Antidepressants: Personalization Is Key!
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Antidepressants: Personalization Is Key!
Yesterday, we asked you for your opinions on antidepressants, and got the above-depicted, below-described, set of responses:
- Just over half of respondents said “They clearly help people, but should not be undertaken lightly”
- Just over a fifth of respondents said “They may help some people, but the side effects are alarming”
- Just under a sixth of respondents said “They’re a great way to correct an imbalance of neurochemicals”
- Four respondents said “They are no better than placebo, and are more likely to harm”
- Two respondents said “They merely mask the problem, and thus don’t really help”
So what does the science say?
❝They are no better than placebo, and are more likely to harm? True or False?❞
True or False depending on who you are and what you’re taking. Different antidepressants can work on many different systems with different mechanisms of action. This means if and only if you’re not taking the “right” antidepressant for you, then yes, you will get only placebo benefits:
- Placebo Effect in the Treatment of Depression and Anxiety ← randomly assigned antidepressants are, shockingly, luck of the draw in usefulness
- Antidepressants versus placebo in major depression: an overview ← “wow this science is messy”
- Comparative efficacy and acceptability of 21 antidepressant drugs: a systematic review and network meta-analysis ← “oh look, it makes a difference which antidepressant we give to people”
Rather than dismissing antidepressants as worthless, therefore, it is a good idea to find out (by examination or trial and error) what kind of antidepressant you need, if you indeed do need such.
Otherwise it is like getting a flu shot and being surprised when you still catch a cold!
❝They merely mask the problem, and thus don’t really help: True or False?❞
False, categorically.
The problem in depressed people is the depressed mood. This may be influenced by other factors, and antidepressants indeed won’t help directly with those, but they can enable the person to better tackle them (more on this later).
❝They may help some people, but the side-effects are alarming: True or False?❞
True or False depending on more factors than we can cover here.
Side-effects vary from drug to drug and person to person, of course. As does tolerability and acceptability, since to some extent these things are subjective.
One person’s dealbreaker may be another person’s shrugworthy minor inconvenience at most.
❝They’re a great way to correct an imbalance of neurochemicals: True or False?❞
True! Contingently.
That is to say: they’re a great way to correct an imbalance of neurochemicals if and only if your problem is (at least partly) an imbalance of neurochemicals. If it’s not, then your brain can have all the neurotransmitters it needs, and you will still be depressed, because (for example) the other factors* influencing your depression have not changed.
*common examples include low self-esteem, poor physical health, socioeconomic adversity, and ostensibly bleak prospects for the future.
For those for whom the problem is/was partly a neurochemical imbalance and partly other factors, the greatest help the antidepressants give is getting the brain into sufficient working order to be able to tackle those other factors.
Want to know more about the different kinds?
Here’s a helpful side-by-side comparison of common antidepressants, what type they are, and other considerations:
Mind | Comparing Antidepressants
Want a drug-free approach?
You might like our previous main feature:
The Mental Health First-Aid That You’ll Hopefully Never Need
Take care!
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“Why Does It Hurt When I Have Sex?” (And What To Do About It)
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This is one that affects mostly women, with 43% of American women reporting such issues at some point. There’s a distribution curve to this, with higher incidence in younger and older women; younger while first figuring things out, and older with menopause-related body changes. But, it can happen at any time (and often not for obvious reasons!), so here’s what OB/GYN Dr. Jennifer Lincoln advises:
Many possibilities, but easily narrowed down
Common causes include:
- vaginal dryness, which itself can have many causes (half of which are “low estrogen levels” for various different reasons)
- muscular issues, which can be in response to anxiety, pain, and occur as a result of pelvic floor muscle tightening
- vulvar issues, ranging from skin disorders (e.g. lichen sclerosis or lichen planus) to nerve disorders (e.g. vestibulitis or vestibulodynia)
- uterine issues, including endometriosis, fibroids, or scar tissue if you had a surgery
- infections, of the STI variety, but bear in mind that some STIs such as herpes do not necessarily require direct sexual contact per se, and yeast infections definitely don’t. Some STIs are more serious than others, so getting things checked out is a good idea (don’t worry, clinics are discreet about this sort of thing)
- bowel issues, notwithstanding that we have been talking about vaginal sex here, it can’t be happy if its anatomical neighbors aren’t happy—so things like IBS, Crohn’s, or even just constipation, aren’t irrelevant
- trauma, of various kinds, affecting sexual experiences
That’s a lot of possibilities, so if there’s not something standing out as “yes, now that you mention it, it’s obviously that”, Dr. Lincoln recommends a full health evaluation and examination of medical history, as well as a targeted physical exam. That may not be fun, but at least, once it’s done, it’s done.
Treatments vary depending on the cause, of course, and there are many kinds of physical and psychological therapies, as well as surgeries for the uterine issues we mentioned.
Happily, many of the above things can be addressed with simpler and less invasive methods, including learning more about the relevant anatomy and physiology and how to use it (be not ashamed; most people never got meaningful education about this!)*, vulvar skin care (“gentle” is the watchword here), the difference a good lube can make, and estrogen supplementation—which if you’re not up for general HRT, can be a topical estrogen cream that alleviates sexual function issues without raising blood serum estradiol levels.
*10almonds tip: check out the recommended book “Come As You Are” in our links below; it has 400 pages of stuff most people never knew about anatomy and physiology down there; you can thank us later!
Meanwhile, for more on each of these, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- Water-based Lubricant vs Silicon-based Lubricant – Which is Healthier? (counterintuitively, it’s the silicon! But do give it a quick read, because here be science)
- How To Avoid Urinary Tract Infections (may be relevant; always good to know)
- Come As You Are – by Dr. Emily Nagoski (book; if we could only recommend one book on responsible vagina ownership, this would be the one)
Take care!
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No Equipment Muscle Gain Routine for Ages 50+
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Sarcopenia, the loss of muscle mass commonly associated with aging, can be a big problem as it leaves us vulnerable to injury (and also isn’t great for the metabolism—keeping adequate muscle mass ensures keeping the metabolism ticking over nicely). Will Harlow, over-50s specialist physiotherapist, is here to share a routine that works without weights:
Where it counts
There’s a fair amount of emphasis here on the lower body and core. That’s because in practical terms, this is what matters more for our health than having bulging biceps:
- First exercise: donkey calf raises to build strength in the calves using a chair.
- Second exercise: single-leg elevated lunge to work the quads and glutes, using a step or books for elevation.
- Third exercise: slow sit-to-stand for quads, glutes, and core strength, focusing on a slow descent.
- Fourth exercise: wall press-up to strengthen the chest, shoulders, and arms, with a variation using towels for increased resistance.
- Final exercise: shoulder raises using bottles or similar weights to target the shoulders and rotator cuffs.
Ok, so that last one was a slight cheat on his part as it does require grabbing a weight, but it’s not specialist equipment at least, and can just be something you grabbed at home. It’s also the least important of the five exercises, and can be skipped if necessary.
For more on all of these plus visual demonstrations, enjoy:
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You might also like to read:
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See what other 10almonds subscribers are asking!
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It’s Q&A Day at 10almonds!
Q: I would be interested in learning more about collagen and especially collagen supplements/powders and of course if needed, what is the best collagen product to take. What is collagen? Why do we need to supplement the collagen in our body? Thank you PS love the information I am receiving in the news letters. Keep it up
We’re glad you’re enjoying them! Your request prompted us to do our recent Research Review Monday main feature on collagen supplementation—we hope it helped, and if you’ve any more specific (or other) question, go ahead and let us know! We love questions and requests
Q: Great article about the health risks of salt to organs other than the heart! Is pink Himalayan sea salt, the pink kind, healthier?
Thank you! And, no, sorry. Any salt that is sodium chloride has the exact same effect because it’s chemically the same substance, even if impurities (however pretty) make it look different.
If you want a lower-sodium salt, we recommend the kind that says “low sodium” or “reduced sodium” or similar. Check the ingredients, it’ll probably be sodium chloride cut with potassium chloride. Potassium chloride is not only not a source of sodium, but also, it’s a source of potassium, which (unlike sodium) most of us could stand to get a little more of.
For your convenience: here’s an example on Amazon!
Bonus: you can get a reduced sodium version of pink Himalayan salt too!
Q: Can you let us know about more studies that have been done on statins? Are they really worth taking?
That is a great question! We imagine it might have been our recent book recommendation that prompted it? It’s quite a broad question though, so we’ll do that as a main feature in the near future!
Q: Is MSG healthier than salt in terms of sodium content or is it the same or worse?
Great question, and for that matter, MSG itself is a great topic for another day. But your actual question, we can readily answer here and now:
- Firstly, by “salt” we’re assuming from context that you mean sodium chloride.
- Both salt and MSG do contain sodium. However…
- MSG contains only about a third of the sodium that salt does, gram-for-gram.
- It’s still wise to be mindful of it, though. Same with sodium in other ingredients!
- Baking soda contains about twice as much sodium, gram for gram, as MSG.
Wondering why this happens?
Salt (sodium chloride, NaCl) is equal parts sodium and chlorine, by atom count, but sodium’s atomic mass is lower than chlorine’s, so 100g of salt contains only 39.34g of sodium.
Baking soda (sodium bicarbonate, NaHCO₃) is one part sodium for one part hydrogen, one part carbon, and three parts oxygen. Taking each of their diverse atomic masses into account, we see that 100g of baking soda contains 27.4g sodium.
MSG (monosodium glutamate, C₅H₈NO₄Na) is only one part sodium for 5 parts carbon, 8 parts hydrogen, 1 part nitrogen, and 4 parts oxygen… And all those other atoms put together weigh a lot (comparatively), so 100g of MSG contains only 12.28g sodium.
Q: Thanks for the info about dairy. As a vegan, I look forward to a future comment about milk alternatives
Thanks for bringing it up! What we research and write about is heavily driven by subscriber feedback, so notes like this really help us know there’s an audience for a given topic!
We’ll do a main feature on it, to do it justice. Watch out for Research Review Monday!
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What Actually Causes High Cholesterol?
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In 1968, the American Heart Association advised limiting egg consumption to three per week due to cholesterol concerns linked to cardiovascular disease. Which was reasonable based on the evidence available back then, but it didn’t stand the test of time.
Eggs are indeed high in cholesterol, but that doesn’t mean that those who eat them will also be high in cholesterol, because…
It’s not quite what many people think
Some quite dietary pointers to start with:
- Egg yolks are high in cholesterol but have a minimal impact on blood cholesterol.
- Saturated and trans fats (as found in fatty meats or dairy, and some processed foods) have a greater influence on LDL levels than dietary cholesterol.
And on the other hand:
- Unsaturated fats (e.g. from fish, nuts, seeds) have anti-inflammatory benefits
- Fiber-rich foods help lower LDL by affecting fat absorption in the digestive tract
A quick primer on LDL and other kinds of cholesterol:
- VLDL (Very Low-Density Lipoprotein):
- delivers triglycerides and cholesterol to muscle and fat cells for energy
- is converted into LDL after delivery
- LDL (Low-Density Lipoprotein):
- is called “bad cholesterol”, which we call that due to its role in arterial plaque formation
- in excess leads to inflammation, overworked macrophage activity, and artery narrowing
- HDL (High-Density Lipoprotein):
- known as “good cholesterol,” picks up excess LDL and returns it to the liver for excretion
- is anti-inflammatory, in addition to regulating LDL levels
There are other factors too, for example:
- Smoking and drinking increase LDL buildup and cause oxidative damage to lipids in general and the blood vessels through which they travel
- Regular exercise, meanwhile, can lower LDL and raise HDL
- Statins and other medications can help lower LDL and manage cholesterol when lifestyle changes and genetics require additional support—but they often come with serious side effects, and the usefulness varies from person to person.
For more on all of this, enjoy:
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Want to learn more?
You might also like to read:
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World Menopause Day Health News Round-Up
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In order to provide variety in this week’s round-up, not all of this is menopause-related, but it is all important:
Menopause & CVD
Untreated menopause is associated with higher incidence of heart disease, and higher mortality. People often forget about how much estrogen does for us (well, for those of us with a physiology running on estrogen, anyway; gentlemen, your testosterone is fine for you), and think it is “just” a sex hormone, but it’s a lot more.
Read in full: Menopause transition linked to increased heart disease risk
Related: What Menopause Does To The Heart
Extraterrestrial medical technology
The much lower gravity in Earth orbit has allowed for tissue engineering techniques that Earth’s normal gravity imposes limitations on. This is big news, because it means that rather than replacing a whole liver, tissue implants could be grafted, allowing the extant liver to repair itself (something livers are famously good at, but they need enough undamaged base material to work with).
Read in full: How liver tissue from the International Space Station may transform tissue engineering
Related: How To Unfatty A Fatty Liver
One thing and then another
As if endometriosis weren’t unpleasant enough in and of itself, the endothelial dysfunction inherent to it also raises cardiovascular disease risk. This is important, because while endometriosis has (like many maladies predominantly affecting women) generally been shrugged off by the medical world as an unhappy inconvenience but not life-threatening, now we know it comes with extra existential risks too:
Read in full: Understanding cardiovascular risks in endometriosis patients
Related: What You Need To Know About Endometriosis
Push-button meditation
Unlike mindfulness meditation, listening to music is a very passive experience, and thus requires less effort from the user. And yet, it has been associated with lower perceived pain levels, lower self-reported anxiety levels, less opioid use, and measurably lower heart-rate.
Read in full: Listening to music may speed up recovery from surgery, research suggests
Related: Nobody Likes Surgery, But Here’s How To Make It Much Less Bad
Cholesterol in menopause: quality over quantity
Much like previous research has shown that the quantity of LDL is not nearly so predictive of health outcomes in women as it is in men, this study into HDL and menopausal women shows that quantity of HDL does not matter nearly so much as the quality of it.
Read in full: HDL quality, not quantity, contribute to the first sign of Alzheimer’s disease in women
Related: Statins: His & Hers? ← consistent with the above, statins (to lower LDL cholesterol) generally help more for men and produce more adverse side effects for women. So again, a case of “the actual amount of cholesterol isn’t so important for women as for men”.
Take care!
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Beetroot For More Than Just Your Blood Pressure
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Beetroot is well-known for being good for blood pressure, but what else can it do?
Firstly, blood pressure, yes
This is because… Well, we’ll quote from a paper:
❝As a source of nitrate, beetroot ingestion provides a natural means of increasing in vivo nitric oxide (NO) availability and has emerged as a potential strategy to prevent and manage pathologies associated with diminished NO bioavailability, notably hypertension and endothelial function❞
Source: The Potential Benefits of Red Beetroot Supplementation in Health and Disease
That’s a little modest in its wording though, so let’s just be clear, it does work:
- The effects of dietary nitrate on blood pressure and endothelial function: a review of human intervention studies
- Clinical evidence demonstrating the utility of inorganic nitrate in cardiovascular health
- Vascular effects of dietary nitrate (as found in green leafy vegetables and beetroot) via the nitrate-nitrite-nitric oxide pathway
…where you can see that it significantly reduced systolic and diastolic blood pressure.
Note: this does mean that if you suffer conversely from hypotension (dangerously low blood pressure) you should probably skip the beetroot.
For your blood sugar levels, too
The fiber in whole beetroot or powdered beetroot extract (but not beetroot juice) is, as usual, good for balancing blood sugars. However, in the case of beetroot, it (probably because of the betalain content, specifically betanin) also improves insulin sensitivity, resulting in lower fasting and postprandial (after-dinner) insulin levels:
See also (cited in the above paper): Post-prandial effect of beetroot (beta vulgaris) juice on glucose and lipids levels of apparently healthy subjects
For your blood lipids, also
This one has less readily available research to support it, so in the category of “papers that aren’t paywalled into oblivion”, here’s one that concludes with the entertainingly specific:
❝Results: Beetroot juice intake increased plasma high density lipoprotein (t= -60.88, P<0.05). Triglyceride, total cholesterol, and low density lipoprotein were reduced (P<0.05). Compared with placebo, beetroot juice reduced the concentrations of triglyceride, total cholesterol, and low density lipoprotein (P<0.05).
Conclusion: Regular beetroot juice intake has significant effects on lipid profile in female soccer players, hence its suggestion for preventing diseases such as hypercholesterolemia and hypertension in female soccer players.❞
However, even if you are not a female soccer player, chances are it will have the same effect on your physiology as theirs (but, credit where it’s due, it’s right that they make claims about only what they know for sure).
Here’s the paper: Efficacy of Beetroot Juice Consumption on the Lipid Profile of Female Soccer Players
What’s good for your blood, is good for your brain
…and that’s just as true here:
When reading that, you’ll see that as well as two health outcome benefits (antidiabetic and anti-Alzheimer’s), there are also two mechanisms of action, which are:
- The blood sugar lowering, insulin sensitivity increasing, lipid improving, qualities we discussed already
- Its fabulous flavonoid content
These two things each in turn have a lot of other components and nuances, so here’s an infographic covering them ← this flowchart makes it all a lot clearer
On which note, those flavonoids aren’t the only active compounds present that result in…
Antioxidant & anti-inflammatory action
This one’s pretty straightforward, but it’s worth mentioning also that (as is commonly the case) what fights oxidation also fights cancer:
❝In recent years, the beetroot, especially the betalains (betanin) and nitrates it contains, now has received increasing attention for their effective biological activity.
Betalains have been proven to eliminate oxidative and nitrative stress by scavenging DPPH, preventing DNA damage, and reducing LDL.
It also has been found to exert antitumor activity by inhibiting cell proliferation, angiogenesis, inducing cell apoptosis, and autophagy.❞
Want to try some?
We don’t sell it, but you can easily grow your own or find it at your local supermarket; if you prefer it in supplement form, dried is better than juice (for a multitude of reasons), so here for your convenience is an example product on Amazon 😎
Enjoy!
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