The Science and History of Treating Depression

[steve2470]

http://www.nytimes.com/2012/04/22/magazine/the-science-and-history-of-treating-depression.html

Few medicines, in the history of pharmaceuticals, have been greeted with as much exultation as a green-and-white pill containing 20 milligrams of fluoxetine hydrochloride — the chemical we know as Prozac. In her 1994 book “Prozac Nation,” Elizabeth Wurtzel wrote of a nearly transcendental experience on the drug. Before she began treatment with antidepressants, she was living in “a computer program of total negativity . . . an absence of affect, absence of feeling, absence of response, absence of interest.” She floated from one “suicidal reverie” to the next. Yet, just a few weeks after starting Prozac, her life was transformed. “One morning I woke up and really did want to live. . . . It was as if the miasma of depression had lifted off me, in the same way that the fog in San Francisco rises as the day wears on. Was it the Prozac? No doubt.”

Like Wurtzel, millions of Americans embraced antidepressants. In 1988, a year after the Food and Drug Administration approved Prozac, 2,469,000 prescriptions for it were dispensed in America. By 2002, that number had risen to 33,320,000. By 2008, antidepressants were the third-most-common prescription drug taken in America.

Fast forward to 2012 and the same antidepressants that inspired such enthusiasm have become the new villains of modern psychopharmacology — overhyped, overprescribed chemicals, symptomatic of a pill-happy culture searching for quick fixes for complex mental problems. In “The Emperor’s New Drugs,” the psychologist Irving Kirsch asserted that antidepressants work no better than sugar pills and that the clinical effectiveness of the drugs is, largely, a myth. If the lodestone book of the 1990s was Peter Kramer’s near-ecstatic testimonial, “Listening to Prozac,” then the book of the 2000s is David Healy’s “Let Them Eat Prozac: The Unhealthy Relationship Between the Pharmaceutical Industry and Depression.”

In fact, the very theory for how these drugs work has been called into question. Nerve cells — neurons — talk to one another through chemical signals called neurotransmitters, which come in a variety of forms, like serotonin, dopamine and norepinephrine. For decades, a central theory in psychiatry has been that antidepressants worked by raising serotonin levels in the brain. In depressed brains, the serotonin signal had somehow been “weakened” because of a chemical imbalance in neurotransmitters. Prozac and Paxil were thought to increase serotonin levels, thereby strengthening the signals between nerve cells — as if a megaphone had been inserted in the middle.

*much more at link above*

[safeinOhio]

1. Other than Skinner radical behaviorism,

almost all psychological theories have come and gone.

[bananas]

2. "As the clinical trials show unequivocally, only a fraction of the most severely depressed patients respond to serotonin-enhancing antidepressants."

"As the clinical
trials show unequivocally, only a fraction
of the most severely depressed patients
respond to serotonin-enhancing
antidepressants. "

Good article.

The last several paragraphs are important.

[RainDog]

6. actually, the article is more nuanced than that

in that it does note that seratonin itself is implicated in depression among people who are depressed - i.e. if someone is severely depressed, low seratonin (induced in experiments) makes the depression worse.

In 2010, researchers revisited Kirsch’s analysis using six of the most rigorously conducted studies on antidepressants. The study vindicated Kirsch’s conclusions but only to a point. In patients with moderate or mild depression, the benefit of an antidepressant was indeed small, even negligible. But for patients with the most severe forms of depression, the benefit of medications over placebo was substantial.

[Odin2005]

3. I have taken Paxil for several years and I have not had a panic attack since I started taking it.

Note to Alt-Medicine folks, St, Johns Wort is also an SSRI! So if Prozac doesn't work, and neither does your herb!

[Zoeisright]

4. Without Prozac, I am miserable, full of rage, and unable to see reason.

It works for me. I have a very strong family history of depression. Mine kicked in after my husband had cancer at age 25, and my mother had a nervous breakdown and blamed it on me.

Nobody is taking it away from me.

[Sarah Ibarruri]

5. When my husband passed away, I went into a depression

And it was not abating. I also developed anxiety attacks.

I missed him so much, that I saw no point in anything. My GP tried to get me to take meds, but I steadfastly refused, believing that pharmaceuticals would prove useless and harm me.

Then I started getting a bit careless about myself. I just didn't care how I looked. Once again, he talked to me about taking meds. I agreed to take meds but at the lowest imaginable dosage. He gave me Zoloft. I didn't think the darn thing would work. However, the dark, morose thoughts of sadness and uselessness began to disappear.

Eventually, my panic attacks disappeared. Good thing, too, since the Zoloft began to cause some symptoms I wasn't happy about. I weaned myself off the Zoloft, but by then I somehow no longer "remembered" the depression. That's the best way I can put it. It helped me a lot.

[CoffeeCat]

7. Is Prozac different from other anti-depressants?

I know a couple of people on Prozac and they swear by it. They describe it as "a little lift" that perks them up and lifted their depression, with little side effects.

However, I have other friends who have taken other anti-depressants and these drugs seem more powerful and take longer to get into their system and work. I had a friend on Paxil who seemed completely messed up--drugged, is the best way to describe it.

Do some anti-depressants numb you out--while others perk you up?

I am in general against pharmaceuticals, such as anti-depressants, but I don't judge and I try to be open minded. I would much rather be on a perky drug if I was depressed, than one which rounded out the rough edges and sorta numbed you out from everything. I would find that yucky.

Anyone versed on what different anti-depressants do? And if Prozac yields better results?

[steve2470]

8. I'll attempt to answer your questions

Each anti-depressant has a slightly different side-effect profile from one another, but the side effects are similar for closely-related ones. Some are "energizing" (Prozac) while others are more sedating (Zoloft). The "perk you up" ones are more like Prozac, while the "numb you out" ones are more like Zoloft.

Patients with very low energy and motivation sometimes are given the energizing ones, while patients with higher anxiety levels are given the more sedating ones.

Every patient's neurochemistry is different, so Prozac might work well for a friend and completely "disagree" with you or not work at all.

The goal of all anti-depressants is the same: to relieve the core symptoms of depression. Unfortunately at this time, it's a trial-and-error procedure mostly. Some patients can tolerate certain side effects (such as loss of libido) better than other patients.

Two last points: 1- Medication is not for everyone but should at least be considered by patients with moderate to severe depression; and 2- a course in psychopharmacology is really needed to thoroughly explain the drugs, their side effects, and other essential prescribing information.

Hope all that helped a tad.

https://www.ncbi.nlm.nih.gov/pubmed/18494537

[CoffeeCat]

9. It does help...

...and I appreciate you taking the time to respond.

I didn't officially know that some anti-depressants worked the "perk" side and that others worked the "numbing" side. Makes sense, I guess.

Again, thank you for the explanation.

[tinrobot]

10. The problem is that "depression" is not much more than a collection of symptoms.

Drugs like Prozac treat those symptoms. This works great for those who need relief. But they don't amount to much more than a painkiller. If you broke your arm, you could certainly mask the pain with powerful drugs, but it doesn't fix the source of the pain. With depression, drugs like Prozac can give relief, but they don't fix the underlying cause of the depression.

Depression can be caused by a myriad of factors - anything from a badly wired brain to a poor diet and many things inbetween. In order to truly root out the depression, you have to go beyond Prozac to address the source of that depression through therapy, lifestyle changes, cognitive changes, etc...

[Blue_Tires]

11. ttt