You probably have met a person at least in passing who has been diagnosed with depression, or perhaps someone closer to you has the disorder – maybe your friend, partner or family member. Sadness, loss of interest, trouble sleeping, changes in appetite, and even thoughts of suicide plague individuals living with depression.
According to Depression and Bipolar Support Alliance data, approximately 7 percent of adults in the United States have been diagnosed with depression. This number does not account for the many individuals who go undiagnosed for various reasons. Genetics, brain chemistry and negative life stressors are known etiologies for developing depression. Although there is no definitive cure for this potentially debilitating disease, selective serotonin reuptake inhibitors (SSRIs) along with psychotherapy remain the mainstay of treatment and has been shown to reduce symptoms – but not in everyone.
SSRIs increase the level of serotonin, a neurotransmitter that is decreased in depression, in the brain by inhibiting its breakdown. Multiple articles published in prestigious medical journals claim that SSRIs are as beneficial as the placebo effect and actually do not work in approximately 20 percent of individuals. “With appropriate treatment, 70-80% of individuals with major depressive disorder can achieve a significant reduction in symptoms, although as many as 50% of patients may not respond to the initial treatment trial,” according to emedicine.
So why are SSRIs a good treatment in some but not others?
A recent study proposed that increasing serotonin levels will increase brain plasticity, meaning that the neurons or brain cells are more easily molded, like clay or cookie dough. By increasing brain plasticity, the researchers believe that environmental conditions the individual is placed in while taking SSRIs as a treatment for depression play a large role in the overall benefit of this medication class.
If someone is in a stressful environment, they may not show symptom improvement compared to those who are in a harmonious environment. The researchers came to this conclusion by placing mice in two different environments, stressful and harmonious, and comparing their levels of stress indicators and signs of depression.
Mice that were placed in a stressful environment had decreased pro-inflammatory cytokines and increased anti-inflammatory gene expression. Pro-inflammatory cytokines are good for harmony, whereas anti-inflammatory gene expression can cause depressive symptoms. The mice that were placed in a healthy environment portrayed the opposite effects, demonstrating that environmental changes may play a role in the efficacy of SSRIs for treating depression.
So can sunshine and rainbows help cure depression?
Although researchers for many years have considered that the environment in some way plays a role in depression and serotonin, this concept is still controversial, and more research must be done. It makes sense that being surrounded with positive people, good food and beautiful sunsets may elicit more happiness than not having any positivity around, but this complicated disorder just is not that simple.
SSRIs, along with psychotherapy such as cognitive behavioral therapy and interpersonal therapy, are shown to increase improvement rates when used together. Psychotherapy can give individuals insight into their thoughts and emotions and provide tools to cope with triggers. In a way, the psychotherapy can actually improve the environment by giving individuals a different outlook on their situation and the techniques needed to improve their surroundings, in a sense, making the cup half full instead of half empty.
Sovereign Health is a leading national behavioral health care provider with facilities across the United States that treat adults and adolescents with mental disorders like depression, substance abuse and co-occurring conditions. For more information, please call our 24/7 helpline.
About the author
Kristen Fuller, M.D., is a senior staff writer at Sovereign Health and enjoys writing about evidence-based topics in the cutting-edge world of medicine. She is a physician and author who also teaches, practices medicine in the urgent care setting and contributes to medicine board education. She is also an outdoor and dog enthusiast. For more information and other inquiries about this article, contact the author at firstname.lastname@example.org.