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Mental Health
The Case Against Antidepressants
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<blockquote data-quote="tareload" data-source="post: 239932"><p>From article in last post:</p><p></p><p>While animal and human studies (<a href="https://www.frontiersin.org/articles/10.3389/fphys.2013.00259/full#B3" target="_blank">Babyak et al., 2000</a>; <a href="https://www.frontiersin.org/articles/10.3389/fphys.2013.00259/full#B12" target="_blank">Engesser-Cesar et al., 2007</a>; <a href="https://www.frontiersin.org/articles/10.3389/fphys.2013.00259/full#B2" target="_blank">Arunrut et al., 2009</a>) have indicated that the combination of exercise and antidepressant medication may confer no advantage over either treatment alone, there is another issue at stake here. Although antidepressant medication—including the tricyclic medications, the serotonin and noradrenaline reuptake inhibitor and the selective serotonin reuptake inhibitors—may have short- to medium-term benefits including the amelioration of depressive symptoms and increased resilience to stress, research has begun to highlight the longer-term adverse cardiovascular effects of antidepressants (<a href="https://www.frontiersin.org/articles/10.3389/fphys.2013.00259/full#B86" target="_blank">Whang et al., 2009</a>; <a href="https://www.frontiersin.org/articles/10.3389/fphys.2013.00259/full#B47" target="_blank">Licht et al., 2010a</a>). Reductions in HRV have been attributable to the specific effects of antidepressants (<a href="https://www.frontiersin.org/articles/10.3389/fphys.2013.00259/full#B49" target="_blank">Licht et al., 2008</a>, <a href="https://www.frontiersin.org/articles/10.3389/fphys.2013.00259/full#B47" target="_blank">2010a</a>) while increases in HRV are associated with their cessation (<a href="https://www.frontiersin.org/articles/10.3389/fphys.2013.00259/full#B47" target="_blank">Licht et al., 2010a</a>). <strong>An epidemiological study (<a href="https://www.frontiersin.org/articles/10.3389/fphys.2013.00259/full#B86" target="_blank">Whang et al., 2009</a>) on 63,469 women aged 30–55 years without baseline coronary heart disease (CHD) reported that while depressive symptoms were associated with fatal CHD, antidepressant use (61% of participants were using an SSRI) was specifically associated with a 3.34 increased risk for sudden cardiac death even after controlling for a variety of confounds. A more recent study has reported that reduced cardiovascular fitness is associated with an increased risk of suicide over a 42 year follow-up period (<a href="https://www.frontiersin.org/articles/10.3389/fphys.2013.00259/full#B1" target="_blank">Åberg et al., 2013</a>) highlighting the importance of cardiovascular health over the lifespan. Together, these findings highlight the importance of research on the cardiovascular effects of antidepressants and specific lifestyle factors such as physical activity. The present study makes an important contribution to this effort highlighting that the cardiovascular effects of regular vigorous exercise and of an acute dose of escitalopram during stress are comparable, i.e., both are associated with a decrease in HR and an increase in HRV.</strong></p><p></p><p></p><p>In the present study we demonstrated that acute administration of escitalopram is associated with increased vagal function under both resting and task conditions; a finding that was particularly robust for HR. This finding is consistent with reported short- to medium-term beneficial effects of SSRIs on cardiovascular and neuroendocrine responses to stress in depressed patients (e.g., <a href="https://www.frontiersin.org/articles/10.3389/fphys.2013.00259/full#B76" target="_blank">Straneva-Meuse, 2004b</a>), but contrast against longer-term research outcomes (<a href="https://www.frontiersin.org/articles/10.3389/fphys.2013.00259/full#B86" target="_blank">Whang et al., 2009</a>; <a href="https://www.frontiersin.org/articles/10.3389/fphys.2013.00259/full#B47" target="_blank">Licht et al., 2010a</a>) highlighting the adverse effects of the SSRI class of antidepressants. Here, an explanation for this apparent discrepancy is the complexity of central and autonomic 5-HT effects on cardiovascular function, which include bradycardia, associated with activation of 5-HT1A receptors, as well as tachycardia, associated with activation of 5HT2 receptors. <strong>It is possible that the effects of SSRIs shift from parasympathetic—as shown here—to sympathetic activation with increasing length of use. Further research is urgently needed on the combination of antidepressants and physical activity over longer-time frames than typical clinical trials (i.e., years rather than months).</strong></p><p></p><p></p><p>[ATTACH=full]27162[/ATTACH]</p></blockquote><p></p>
[QUOTE="tareload, post: 239932"] From article in last post: While animal and human studies ([URL='https://www.frontiersin.org/articles/10.3389/fphys.2013.00259/full#B3']Babyak et al., 2000[/URL]; [URL='https://www.frontiersin.org/articles/10.3389/fphys.2013.00259/full#B12']Engesser-Cesar et al., 2007[/URL]; [URL='https://www.frontiersin.org/articles/10.3389/fphys.2013.00259/full#B2']Arunrut et al., 2009[/URL]) have indicated that the combination of exercise and antidepressant medication may confer no advantage over either treatment alone, there is another issue at stake here. Although antidepressant medication—including the tricyclic medications, the serotonin and noradrenaline reuptake inhibitor and the selective serotonin reuptake inhibitors—may have short- to medium-term benefits including the amelioration of depressive symptoms and increased resilience to stress, research has begun to highlight the longer-term adverse cardiovascular effects of antidepressants ([URL='https://www.frontiersin.org/articles/10.3389/fphys.2013.00259/full#B86']Whang et al., 2009[/URL]; [URL='https://www.frontiersin.org/articles/10.3389/fphys.2013.00259/full#B47']Licht et al., 2010a[/URL]). Reductions in HRV have been attributable to the specific effects of antidepressants ([URL='https://www.frontiersin.org/articles/10.3389/fphys.2013.00259/full#B49']Licht et al., 2008[/URL], [URL='https://www.frontiersin.org/articles/10.3389/fphys.2013.00259/full#B47']2010a[/URL]) while increases in HRV are associated with their cessation ([URL='https://www.frontiersin.org/articles/10.3389/fphys.2013.00259/full#B47']Licht et al., 2010a[/URL]). [B]An epidemiological study ([URL='https://www.frontiersin.org/articles/10.3389/fphys.2013.00259/full#B86']Whang et al., 2009[/URL]) on 63,469 women aged 30–55 years without baseline coronary heart disease (CHD) reported that while depressive symptoms were associated with fatal CHD, antidepressant use (61% of participants were using an SSRI) was specifically associated with a 3.34 increased risk for sudden cardiac death even after controlling for a variety of confounds. A more recent study has reported that reduced cardiovascular fitness is associated with an increased risk of suicide over a 42 year follow-up period ([URL='https://www.frontiersin.org/articles/10.3389/fphys.2013.00259/full#B1']Åberg et al., 2013[/URL]) highlighting the importance of cardiovascular health over the lifespan. Together, these findings highlight the importance of research on the cardiovascular effects of antidepressants and specific lifestyle factors such as physical activity. The present study makes an important contribution to this effort highlighting that the cardiovascular effects of regular vigorous exercise and of an acute dose of escitalopram during stress are comparable, i.e., both are associated with a decrease in HR and an increase in HRV.[/B] In the present study we demonstrated that acute administration of escitalopram is associated with increased vagal function under both resting and task conditions; a finding that was particularly robust for HR. This finding is consistent with reported short- to medium-term beneficial effects of SSRIs on cardiovascular and neuroendocrine responses to stress in depressed patients (e.g., [URL='https://www.frontiersin.org/articles/10.3389/fphys.2013.00259/full#B76']Straneva-Meuse, 2004b[/URL]), but contrast against longer-term research outcomes ([URL='https://www.frontiersin.org/articles/10.3389/fphys.2013.00259/full#B86']Whang et al., 2009[/URL]; [URL='https://www.frontiersin.org/articles/10.3389/fphys.2013.00259/full#B47']Licht et al., 2010a[/URL]) highlighting the adverse effects of the SSRI class of antidepressants. Here, an explanation for this apparent discrepancy is the complexity of central and autonomic 5-HT effects on cardiovascular function, which include bradycardia, associated with activation of 5-HT1A receptors, as well as tachycardia, associated with activation of 5HT2 receptors. [B]It is possible that the effects of SSRIs shift from parasympathetic—as shown here—to sympathetic activation with increasing length of use. Further research is urgently needed on the combination of antidepressants and physical activity over longer-time frames than typical clinical trials (i.e., years rather than months).[/B] [ATTACH type="full" alt="1670427612297.png"]27162[/ATTACH] [/QUOTE]
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The Case Against Antidepressants
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