A Guide to Anti-depressants

Lots of people often have false impressions about what antidepressants are capable of.

First of all, they are not perky pills; they don't artificially bring on a feeling of pleasure, euphoria, or unrealistic well-being. Neither do antidepressants insulate you from life, make you not care about significant things, or make you inconsiderate to anguish or loss.

What antidepressants do is counteract depressed persons from descending into the blackest depths of depression when something awful happens. They can still feel hurt, pain, and discomfort, but they feel these the way people normally do when they don't have depression. They also can help depressives sleep better, increase their everyday energy, and buildup their ability to concentrate.

The way antidepressants work is interesting. There are two chemicals, serotonin and norepinephrine, that have to do with the transmission of impulses between nerve cells in the brain and seem to be associated with depression. It appears as if depressed people use up these chemicals quicker than other people. Antidepressants help to sustain these chemicals, apparently leading to feelings of decreased anxiety, more security, increased self-worth, assertiveness, and resilience.

There are a assortment of types of antidepressants, but they fall into a number of straightfoward categories. These are tricyclics, MAOIs, and lithium, and the newer medications: hetereocyclics and Prozac and Prozac-related drugs.

Until rather recently, tricyclics were the normal treatment for depression. These medications include imipramine (Tofranil), amitriptiline (Elacil), Vivactil, Norpramin, Pamelor, and Sinequan. Still in general use today, 40 to 70 percent of depressed patients build up substantially with tricyclics.

Although they are quite efficient medications, there are a few disadvantages to their use. They normally take several weeks of accurate administration to be helpful, which is tricky to handle when people are very distressed. Further more, it is reasonably easy to take a fatal overdose. In general, tricyclics should only be used on a short-term basis. They are not addictive, but they must be used with care, especially with people who have cardiovascular disease.

Monoamine oxidase inhibitors (ie. MAOIs) include Marplan, Parnate, and Nardil. They are a different class of drugs and cause a different reaction in the brain. These drugs are advantageous from some people who do not respond to tricyclics. These drugs can have not nice side effects, but the main disadvantage of MAOIs is that they can also cause a stroke if certain foods containing the compound tyramine (cheese, red wine, pickles) are consumed while they are being used.

Lithium is generally the treatment of choice for bipolar disorder (the cycle of manic highs with depressed lows). In the correct dose, lithium reduces by about 50 percent the chances of another manic episode within a year. Mood swings become fewer, shorter, and less critical. The success rate for lithium treatment is 70 percent, and 20 percent of people become symptom-free. It is generally seen as a maintenance drug. Once the patient is on Lithium, they are on it for life.

One of the most well-known drugs on the market today is Prozac. It has been followed into the marketplace by many other new antidepressant medications like Zoloft and Paxil, two near cousins, Effexor and Serzone, and some more distant cousins, notably Wellbutrin, Desyrel, and BuSpar.

Unlike tricyclics, which affect the levels of both serotonin and norepinephrine in the brain, Prozac, Zoloft, and Paxil affect only serotonin. Hence they are known as selective serotonin reuptake inhibitors, or SSRIs, meaning that they put a stop to or slow down the reabsorption of serotonin. Effexor and Serzone affect both serotonin and norepinephrine, and the others have more intricate effects. All, however, have been shown to be useful in the treatment of depression. The choice of which of these medications to use for a particular person has to do with their dosage and side-effect profile. Paxil, for example, seems to have a soothing effect on anxiety that Prozac lacks. Effexor has the reputation of being more energizing than Prozac.

Compared with tricyclics, the side effects of Prozac and its cousins are usually slight. Tricyclics can give you dry mouth, make you constipated, and actually slow you down, whereas Prozac has none of these problems and gives you a little more energy. However, there are some side effects with the newer antidepressants which should be mentioned. Most notable among these is a reduction of interest in sex and problems maintaining an erection. Although the male performance problems usually go away after a few weeks, many people on SSRIs report a continued diminished interest in sex, which can certainly add to marital problems.