Depression may be one of the most mysterious conditions to affect human beings. How does the emotion of sadness, melancholy or grief become a biochemical condition? …and why don’t serotonin-enhancing antidepressants work as well as expected, if they even work at all? Here’s a brief history of depression treatment that may serve as a starting point to understanding more about depression.
The antidepressants Prozac, Paxil and Zoloft were introduced for use between 1974 and 1977, although the trade names were introduced some years later. These drugs were thought to work by elevating serotonin concentrations in the brain. Thru the 1980s and 1990s, several seemingly contradictory studies had results that shared a couple of consistent points.
First, patients with severe depression tend to respond most meaningfully to antidepressants, while patients with moderate or mild depression do not. Second, in a majority of those who do respond, serotonin very likely plays an important role, because depleting serotonin in depressed patients often causes relapses.
In 1997, Irving Kirsch, currently a psychologist at the Harvard Medical School, set out to look at the placebo effect in relation to depression, which was later verified.
Kirsch combined 38 trials that included patients who had been given antidepressants, placebos or no treatment and then applied mathematical reasoning to estimate how much the placebos contributed to the improvements in mood. In 2010, researchers revisited Kirsch’s analysis using six of the most rigorously conducted studies on antidepressants. In patients with moderate or mild depression, the benefit of an antidepressant was indeed small, even negligible. However, for patients with the most severe forms of depression, the benefit of medications over placebo was substantial.
New studies suggest that antidepressants may not be acting as passive “signal-strengtheners” or serotonin “regulators” in the brain as previously considered. Instead, neurochemicals like serotonin may help change the wiring in the brain and perhaps even form new circuits.
The evidence-base teaches us a great deal. As more studies are done, we know more. Antidepressants, which are given out like candy by some physicians, do not show much efficacy in those who have mild or moderate depression. If you suffer from severe depression, see a psychiatrist specializing in depression to help you learn what all your options are. In conjunction with medication, many people see symptom improvement using acupuncture, meditation, and talk therapy in combination. With continued research, we will find better solutions to treating depression.