Why You May Want To Stay On Your Antidepressant

Depression, Bipolar Disorder and PTSD. How Repeated Bouts Off Medication Cause More Severe Episodes in the Future.

An article in Aeon recently called The Kindled Brain, caused me to rethink my theory that once my patients received testosterone for 4-6 months and their mood disorder such as Depression, Bipolar Disorder or PTSD had abated, that they should be able to approach their psychiatrist and decrease their dose of antidepressants or even get off of them. This article suggests that there is actual acceleration of the severity and the frequency of episodes of these mood disorders with each new episode, which is assumed to be because a patient goes off and on his or her medication.

They call it The Kindling Effect meaning that the more episodes of say depression a person has, the higher the stress hormone Cortisol, which causes damage to an area of the brain called the Hippocampus which seems to form a “path” of abnormal connections, causing the path to get deeper and more fixed with each new episode.  If a person goes off his or her medicine after an episode then the number of episodes, therefore the more damage, they will sustain. I would have called it Priming the Pump but I’m not the researcher!

The hippocampus (named after its resemblance to the seahorse, from the Greek ἱππόκαμπος, “seahorse” from ἵππος hippos, “horse” and κάμπος kampos, “sea monster”) is a major component of the brains of humans and other vertebrates. Humans and other mammals have two hippocampi, one in each side of the brain. The hippocampus belongs to the limbic system and plays important roles in the consolidation of information from short-term memory to long-term memory, and in spatial memory that enables navigation. The hippocampus is located under the cerebral cortex(allocortical)^[1][2][3] and in primates in the medial temporal lobe. It contains two main interlocking parts: the hippocampus proper (also called Ammon’s horn)^[4] and the dentate gyrus.

In Alzheimer’s disease (and other forms of dementia), the hippocampus is one of the first regions of the brain to suffer damage; short-term memory loss and disorientation are included among the early symptoms. Damage to the hippocampus can also result from oxygen starvation (hypoxia), encephalitis, or medial temporal lobe epilepsy. People with extensive, bilateral hippocampal damage may experience anterograde amnesia (the inability to form and retain new memories).

The result is not only that there are more mood episodes to suffer through but that they get more severe each time.  I can’t say that I have observed that clinically, or experienced that myself, but their research says that is common.  The mechanism for this is a magnified stress reaction with more Cortisol and a lowering a substance in the brain called Brain Derived Neurotropic Factor (BDNF).  Cortisol suppresses growth of new brain cells and over time high levels cause the brain to shrink.  The job of BDNF is to stimulate brain cell healing and growth in the number of brain cells. If recurrent episodes of one of the three psychiatric diseases, because a patient is not on their medication, causes the brain to shrink, specifically the Hippocampal area, then the onset of Dementia of all kinds would come earlier than genetically programmed.

Since I have not observed the severity increasing in my depressed patients as a gynecologist, I am skeptical about the severity issue.  However the effect of Cortisol on the brain and the Hippocampus is known, and its effect on BDNF is also a fact then the mechanism for accelerating brain shrinkage and onset of dementia makes sense.

My advice will have changed for those of my patients who do not have hormone deprivation-stimulated mood disorders: If you have a lifetime of mood episodes then staying on the lowest dose that prevents a recurrence is not harmful and might be helpful!

This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author, with Brett Newcomb, MA., LPC., Family Counselor, Presenter and Author. www.BioBalanceHealth.com.