How to improve your mood without hurting your brain
By Dr. Janelle Louis, ND
Can you relate? After years of trying different antidepressant medications, Sarah and her primary care provider finally found one that addressed her symptoms. This was no small feat, considering the facts that the odds of beating depression decrease with each additional medication tried and one in three people who struggle with major depression will not experience remission, even after trying four different treatments or combinations of treatment.
Sarah has been on her medication for four years now and she is pretty pleased with the results. She feels hopeful when she wakes up each morning. She has an overall positive outlook, and her relationships are prospering. Things are going extremely well.
Rather, things were going well, until she came across a piece of research that completely rocked her world. At the end of the study that Sarah found, researchers concluded “that antidepressant medication is a potential risk factor for dementia, independent from any effect of depression itself.”
Sarah’s maternal grandmother and grandfather both passed away from complications of dementia, and recently her mom has started to show early symptoms of cognitive decline. With this strong family history of dementia, Sarah has begun to wonder if she should be taking the type of medication that she is taking. Yes, it helps her mood, but she keeps asking herself, “if it increases my risk of developing dementia and causes me to spend my last days the way my grandparents did, is it really worth it?”
What the research actually says
A study published in early 2019 confirmed that strong anticholinergics increase the risk of being diagnosed with dementia. These drugs work by blocking a neurotransmitter called acetylcholine at the synapses in the central and peripheral nervous system. Anticholinergic drugs include a wide range of drugs across multiple drug classes, including certain antidepressants such as paroxetine (Paxil), amitriptyline (Elavil), and clomipramine; bladder antimuscarinics, such as oxybutynin, tolterodine, and darifenacin; antipsychotics, such as olanzapine (Zyprexa), clozapine (Clozaril), and quetiapine (Seroquel); and anti-epileptic drugs, such as carbamazepine and oxcarbazepine, among others.
Long-term use of these medications was associated with greater risk of being diagnosed with dementia. The study author, Dr. Carol Coupland, PhD, of the University of Nottingham, concluded that, based on the current research, physicians should avoid prescribing these drugs to older people whenever possible. The research stated that taking just one strong anticholinergic drug on a daily basis for three years led to a 50% increased risk of dementia in people aged 55 and older.
If you have a strong family history like Sarah and you’re taking one or more anticholinergic drugs(s), you may be wondering if you should stop taking your medication altogether or if you should talk to your doctor about your concerns. Well, the answer to this question is always talk to your doctor. You should never stop taking your psychotropic medication without being under the care of a healthcare professional, because doing so can lead to serious withdrawal symptoms.
When you share your health concerns and your symptoms with your doctor or psychiatrist, he or she will be able to take a look at your medical records, which includes your family history, and provide you with sound medical advice regarding what your next steps should be. Your provider will likely share information about your relative risk given your family history and the drugs you are taking, and he or she may recommend that you switch to a different drug that does not carry as much risk as the one you are currently on.
For example, in one study, paroxetine (brand name Paxil) was associated with increased risk of being diagnosed with dementia, regardless of the length of time that the participants took the drug. On the other hand, SNRIs like venlafaxine have very low anticholinergic effects and are therefore associated with a much lower risk of dementia. This tells us that not all drugs are created equal, and your doctor will be able to help you get started on the treatment option that is best suited to your unique circumstance.
If you’re concerned because you’ve been taking an anticholinergic drug
If you’ve been taking or took an anticholinergic drug in your 40s, 50s, or 60s, you’re likely concerned about your risk for dementia. The first thing you need to know is that increased risk does not mean it’s inevitable that you receive the diagnosis; not everyone who takes one or more of these drugs gets dementia.
If you took or are taking one of these drugs in your 20s or 30s, you’re likely wondering how this affects your risk. To be completely transparent, we’re not quite sure.
All of the available research was conducted on middle-aged to older individuals, and the general consensus is that each exposure to the medication for at least the 20 years prior to the dementia diagnosis leads to increased risk. We don’t have enough information yet to draw conclusions about the risk associated with taking these drugs earlier in life.
Now, let’s address your concern. Here’s what I tell my patients who are in either of these categories: your quality of life is our priority, both now and in your later years. In order to prioritize your quality of life, we’ve got to be able to balance risks and benefits.
This means that if an antidepressant with mild anticholinergic effects is the only thing that has been able to help you get out of bed in the morning and continue to enjoy the things and people you’ve always loved, then the benefit is worth the slightly increased risk, at least until we can address your mood using other therapies and wean off of the medication. In situations like these, I always recommend doing the best that we can until we can do better.
If you’re concerned about dementia but haven’t started taking medication
If you have a personal history of depression and a family history of dementia, but you haven’t started taking medication to address your concerns, consider trying less invasive treatment options prior to starting psychotropic medication.
For example, I screen all of my patients, including those with recent onset and those with long-standing concerns of depression, for thyroid and reproductive hormone disorders. I do this because these two types of health concerns can actually masquerade as depression. When we correct these imbalances, we see an improvement in or a complete resolution of depressive symptoms in most cases.
Hypericum perforatum (St. John’s Wort)
Another option is to support optimal mental wellbeing using natural supplements. St. John’s wort is an herb that has been demonstrated to be as effective as serotonin-specific reuptake inhibitors in addressing mild to moderate depression. This herb interacts with many antidepressants and many other prescription medications, so don’t use it unless you’re not taking any medication or you’re working with a provider who is knowledgeable concerning both pharmaceutical medication and herbal therapies.
Withania somnifera (ashwagandha)
Ashwagandha is another herb that has been demonstrated to have antidepressant and anti-anxiety effects. This herb supports a more normal response to chronic stressors because of its positive effects on the hypothalamic-pituitary-adrenal axis, so it is most beneficial in cases of stress- or trauma-induced depression.
Crocus sativus (saffron)
Saffron has been demonstrated to have similar efficacy to pharmaceutical antidepressants. Researchers report that its antidepressant properties are likely due to its effect on serotonin, as well as its antioxidant, anti-inflammatory, neuro-endocrine, and neuroprotective properties. Saffron is most beneficial in cases where the depression is characterized by sexual dysfunction.
Bacopa monnieri (Brahmi)
Bacopa, also known as Brahmi, is another herb that has been demonstrated to help support healthy mood. This herb is of special interest because it also supports memory and has been demonstrated to enhance cognitive performance in older people.
The conclusion of it all
To sum it all up, research does suggest that anticholinergic drugs, including many antidepressants, can significantly increase your risk of developing dementia. Unfortunately, this holds true in many cases, even after taking the drugs for a comparatively short period of time.
Fortunately, however, all antidepressant medications do not carry the same risk. When you share your concerns with your primary care provider, he or she should be able to provide you with sound medical advice that both effectively manages your mood and minimizes your risk of future cognitive decline.
Additionally, there are many herbs and natural supplements that can support a healthy mood and positive outlook. I recommend working with a healthcare provider who can help you construct the integrative treatment plan that best meets your unique needs.
You may be wondering what happened with Sarah. Well, she decided to talk with her provider about her concerns and it turned out that the medication she was on had comparatively low dementia risk. Sarah decided to continue taking her medication for the time being, while also working with her provider to explore other avenues of her physical health, such as her hormones and gut bacteria, that could have been contributing to her depression. She sees this as a step in the right direction toward her ultimate goal of optimizing her mood without the use of pharmaceutical medication.
Dr. Janelle Louis is a licensed naturopathic doctor who specializes in helping people with childhood trauma overcome the chronic health concerns they are at increased risk for developing, including mental health conditions, reproductive concerns, autoimmune diseases, and metabolic syndrome. Dr. Louis is committed to ensuring that her patients live their healthiest lives in the present in spite of their difficult pasts.