Statin drugs, cholesterol, depression and reductionism.

Statin Drugs = Less Depression?

A recent study found that of 965 heartdisease patients, those who were taking statin drugs where less likely to be depressed.

The study then follow the 776 of those patients who were not depressed.

18.5% of the 520 patients on statins became depressed by follow up.

28% of of the 256 not on statins became depressed by follow up.

This was translated into a 38% reduced risk of developing depression.

Statistical Manipulation?

Medical studies do not need to lie to be misleading. Statistics can be manipulated in all sorts of ways. In this case, the 38% reduced risk of developing depression sounds impressive. But lets look at this study using another statistic, the number to treat (NNT).

The NNT is the number of patients who need to be treated in order to prevent one additional bad outcome.
In this case the NNT is 10.5.

So according to this study, 10 ½ people would need to be treated with a statin drug, in order to prevent one incidence of depression.

But Don't Statin's Cause Many Side Effects?

Yes they do! Side effects such as liver damage, elevated liver enzymes, rhabdomyolysis, diabetes and much more! In fact, and reasonable review of the negative effects of statin drugs would be quite lengthy, and beyond the scope of what I wish to write about in this post.

Why might statins lower depression?

Inflammation can divert tryptophan and 5-HTP into inflammatory cytokines instead of serotonin. Therefore, taking anti-inflammatory medications or supplements may improve mood in some people. I don't know if statins make anyone feel better, but this is at least a possible explanation.

However, considering the numerous side effects of statin drugs, and the fact that over 10 people needed to be treated in this study to see one positive outcome, plus the negative effects statins do have on cognitive function, and a plethora of natural anti-inflammatory supplements, using statins in this way would be simply foolish.

Even the study itself says, that this does not mean statins should be used solely as anti-depressants. However, headlines and a few statistics can be taken out of context, to make statin drugs seem like better options when treating high cholesterol.

What is wrong with this approach to medical research?

This study is an example of the extreme reductionism in medicine. A large population is selected, along with a few variables, and then some general result is given.

However, feeling “depressed” is a mulch-factorial phenomena. Contributing factors include psychology, toxicity, infection, inflammation, nutritional statues, and even musculo-skeletal problems. Mufti-factorial problems demand individualized solutions. Even a study showing improvement of 90% of patients, does not necessarily tell a physicians if that treatment will help the patient in-front of them.

You can only treat people, not feelings

Depression is not a disease per se, it is a feeling. It makes no sense to treat a feeling.

You can only treat a person who has those feelings. I'm not saying this to belittle "depression" as if it's a non problem. In fact I take mental symptoms very seriously. My point is, if we really want to develop successful treatment plans then we need to start out by being honest about what we are dealing with.

If one person is depressed due to metal toxicity, and another due to psychological abuse, then very different treatments are needed. Not a generic drug (or supplement) that treats depression.

But this is what psychiatry does, when it calls the feeling "depression" a disease in and of itself and throws mind altering drugs at the feeling.

Language and the distortion of reality

The very thought of "treating" a feeling per se, is mind boggling nonsensical.

Terms such as ""treating depression" become imbedded into language, and changes how we think.

Language is not just a means of communication and thought, but actually sets the boundaries in which thought can take place. If vocabulary assumes a false paradigm, then it may become almost impossible to see the truth.

The distorted idea of treating a feeling, instead of the person who has the feeling, is handed down to us by psychiatry. For example, psychiatrists call DSM labels diagnoses. In truth, the DSM explicitly states that none of its labels is a diagnosis. Psychiatrists know these are not real medical diagnoses. Nonetheless, they use such terms manipulate language and how people understand reality.

This is why I often put terms such as “depression” and “anxiety” in quotes. I do not wish to add to the confusion.

People tell me they have "depression" or "anxiety" all the time. Those terms are mostly useless by themselves. I have to dig deeper. I Ask them to describe these feelings? Is it in the mind? Is it physical? What systems is it related to? What was going on when all this began?

I need things to be clear, that I am helping them, not their "anxiety" or "depression."

Reductionism

Reductionism is the belief that complex systems can be understood as the sum of all their parts. Reductionism works well in many fields. However, it does not work for complex, dynamics, emergent systems such as the human body. To put it quite simply, we are much more than the sum of all our parts. Feeling depressed can not be reduced down to something so simple as serotonin (although both psychiatry and many people in natural health seem to believe that). I do not wish to dismiss the importance of the 5-Htp > serotonin pathway.  It is simply not the entire story.

The “gold standard” double blind placebo controlled study, is based on a reductionist model. This doesn't make such studies worthless. However, these studies do not have the final say in what specific treatments are needed for a specific individual. Especially since such studies only look at symptoms which large groups of people have in common. The "strange and peculiar" symptoms that we see on an individual basis are ignored. But often it is these other symptoms which show what the individual patent actually needs. 

Instead of reductionist models of "mental illness," we need dynamic models. Models that consider all the multi-factorial conditions that may lead an individual to feel depressed. In the real world, the real question is, "what does this individual patient need." Not what random drug or supplement will have a 30% chance of improving symptoms.

Depression, Infection and Inflammation

A recent study from has found links between depression and infections.

http://news.emory.edu/stories/2012/02/depression_evolution/index.html.

A summary of their findings is as follows:

• People with depression tend to have higher levels of inflammation, even if they are not actively fighting an infection.
  
  
• Researchers have made genetic links between depression and immune system function.
  
  
• Depressed behavior (low energy, social isolation) actually in beneficial to people when they are sick with an infection. This behavior allows the body to use its resources fighting the infection.
  
  
• Stress is linked to depression, by activating the immune system.
  
  
• This may guide future research on depression, especially in terms of how markers of inflammation may predict how people respond to treatments for depression.
  
  

Personal Comments:

Although it's good that the above mentioned study is showing objective evidence for a link between infection and depression, this is really nothing new that many holistic practitioners have not known for years.

This is not only known through clinical experience. Practitioners familiar with organic acid testing know that tryptophan does not necessarily convert to serotonin. In case in inflammation and/or infection it can be converted down the kyurentate pathway, and into pro-inflammatory cytokines.

For a long time psychiatry held the belief that depression was due to a “chemical imbalance” involving serotonin. So they would give drugs which in theory effected the serotonin pathway.

Many practitioners in natural health would basically do the same thing, except instead of giving medications, gave supplements to facilitate serotonin production. These include vitamin B6, magnesium, tryptophan, and 5-htp.

Although this approach has merit and does help some people, it is not universally successful. It is also often based around expensive functional lab test, and supplement programs.

If a practitioner is doing this for depression (and only this), then it might be called natural, but it certainly is not holistic. Again, amino acid labs test, and supplements absolutely have their place, and I do utilize them when appropriate. I am simply saying that in terms of mental symptoms, this should not be a myopic focus.

When working with someone who feels “depressed,” “anxious,” or any other mental symptoms, the first thing I do is take a full history to see what else is going on. Is there a possibly hormonal problem, infection, digestive issue, candida, toxicity, or some other problem? This is what Naturopathy is about, looking for the underlining cause of illness in each individual. In naturopathy, we can treat a person who feels depressed. But it makes no sense to “treat depression.”

Concerns about this study:

While I like the information in the study, over time these findings may lead to treatment strategies I do not agree with.

• Infection and inflammation are just one possible cause of feeling depressed. While even the authors of study clearly agree, conventional medicine often forces treatment to follow a simple path of matching medications with diagnosis, regardless of individual differences.
  
  
• There are already many ways to lower inflammation and boost immune function in natural health. Medications that are both much more costly, and come with numerous side effects may be developed as a first option for depression, when in my opinion, they should be a last option.