Treatment for Depression: Medication

Medication for Depression

There are many options for medications in order to treat depression.  A positive aspect of antidepressants is they often treat anxiety as well, and many people have anxiety and depression combined.  Although there are many classes of medications for depression, I will focus on three different classes – Selective Serotonin Reuptake Inhibitors or SSRI’s, Selective Norepinephrine Reuptake Inhibitors or SNRI’s, and Selective Dopamine Reuptake Inhibitors also known as SDRI’s.

Basic Neurobiology of Antidepressants

Many anti-depressants work in similar ways but work on different neurotransmitters. Remember when we talked about neurons, serotonin, norepinephrine, and dopamine. If you would like to review, click on the words.

The neurons in the brain secrete different neurotransmitters (e.g. serotonin, norepinephrine, and dopamine). When the neuron secretes a specific neurotransmitter, those chemicals cross the synapse (the space between the sending and the receiving neurons), and they land on the receptors which stimulate an electrical signal down the second neuron.  When the receptors are full, the excess neurotransmitters are floating around in the synapse. There are enzymes that pick up all the excess neurotransmitters and package them back up to be reused again. The SSRI blocks the enzyme from taking the excess serotonin back up into the neuron.  The SNRI blocks the enzyme from taking the excess norepinephrine back up into the neuron, and the SDRI blocks the enzyme from taking the excess dopamine back up into the neuron. This is important because the longer the neurotransmitters “hang out” in the synapse, the more neurotransmitter is available once the neurotransmitters already sitting on the receptors have been utilized fully. If the medication gets taken back into the first neuron for repackaging too soon, depressive symptoms are present.  It’s kind of like a person waiting in line stands on the receptor, gets off because their turn is over, and the next person gets to step up.  If there aren’t any people in line, the receptor can’t be utilized. When more neurotransmitter is available, the neuron makes more receptors for the neuron to attach to.  This is called upregulating. The neuron thinks, “There’s so many people in line at the grocery store, we better open up more lines!” When this happens depression can be lifted.

Choosing the right Antidepressant

You may recall in my post called Diagnosis of Depression, there are different symptoms which characterize depression. The different antidepressants often target different symptoms. For example, the SDRI, bupropion (Wellbutrin) it can target anhedonia (or lack of ability to feel pleasure.) The SNRI, venlafaxine (Effexor) can increase motivation and energy as well. Maybe the depressed person can’t sleep or eat. There is a medication called mirtazapine (Remeron) that can improve appetite and insomnia. You can see that providers have many things to consider when helping to chose the correct medication.

Another consideration when your provider is helping to chose a particular medication is how long the medication lasts. For example, fluoxetine (Prozac) has a very long half life. This may be useful for a teenager who might forget to take their medication at times.

It takes some patience and flexibility to find the right medication sometimes. Everyone responds to medications differently. If your doctor recommends an antidepressant and you chose to take one, be patient as it can take some time to find the correct medication. Additionally, there are many choices of antidepressants, so if one does not work, likely another will. Also, it takes 4-6 weeks to see the complete effect of the medication. Lastly, medication works best in conjunction with therapy.

Risks and Benefits of Antidepressants

There are risks and benefits to every medication, vitamin, and mineral. It is important to find out about the risks and benefits before you begin taking anything.

Benefits of antidepressants:

• Improvement in mood
• Can improve sleep
• Appetite may become more balanced
• Improve concentration
• Can improve self-esteem and feelings of guilt
• Reduces anxiety

Risks of antidepressants:

• Headaches
• Nausea or upset stomach
• Drowsiness
• Insomnia
• Dry mouth
• Weight gain
• Weight loss

Side effects, especially headaches and/or nausea and stomach upset can be present but then generally go away within a few days. There can be serious side effects; however, these are very rare. Some of these can be changes in your blood cells, rashes, and allergic reactions.

Next time, we will discuss complementary and alternative treatments for depression. After that, we will be hearing from people who have experienced depression. Following that discussion, we will talk about suicide awareness and prevention. Then we will wrap up our discussion on depression by looking at faith and what the Bible says about depression.