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  Antidepressant Therapy - An Overview  
  At least 30 years before modern antidepressants such as Prozac, Paxil, Zoloft, Wellbutrin and others were developed, the original 'tricyclic' antidepressants Elavil, Tofranil and a number of others were widely and effectively used in the treatment of depression. Publicity and media attention devoted to Prozac and the newer medications misleadingly suggests that a wholly new or effective treatment for depression commenced with their introduction. In fact there is little or no evidence that the newer drugs are therapeutically superior to the original antidepressants, Elavil(amitriptyline) and Tofranil(imipramine) for the relief of depression. Where the most modern drugs do excel, however, is in their ease of use, safety, and generally mild or absent side effects. It is largely because of the latter advantages, not as a result of their innate superiority or greater effectiveness, that the new generation of antidepressants beginning with Prozac(fluoxetine) have largely supplanted the original tricyclic antidepressants in ordinary clinical practice. Antidepressants, in other words, are not new - simply improved in regard to their non-essential features such as side effect profiles.

Not all types of depression respond to antidepressant therapy. It is often difficult to determine in advance which depressions will respond favorably to medication and which will not - and the general, though perhaps not altogether fortunate trend these days is to medicate liberally in hopes of not missing a potentially pharmacologically responsive depression. Because of the exceptionally benign side effect profile of modern antidepressants there is probably little direct harm in such generous prescribing practices; but there is considerable risk of overlooking or slighting important and remediable psychological and personal factors when excessive reliance is placed upon medications as the sole treatment of all forms of depression.

The more severe depressions are characterized by physical symptoms such as persistent fatigue, weariness, and lack of energy; significant sleep disturbance, either insomnia or hypersomnia(too much sleep); major distrubances in mood, attitude and outlook; and cognitive impairments such as difficulty concentrating, trouble making decisions, and disturbances in recent memory. Such dramatic and frequently disruptive mood disorders often respond promptly to appropriate antidepressant therapy, which restores the individual to their normal mood and functional status. The picture is complicated, however, by the fact that milder and more insidious depressions, often of years or even lifelong duration, may also respond to antidepressant treatment.

Antidepressants in common use in the United States today include Prozac, Paxil, Zoloft, Wellbutrin, Serzone, Effexor, Remeron and Celexa. There are also a number of less commonly used  medications, including the monoamine oxidase inhibitors(MAOI) Nardil and Parnate. On the whole, no one of these medications has been consistently and convincingly demonstrated to be superior to the rest of them in the treatment of depression. In general, one is as effective as another - although there are indeed individual differences in responsivity such that a given patient may respond better to one and not at all to another. Sometimes several medications may need to be tried for an individual patient before the right drug is found.

Antidepressants are not habit forming, addictive, or abusable. They have no 'street value' - meaning that they cannot be sold on the Black Market at inflated prices like certain potentially habit forming drugs, e.g. Valium, can be sold. Drug addicts and alcoholics cannot get 'high' on antidepressants and therefore do not seek them out for this purpose nor do they frequently escalate their dosage of them for this purpose when prescribed for depression.

The presumed mechanism of action of antidepressants is  the correction of  those abnormalities of brain chemistry which cause symptoms of depression. The actual neurophysiology of depression is more complex than the widely known 'biogenic amine'(serotonin, norepinephrine, dopamine deficiencies) model would suggest. The basic idea, however, is that antidepressants act to normalize or bring back into proper balance those chemical pathways in the brain that are responsible for mood regulation and hedonic(pleasure and reward) tone. Antidepressants can be compared to the medical use of insulin in the treatment of diabetes mellitus in that certain types of depression, like diabetes, appear to be 'deficiency' diseases in which there is a relative or absolute lack of normal body chemicals required for healthy functioning of the mind and body.  Antidepressants restore abnormal brain functioning to normal - they are not illegitimate, artificial or 'cheating' approaches to feeling better.

The duration of antidepressant therapy varies from individual to individual. In serious and recurrent depressions, indefinite prophylactic maintenance may be indicated. Most experts advise that single or initial episodes of depression should be provided maintenance therapy of at least 6 months and possibly one year before discontinuation of medication is attempted. Depression tends to be a recurrent disorder, and many studies suggest that longer treatment is superior to shorter treatment in the prevention of relapse. Serious long term side effects of antidepressants have, fortunately, not appeared.

Appropriate medical treatment of serious depression, far from impeding  the psychotherapy of personal issues, almost always enhances and accelerates progress when the 'millstone' of depression is removed.


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Depression Central
The Internet's central clearinghouse for information on all types of depressive disorders and on the most effective treatments for individuals suffering from Major Depression, Manic-Depression (Bipolar Disorder), Cyclothymia, Dysthymia and other mood disorders.

Famous People With Bipolar Disorders

MEDLINPlus - Antidepressants

National Institute of Mental Health
Information about medications.

What Are the Drugs Used For Depression?

WebMD article on antidepressants.