How do antidepressants work?
People suffering from depression are
thought to have lower levels of some of
the chemical messengers in the brain,
called
neurotransmitters. The three
neurotransmitters believed to be
involved in depression are
serotonin, dopamine, and
norepinephrine. Neurons in the brain
constantly produce, release, and
reabsorb these brain chemicals.
Antidepressants increase the levels of
these neurotransmitters in the brain by
blocking their reabsorption. Watch the
video
Antidepressants — How they help relieve
depression for an illustration of
how this works.
While this has led to the popular belief
that depression is the result of a
chemical imbalance in the brain that
can be corrected with drugs, the reality
is more complex. It is not yet known
whether low levels of neurotransmitters
cause depression, or whether depression
causes this imbalance in brain
chemistry. For more, read Causes of
Depression and
The Brain and Depression.
How effective is medication for
depression?
While antidepressants provide relief
for some people, they are not a “magic
bullet” for depression. Antidepressants
reduce symptoms in approximately 70
percent of people. This leaves nearly 1
out of 3 people who don't get relief.
Even in those who respond to medication,
complete remission is rare. More
commonly, their symptoms are reduced but
not cured. This is important because, as
Psychology Today notes, unless a
full remission is achieved, depression
is very likely to recur.
Placebo Effect
Some of the improvement that people
experience from antidepressants can be
attributed to the
placebo effect. In fact, recent
research suggests that
antidepressants don't work much better
than sugar pills. For more information,
read
Placebo Power and
Antidepressants: A Triumph of Marketing
Over Science?.
Medication vs. Therapy
While antidepressants may improve
mood by boosting the “feel-good”
chemicals in your brain, they don't
treat the actual cause of the
depression. Because of this, relapse
rates are high once drug treatment is
stopped. In contrast, the emotional
insights and coping skills acquired
during therapy can have a more lasting
effect on depression. A
University of Pennsylvania study
backs up this claim. It found that
cognitive therapy works just as well as
antidepressants and is more effective
than medication in preventing relapse
once treatment ends.
In a moderate to severe depression,
medications may be useful in the short
term, but should be accompanied by
therapy to address underlying issues.
Sometimes the heaviness of a depression
serves to mask painful emotions, which
may then come to the surface when
medications are taken. The result can be
an unexpected sadness – yet another
reason that psychotherapy is so
important when using antidepressants.
Can antidepressants make depression
worse?
There is a risk that antidepressant
treatment will cause an increase, rather
than a decrease, in depression. In fact,
all depression medications are required
by the FDA to carry a warning about the
increased risk of suicide, hostility,
and agitation. The FDA advises that all
individuals on antidepressants be
closely watched for increases in
suicidal thoughts and behaviors.
Monitoring is especially important if
this is the person’s first time on
depression medication or if the dose has
recently been changed. If the depression
appears to be getting worse, an
evaluation by a mental health
professional should be scheduled as soon
as possible. New problems with anxiety,
insomnia, aggressiveness, irritability,
impulsivity, and
restlessness—particularly if the
symptoms are severe or appeared
abruptly—are red flags as well, and
should be evaluated immediately.
