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Glavno medicinsko razumevanje depresije je že desetletja osredotočeno na serotonin. Depresijo smo preprosto opredelili kot "kemično neravnovesje", ki zaradi nizke ravni možganskega serotonina ali serotoninske aktivnosti povzroča simptome depresije. Depresivne osebe, ki imajo manj serotonina lahko zdravimo z antidepresivi. Najpogosteje uporabljeni so selektivni zaviralci ponovnega privzema serotonina (SSRI). Vendar pa nova študija to hipotezo postavlja pod vprašaj.
V reviji Molecular Psychology [1] je bil pred kratkim objavljen nov obsežen pregled študij, ki povezujejo serotonin in depresijo. Študija obravnava dokaze iz prejšnjih pregledov in metaanaliz. Skupina raziskovalcev iz Velike Britanije, Italije in Švice je povzela in združila dokaze iz vseh obstoječih študij ter ugotovila, da "ni doslednih dokazov, da obstaja povezava med serotoninom in depresijo ali da je depresija posledica zmanjšane aktivnosti ali koncentracije serotonina".
Serotoninska hipoteza je temeljila na poskusu z drogami
Antidepresive so sprva odkrili s spremembo namembnosti zdravila, ki so ga uporabljali za zdravljenje tuberkuloze, pri čemer so slabo razumeli njegove učinke na možgane. Začetne raziskave so pokazale, da antidepresivi povečajo količino serotonina in noradrenalina v možganih. Te ugotovitve so bile podlaga za teorijo depresije, znano kot monoaminska hipoteza, po kateri je nezadostna raven teh nevrotransmiterjev temeljni mehanizem depresije, ki ga je mogoče odpraviti z antidepresivi. [2]
Ta poenostavljena razlaga depresije in njenega zdravljenja je naletela na nasprotujoče si podatke in upravičen skepticizem, zato je bilo na primer predlaganih več alternativnih teorij o depresiji in antidepresivih:
Na ožičenje in preoblikovanje naših možganov (nevroplastičnost) vpliva naš življenjski slog in lahko vpliva na depresijo.
Na naše vnetno stanje vplivajo stvari, kot sta kakovost prehrane in količina spanja, in je povezano z depresijo.
Na povezavo med črevesjem in možgani ter na naše hormonsko stanje vplivajo izbire življenjskega sloga in so povezane z zdravjem možganov in depresijo.
[Preberite več: Acupuncture Therapies and Neuroplasticity] [Preberite več: Protivnetna aktivnost zelišč tradicionalne kitajske medicine]
Ali so antidepresivi učinkoviti pri depresiji?
Naključno kontrolirano preskušanje velja za zlati standard kliničnih raziskav. Velja, da je to najbolj objektiven in nepristranski način preučevanja učinka intervencije. To pomeni, da se v študijo vključi skupina ljudi, ki izpolnjujejo določena merila, nato pa se jih naključno razporedi v skupino "pravega zdravljenja" ali placeba, pri čemer niti raziskovalec niti udeleženec ne vesta, v katero skupino sta razporejena. Mnoge od teh poti je nato mogoče nadalje preučiti s sistematičnim pregledom in metaanalizo, ki pomeni združevanje vseh podatkov in iskanje trenda. V tej študiji, objavljeni v reviji Lancet, enem najpomembnejših medicinskih časopisov, je bilo ugotovljeno, da so bili vsi antidepresivi pri odraslih z veliko depresivno motnjo učinkovitejši od placeba. [3]
Katere so alternative antidepresivom?
V konvencionalni medicini se klinična depresija običajno zdravi s psihoterapijo in zdravili. Zaradi pomanjkanja učinka ali njihovih stranskih učinkov vse več ljudi išče alternativno zdravljenje. Primeri alternativnih terapij vključujejo:
Refleksoterapija.
Vadba.
Masaža.
Pri zdravljenju je pomembna učinkovitost
Tradicionalna kitajska medicina, vključno z akupunkturo in zeliščarstvom, je že desetletja tarča kritik zaradi pomanjkanja terapevtskega mehanizma. Kot razkriva ta nova študija, je lahko tudi pri splošno sprejetih in uporabljenih zdravilih nejasen molekularni mehanizem. To nedvomno odpira več možnosti za iskanje "alternativnih" in predvsem učinkovitih metod, ki pomagajo ljudem v trpljenju.
Literatura:
Serotonin Imbalance Found Not to Be Linked o Depression
The mainstream medical understanding of depression has centered on serotonin for decades. We simply put depression as a “chemical imbalance” that low levels of brain serotonin or serotonin activity leads to symptoms of depression. Depressed people have less serotonin can be treated by antidepressant. The most used one is the Selective Serotonin Reuptake Inhibitors (SSRIs). However, a new study is fundermentally challegning this hypothesis.
A new large-scale review of studies linking serotonin and depression was recently published in the journal Molecular Psychology [1]. The study examines evidence from previous reviews and meta-analyses. The team of researches from the UK, Italy and Switzerland summarize and combine evidence from all existing studies and conclude that “no consistent evidence of there being an association between serotonin and depression or that depression is caused by lowered serotonin activity or concentrations.”
The Serotonin Hypothesis was built on a drug experiment
Antidepressants were discovered initially by repurposing a drug used to treat tuberculosis, with little understanding of its effects on the brain. Initial research revealed that antidepressants increased the quantity of serotonin and noradrenaline in the brain. These findings formed the basis of a theory of depression, known as the monoamine hypothesis, which suggests that insufficient levels of these neurotransmitters are an underlying mechanism of depression that can be corrected with antidepressants. [2]
This simplistic explanation of depression and its treatment has been met with conflicting data and justifiable scepticism, and several alternative theories of depression and antidepressants have been proposed, for example:
The wiring and rewiring of our brains (neuroplasticity) is influenced by our lifestyle and may affect depression.
Our inflammatory state is affected by things like diet quality and sleep quantity, and has been linked to depression.
The gut-brain connection and our hormonal state are influenced by lifestyle choices, and are connected to brain health and depression.
[Read more: Acupuncture Therapies and Neuroplasticity] [Read more: Anti-inflammatory activity of traditional Chinese medicinal herbs]
Is anitdepressant effective for depression?
Randomised controlled trial is regarded as the gold standard of clinical research. This is believed to be the most objective and non-biased way to study the effect of an intervention. That means a group of people who met certain criteria will be included in the study, then randomly assigned to a “real treatment” or placebo group and neither in researcher non the subject know which group they are assigned. Many of these trails then can be further studied in systematic review and meta-analysis, which is grouping all the data together and find the trend. In this study published on Lancet, one of the most important medical journal, concluded that all antidepressants were more efficacious than placebo in adults with major depressive disorder. [3]
What are the alternatives to antidepressants?
Clinical depression is typically treated with psychotherapy and medication in conventional medicine. Due to the lack of effect or their side effects, more and more people look for alternative therapy. Examples of alternative therapies include:
Reflexology.
Exercise.
Massage.
Treatment is all about the efficacy
For decades, Traditional Chinese medicine, including acupuncture and herbal medicine, has been criticized for its lack of therapeutic mechanism. As it is revealed by this new study, even the widely accepted and used medication could also be unclear in terms of molecular mechanism. This is undoubtedly opening more possibilities to look for “alternative” and most importantly effective methods that help people in sufferings.
Literature:
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