Growing evidence suggests drugs are not the only cure for depression
Photo by Sweet Tooth Ice Cream Photography (unsplash)
by Rebecca Clark
Depression is a mental disorder affecting millions of people worldwide. It is characterised by a depressed mood, feelings of low self worth, decreased feelings of pleasure, poor appetite and sleep, and poor energy. While everyone will feel low at times in their lives, people suffering with depression will experience persistent extreme emotions. Having been thought of once as a chemical imbalance, it is clear today that depression it is not that simple as we still don’t fully understand how the brain functions.
The current treatment of depression is with antidepressants. There are many different types and they all work by targeting different brain mechanisms. One type are selective serotonin reuptake inhibitors (SSRIs), one common drug name being Prozac. Serotonin is a neurotransmitter associated with feelings of happiness and wellbeing and so SSRIs prevent serotonin being taken back up into the presynaptic neurone. This means the serotonin will continue to bind to receptors on the post-synaptic neurone and cause it to be stimulated. This results in increased levels of pleasure.
Other types of antidepressants include monoamine oxidase inhibitors (MAOIs). Monoamine oxidase is an enzyme that breaks down serotonin and thus by inhibiting it, serotonin levels will rise.
Prescriptions for antidepressants are on the rise and have doubled since 2006.
And they are not without fault; there are many negatives to the drugs. They are often taken for long periods of time meaning people get dependant. In addition, their efficacy has long been debated and more recently been brought to the public’s attention by a controversial publication by Kirsch that highlights the role of placebo response in trials. Antidepressants also have a large range of side effects including dizziness, fatigue, blurred vision, sexual side effects, weight gain, constipation, insomnia, dry mouth, nausea, and anxiety. But what are the alternatives? While it may be easier to pop a pill, there are other ways to cope with depression; there just isn’t the research to back them yet.
One alternative to antidepressants that is currently making the news headlines is open water swimming. Being filmed for the BBC series, ‘The Doctor Who Gave Up Drugs’, a 24-year-old woman suffering from depression was set the challenge to swim weekly in open water. Sarah had been suffering with depression since she was 17 and was not happy with how the drugs made her feel, describing it as a “chemical fog”. After giving birth, she decided she wanted to quit the drugs and be rid of depression, an ambitious ask many said. However after four months of the swimming in 15C temperatures and a gradual reduction in her medication, the results were remarkable; she was drug-and-symptom-free.
Christoffer van Tulleken, a doctor and researcher at University College London, developed and presented the programme and is a strong advocate for the reduction of doctors prescribing drugs as the first course of action. Val Tulleken published Sarah’s story along with his other findings in a report in the British Medical Journal. However, he is aware that this is just one case, and thus more research needs to be done to establish a correlation and to discount Sarah’s story as merely due to the placebo effect.
But how can open water swimming help?
As the body is immersed in cold open water, there is an immediate drop in skin temperature resulting in an increased breathing and heart rate. While in the past, the main focus was on the dangers of cold-water swimming; there is growing evidence that it is anti-inflammatory. It also activates the stress response, a set of physiological and hormonal reactions, and so after continued cold-water immersion, the body adjusts to the response in a process called habituation. This could mean you are less likely to become stressed in daily activities. Van Tulleken described his experience open water swimming: "Underwater, I feel an intense mixture of burning pain and, even after doing this for years, a little panic. But it's the only time the anxious negative chatter in my head is truly silenced.”
Open water swimming also offers social interaction, with thousands of weekly events being held in lakes and open water locations around the UK. The routine it provides, the friends you make alongside the feeling of camaraderie as you, rather crazily, plunge into the freezing water and begin to swim out into the depths all provide benefits to your mental health. Open water swimming also has many other benefits. Cold-water swimmers report reduced numbers of colds, and research at University of Portsmouth also supports this claim.
While the evidence is still not quite there, there is little harm the odd swim in the outdoors can do to your health. As a sceptic of drugs myself, I look forward to what the future holds for non-medicated prescriptions and a decreased reliance on the small round chemicals we have become all too familiar with.
