Depression Medications - What Works?

Antidepressant medications work for about one third of the people who take them. For another one third there is partial relief and for the remaining third, they do not help at all. In almost all cases, the relief provided by these medications is temporary and relapse into depression again is all too common. With this type of random, hit or miss type success rate it is clear that the medical and pharmaceutical communities do not have a firm grasp on the complete biological causes and cures for depression. Clearly, depression is much more than just a chemical imbalance in the brain so to say what works and what does not work is still a very open-ended question.

In the current state of medical research, there are three main families of antidepressant medications:

1. Selective serotonin reuptake inhibitors (SSRIs) such as Celexa, Paxil, Zoloft and Prozac. This is the newest, largest and most popular group of antidepressant medications. They work by reducing the amount of serotonin that is reabsorbed by nerve synapse thereby increasing the amount of serotonin available at the synaptic connections. This, in turn, is supposed to enhance the brain signals that are present independently of whether or not those signals are good or bad.

2. Tricyclic antidepressants (TCAs) such as Pamalor, Ludiomil and Elavil. These are the precursors to SSRIs and basically work the same as SSRIs except that they are not selective. In other words, they can affect many neuro

ransmitters other than serotonin and therefore, generally, have more pronounced side effects. TCAs are sometimes prescribed today but generally, they are considered to be an older generation of antidepressants compared to SSRIs.

3. Monoamine oxidase inhibitors (MAOIs) such as Nardil, Parnate, Wellbutrin, Effexor and Marplan. These are often called atypical antidepressants because they are most often prescribed when other more typical medications such as SSRIs and TCAs have failed to produce good results. Sometimes certain depression symptoms such as anxiety attacks, phobias and excessive sleeping will indicate the best course of action is a MAOI.

If you and your doctor are looking at various medication options there is no clear path to deciding which to try. There is no blood or other clinical test available that can point you to one medication over any other. Often if one medication does not work, it does not eliminate that entire family of medications. Sometimes almost an identical medication will help reduce depression. Unfortunately, all of these medications work very slowly and you need to take the medication for 6 to 8 weeks to identify whether or not it is helping. If it isn't working, it takes almost as long to clear it out of your system. You and your doctor may have to go through many different types of antidepressants before you find one that works. Generally, you never want to take two different types of depression medication at once unless your doctor specifically prescribes it. Drug interactions, with MAOIs in particular, can be very dangerous. Generally, your doctor will start you out with medications that are SSRIs, which are safer and have fewer negative side effects. Usually the best course of action is to combine medication with talk therapy.

Michael Russell

Your Independent guide to Depression