Depression Treatments
Antidepressant Medications
SSRI’s
Most antidepressant medications are designed to block these receptor sites from absorbing serotonin too quickly. That is why they are called Selective Serotonin Reuptake Inhibitors (SSRI’s), because they block the 5HTT receptor sites from reabsorbing serotonin. These medications are most widely prescribed for depressive disorders and work moderately well in many patients. However, new FDA evidence questions the effectiveness of SSRI’s in combating depression, and the FDA has issued an Advisory Letter cautioning against the assumption that SSRI’s will solve the depression problem. The FDA is especially concerned about SSRI’s and teenage suicide rate increases.
SSRI’s may not be effective in many cases because of the brain’s inability to produce enough serotonin to begin with. If existing levels of serotonin are too low, SSRI’s won’t be effective. Thus a second main cause of depression is the brain’s inability to produce sufficient quantities of serotonin. The difficulty here though is that one cannot simply take a serotonin supplement. The brain has a defense system called the brain barrier that is designed to protect it from most external chemicals. This is why serotonin supplements have not been found in scientific studies to be of any therapeutic effect.
Tricyclic antidepressants
Tricyclics were first discovered almost 50 years ago and are effective at blocking serotonin from being absorbed. However, tricyclics caused many side effects and in some cases increased the risk of suicides. Tricyclics are so named for their distinctive three-ring molecular composition. Doctors now generally favor SSRI’s over tricyclics because of fewer side effects. SSRI’s are the most common antidepressant medications, and some variations work on both serotonin as well as norepinephrine.
Monoamine oxidase inhibitors ( MAOI’s)
MAOI’s prolong the effect of monoamines such as serotonin, by retarding the breakdown of these hormones. However, MAOI’s increase the risk of several side effects and react negatively with other medications and some foods. MAOI’s are generally prescribed only for specific conditions such as agraphobia or when SSRI’s are ineffective. A new type of MAOI has been deveolped, which holds promise for those who have not responded well to SSRI’s or tricyclic medications. Manerix is the first reversible inhibitor of monoamine oxidase (RIMA). Manerix (or Moclobemide), does not pose the same negative interactions with food as standard MAOI’s.
Antidepressant Augmentors
Some medidcations improve the effect of other antidepressants and so are known as augmentors Tryptofan and buspirone are two such medications. Specialized bright light is also an antidepressant augmentor. Although tryptophan and buspirone work in specific conditions, light has been shown to elicit a synergistic effect with most antidepressant medications.
Tranquillizers
Seditives such as the benzodiazepine family are used to reduce anxiety and initiate sleep. Most tranquilizing drugs can be highly addictive and are generally only prescribed for short-term use.
Antipyschotics
Antipsychotics are most commonly prescribed as mood stabilizers for bipolar disorders, but are also used for treating anxiety. Antipsychotics can cause dependancy, and in higher doses carry a risk of serious side effects. Lithium is one of the most reliable mood stabililzer and is most often used for bipolar disorder, but can also have applications in depression treatments, As with antipsychotics, lithium has common side effects, including nausea, tremors, dry mouth, dizziness, etc.
Other Depression Treatments
Electroconvulsive therapy (ECT)
Also known as electroshock therapy or shock therapy, ECT uses a low level electric impulse to induce an artificial epileptic siezure. The patient remembers nothing of the treatment as he/she is under general anesthesia at the time. Although experts do not quite understand how ECT works, it is thought that ECT causes a temporary blockage of the brain’s current depressed conditioning. The effects of ECT may last from a few to several months. Because of side effects and potential short-term memory loss, ECT is considered as an alternative when other medications are not effective or in cases such as pregnancy where medication is not advised. In order for ECT to be effective, treatments usually continue over a three to four week period.
Transcranial Magnetic Stimulation
Repetitive Transcranial Magnetic Stimulation (rTMS) has grown out of ECT, and may become a preferred treatment. RTMS is still under investigatoin but shows some promising results. Instead of using an electrical current, rTMS creates a strong magnetic field around the left prefrontal cortex of the brain. The left prefrontal cortex is associated with abnormal behavior in depressed patients. There are fewer side effects with rTMS than with ECT, especially where memory loss is concerned. Patients also do not need to undergo anesthesia, but require a similar number of treatments. |
