepressant treatment?

If you are looking for a quick fix to help you feel better and quickly transition back into your daily routine, then it is likely you will be prescribed with antidepressant treatment. Although this approach may prove effective for some individuals, it may not be for others. In the long-run, benefits of treatment may reach a plateau and you may notice other symptoms appearing, causing an inability to follow treatment including dependency and withdrawal effects. Overall, this leads to the worsening of mental and physical health symptoms. Many don’t know that the effect of improved nutrition, particularly with dietary supplements, on depression may provide a complementary approach to standard medical treatment. 

Who is most affected?

Antidepressant prescription rates in Cyprus are increasing. Nonetheless, depression is common and the efficacy of antidepressants is suboptimal.

There has been a modest increase in the prevalence of depression in young Cypriot adults under 45 years of age, especially in young women. Indeed, females are 50% more likely to experience depression compared to males. Meanwhile, studies in other countries show that while 35-45% of depressed patients experience complete relief from their symptoms with prescribed medicines, between 25-55% have an inadequate response (called tachyphylaxis) or experience different intolerable side effects. Many have reported switching repeatedly from one drug to another or combining drugs to maximise their effects.

Five common side effects that can be addressed with nutritional therapy:

  1. Weight gain

Certain classes of medications have a high metabolic liability and are pro-inflammatory, leading to body weight changes. Moreover, there are drugs shown to interact with the gut microbiome, where the resulting gut imbalances have shown to mediate weight gain. To conclude, you can avoid any increments in body weight by adjusting your diet and lifestyle with the help of a suitable practitioner to accommodate for these physiological changes.

  1. Sexual dysfunction

Some studies report up to 80% of SSRI-induced sexual side effects. It is important to rule out factors that can contribute to this phenomenon such as alcohol, substance abuse or the presence of illness or dysfunction. Assuming absence of the aforementioned, there are promising herbal remedy methods that can help with SSRI-induced sexual dysfunction, such as saffron. Exercise has also shown to be helpful with increasing arousal by activating the sympathetic nervous system. The benefits of these methods are maximised if provided as part of an integrative protocol that combines psychotherapeutic techniques such as cognitive behavioural therapy (CBT).  

  1. Gastrointestinal side effects

Interestingly, in nearly half of all mood disorder patients, irritable bowel syndrome is a striking clinical concomitant phenomenon. Long-term use of SSRIs i.e. fluoxetine, sertraline and paroxetine can influence the integrity, balance and composition of the gut microbiome. Indeed, the most frequent side effects to antidepressant treatment are diarrhoea, stomach ache and gastric distress. Two ways they influence this process is by:

  1. Depleting the stomach’s innate ability to produce stomach acid, thereby impacting digestion.
  2. Causing gut bacterial imbalances (called microbial dysbiosis).  Microbial dysbiosis can affect the way you absorb nutrients and can make you more vulnerable to infections and chronic diseases by mediating inflammation and a weakened immunity. Moreover, dysbiosis can also influence emotions, responses and behaviour.


Pre- and probiotic regimens in complement to drug therapy are beneficial interventions that can nourish and enhance the growth of the beneficial bacteria that colonise your gut. Specific probiotic strains or prebiotic fibre-rich formulations can be used to address specific neuropsychiatric conditions and/or mood symptoms. These interventions are provided within the context of my Gut Health Protocol, which looks to eliminate, replace, repopulate, repair and rebalance your gut and regain fast recovery.

  1. Lethargy and fatigue

Some drug therapies can deplete CoQ10, an antioxidant that helps with energy production, causing you to feel more tired than usual. As a result of low energy, you resort to stimulants such as sugar, caffeine, sweetened beverages and nicotine to keep you going throughout the day. What’s more is you experience a vicious cycle of energy highs and lows (blood sugar dysregulation), typically manifesting with ongoing cravings, poor sleep, low drive and mood disorders.

There is lots of research reinforcing the connection between nutrition and brain function, demonstrating how specific nutrients or food patterns can have positive effects on mental health. Patients who follow diets that are high in vegetable, fruit, healthy fats and whole grains with moderate intake of fish have better mental health than those following a ‘Western’ diet high in animal and processed foods.

  1. Med-Food & Nutrient Reactions: avoidance and safety profile

The following are inadvisable and should not be combined with drug therapy due to their interactions with drug metabolism, absorption and efficacy.

  • Grapefruit / Grapefruit juice
  • John’s Wort
  • 5-HTP
  • Alcohol i.e. beer and wine – can intensify the sedative effect
  • Aspartame-containing cola beverages – may interact with some drugs
  • Herbal and/or black tea 2 hours away from medication
  • Tyramine-containing foods i.e. aged cheeses, cured or processed meat, alcohol, citrus fruit and pickled or fermented vegetables.

Summary

Nutritional therapy is not a quick fix but it is a sustainable solution that allows you to understand how your body behaves and what it needs to function optimally. To conclude, the effect of improved nutrition, particularly with nutraceuticals, as well as dietary and lifestyle changes can have empowering effects in people suffering with depression during treatment.

Disclaimer

No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinicianR

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