Experimental Vaccines Daily Blog: Comedy Sunday "Bill Hicks"

Salt Linked to Depression

I grew up in a family that loved salt - it was always handy in a shaker on the dinner table, and we added it to everything. I can remember the soups my mother made as being particularly salty, and how that made them particularly good. I've since given up adding salt to my foods, but I still enjoy a nice, salty bag of chips from time to time. Salt is an awfully satisfying experience for my tongue.

At the University of Iowa some researchers have posited that salt enhances mood, which certainly fits nicely into my own anecdotal experience. Rats were less likely to engage in pleasurable behaviors, such as drink sugary rat goodness, if their salt levels dropped too low. Between the researchers and me we've come up with a few observations about this:

• Salt is a good conductor and probably affects brain function.
• We evolved in a saline environment (the ocean), and have carried on with the same basic chemistry on land.
  
• Our bodies and minds seek out more salt than we probably need, which could suggest addiction or a system that hasn't adapted to the relative abundance of salt we now have. It's not clear if the reason makes much of a difference in the result.
  
• Mood elevation that's tied to salt consumption could be caused by the salt, but it also could be the other way around. Maybe the lack of salt causes anxiety, which is alleviated by eating salt and giving the body what it wants.

"One sign of addiction is using a substance even when it's known to be harmful. Many people are told to reduce sodium due to health concerns, but they have trouble doing so because they like the taste and find low-sodium foods bland."

Again, it could also be that it takes thousands of years for our bodies to adapt to changing circumstances - two thousand years ago the phrase "common table salt" would have been incomprehensible. The desire for salt could simply be an overexaggeration of a real need.

Migraines and Depression

I suffered from migraines as a child, and I became depressed as an adolescent. I would have thought it just bad luck, but a study suggests migraines and depression may both be linked to serotonin levels. I suppose I should have seen it coming, since it's kind of a dummy smack. My own anecdotal experience, now that I look at it, suggests a link between the worst headache ever invented and depression.

SSRIs are being prescribed as migraine preventatives in response to this area of research. The research suggests a link (47% of Migraineurs experience clinical depression as opposed to just 17% of the general population), but is not yet clear on whether one causes the other or not, or perhaps both are caused by the serotonin levels. I wouldn't be surprised if the serotonin imbalance itself was eventually proven to be a symptom only; however, I don't anticipate that being proven easily by science because of the difficulty of the scientific community in overcoming the body/mind link that depression and related illnesses straddle.

Fish Oil is not Snake Oil

Studies have not shown if fish liver oil helps with depression. Science sometimes fails to be like the thing that it studies; that is, slow-moving and focused. I have not the slightest idea if fish oil has any impact on depression (although it is probably as effective a placebo as anything else out there), but I'm pretty sure that you aren't going to get fast results out of a natural phenomenon.

Any scientific study must be funded, and most funding comes from the companies that profit from research - the ones making products that they can sell. Sunlight, plants you can pick from your own garden, and air just aren't going to be studied as serious treatments for anything since they're free and plentiful (unless a marketing person can find a way to sell us what we already have, a la pet rocks); things like fish oil and cow pies and cat hair are all common enough that it would be tough to charge a lot for treatments derived from them, also discouraging the really big research bucks. We aren't likely to see long-term studies on depression treatments that nobody can make money from.

There have been some amazing breakthroughs for treatments of all manner of diseases through new drugs. That doesn't mean that every drug is wonderful, nor does it mean that every disease's cure is in pill form. Well-trained pharmaceutical representatives earn a great living convincing doctors to prescribe their products, and no one is out there equally passionately pitching St. John's wort, taking a walk every day, fish oil, getting a puppy, copper bracelets, and believing in God (at least in doctor's offices). Plenty of alternative therapies may be effective, but the medical community isn't designed to find out.

Of course, I can't say that I would like the idea of being accosted by fish-oil salesmen.

Placebo: What Your Brain Can Do for You

The placebo effect is the measurable, observable, or felt improvement in health not attributable to treatment. This effect is believed by many people to be due to the placebo itself in some mysterious way.

So states this article on placebos and depression from the Skeptic's Dictionary, and appropriate resource. Like this UCLA article about placebo usage, it discusses how, when a patient is told they are receiving a placebo, the effectiveness often goes away. Is this because the treatment was all in their heads? Or that the depression was?

Many studies try to compensate for the "placebo effect." Others, more recently, have specifically studied this factor as a healing process. A study by Dr. Arif Khan showed, according to the New York Times, that:

It turns out that the more severely depressed people are, the less likely they are to respond to a placebo. And people with more mild depressions get better with just about all treatments, including placebos. Since most clinical trials enroll less severely depressed patients, the observed difference between the response to an antidepressant and a placebo can be misleadingly small.

Other studies, including one by Dr. Irving Kirsch, suggest that medications are nearly useless because the placebo effect is so high in depression treatment. Meanwhile, doctors wrestle with the ethics of "tricking" patients with placebos.

I think the point is not quite being realized by the scientific community. Depression is a disease that is has an effect upon the body as well, because the brain controls all things. Placebo is the brain's natural ability to repair damage to all the human systems. This process is easily interrupted by doubts and limiting beliefs. At this point in our development we have identified the process, and we recognize that it can be encouraged by presenting patients with a physical talisman, if you will, of healing; the pill. More severely depressed people need more than a sugar pill because they are so very sick their limiting beliefs extend deep into the unconscious, metastasizing like cancer. They need medications to bring them to the point where the placebo process can recover enough to even try to work.

I foresee a time when the scientific community will focus serious research on placebos, not to remove them as a variable or identify what is "in a patient's mind," but to determine how to harness our own healing ability and hone it. This research will not be conducted by drug companies, because it would not be advantageous to cure such a lucrative market for maintenance medications. It will be research into areas currently sidelined as psychology or superstition, and will tap into the true potential of the human brain.

The lucky depression patients have found other avenues to unlock these secrets, either through sugar pills or prayer or exercise or therapy, and they have been given a chance at true healing, y allowing their brains to overcome depression naturally. It's time the scientific community figures out a way to give the rest of the victims that opportunity.

Self-Care Options

This article reinforces my position on the paradox of depression: you aren't going to get better if you can't learn to do it yourself, but depression keeps you from believing that this is possible. Drugs and therapy can be important tools for recovery, but neither of them will succeed without your help, and neither of them should be considered for a lifetime. If you plan for a day when you won't need them you're much more likely to reach that day.

Either of those treatment options may give you the needed push to get to a point where you can do something for yourself, crawl just far enough out of your own personal pit that you can take at least a small amount of responsibility for your own recovery. If they can't get you to that level, and you aren't functional enough to make it there without further help, you should find that help. Never forget that the worst symptom you have is the belief that you are going to stay this way, that nothing you do can change it, that it's pointless to even try. Don't give in to that crap, because if you expect the worst you're rarely disappointed. Do you have anything to lose by trying for more? Can it really get worse than it is? Really?

Some thoughts on the five suggestions given:

• Keep Active: yep, I've mentioned how important even a little bit of exercise can be. Don't want to get out of bed? Consider having a friend drag you out if necessary.
• Eat well. A well-balanced eating strategy will help you feel better now and later. Good thought. I've had comments here from depression victims that eat like crap, and it shows in the writing that they're just making things worse. Your body needs good fuel to do a good job.
• Get adequate sleep. I would modify this to say, "Get appropriate sleep." Insomnia is a symptom of depression, but I was more prone to the fourteen-to-sixteen-hour power nap. I psychiatrist I knew said that the best way to regulate sleep is to get up at the same time, every day, without fail. Your body will take care of the rest.
• Control stress. Coping with depression is stressful enough, so try to limit other sources of stress. And depression does a marvelous job of amplifying the other stress, doesn't it?
• Stay connected. Make relationships a priority. Social ties give you a sense of purpose and meaning in life. I can't emphasize this more. You need to be around people, even if you don't feel like it, because even if you believe you're alone in a crowd it is better than being alone alone. Do it even if you don't want to.
  

Tasteful Research Opens Doors

Scientists have discovered that, not only do depression and anxiety have a measurable effect upon the sense of taste, it is even possible to determine which chemicals are most out of balance by how taste has been diminished. This is exciting for a couple of reasons.

This is the first research I have seen that shows physical evidence of anhedonia, the inability to experience pleasure. Anything that reinforces the physical nature of depression is very important. Research that demonstrates the physical symptoms of this disease go a long way towards dispelling the myth that it is "in your head." That phrase makes it sound like depression victims make a decision to suffer, which is not true. Ironically, the very nature of the disease does cause those selfsame victims to make a decision to continue suffering, but this doesn't occur until the will is compromised. Scientific research can demonstrate the physical nature of this disease, although I am of the belief that it will never discover a physical organism, a "depression virus," if you will. The root is not in the body, although much of the damage ends up there.

Diagnosis by taste-test is really just a fancy way of suggesting that we should listen to what our bodies are telling us. We are given a plethora of clues about our health, day in and day out, and either we ignore them or we just don't understand what they mean. Now we have an additional level of understanding, and another tool to use in the evaluation of our health. Another piece of the puzzle is slipped into place as diminished taste is coupled with diminished appetite in some people. We have been given one more solid tool to use to to sweep away the miasma; something corporeal with which to document a disease that prides itself on being as vaporous and insubstantial as a hunting vampire.

Wellbutrin and SAD

I think the most promising thing about this discussion of Wellbutrin is that it's only recommended to be taken during the dark months. It's very easy to get into a maintenance program with depression, and it's often not necessary. Long-term medication creates a dependence in a way that isn't defined by the scientific community; it's a belief that develops that one cannot be well without a drug, which becomes a self-fulfilling prophecy. If you're depressed you're already extremely susceptible to the belief that you are simply not a strong person, and drugs can easily reinforce that by becoming a security blanket. Properly used, a medication for most depression victims should be a trainer, showing their minds what health looks like so that they can reproduce it in themselves.

That being said, I'm glad that Wellbutrin might be useful for SAD sufferers. If it gets you through the darkest times, and allows you enough energy and motivation to modify your behavior for health (exercising, exposing yourself to more sunlight), then it could be a godsend for many. Only for a very small percentage of depression victims is a permanent drug solution logical. And I know how you think if you're depressed, so let me make this clear: you're not one of that small percentage. Don't believe it. The light is inside you, and the drug is only a tool that can bring you back to the level where you can find and use what you've had all along.

Ketamine No Quick Answer

Ketamine is a veterinary anesthetic that has been used recreationally for at least ten years. Early research suggests that it could have the ability to address all the symptoms of depression, with the effects being felt in hours, rather than the weeks it can often take with traditional antidepressant medications.

However, the hallucinatory properties of this drug have to be considered before any serious look at it as a treatment option could take place. And considering how easily depressed persons self-medicate with any number of substances, it would be counterproductive to prescribe a drug that already has a history of being abused. Even though it appears to be treating the actual symptoms, not just inducing euphoria, the frustrating truth is that it would be too easy to turn a blind eye to "Special K" as a fun drug and doom many depression victims to a life of more drug dependence instead of more freedom from pain.

Seems like a cruel joke, but it really isn't. If ketamine had "instant relief" properties with no obvious dangers, it would be fast-tracked through the approval process, with drug companies rubbing their hands together with glee at the thought of being able to sell it at a much higher price, since the potential market would be expanded from house cats in need of surgery to a large percentage of the human population. Media reports would herald it as the cure we've all been waiting for. Much fanfare would ensue.

Drugs, however, have a strange habit of hiding some of their side effects for months, even years. Fast track research didn't benefit the users of Vioxx. Better to not allow large companies to quickly capitalize on the desire for hope, and make sure they do their homework. The last thing we want is to cause more harm than good.