Depression is a serious condition that affects around a quarter of the population in Western countries each year. Its main symptoms are low mood, low self esteem, depleted energy and loss of interest. This can seriously affect the lives of sufferers and even result in death, with 60% of suicides being caused by clinical depression. As it places stress on the nervous system and can also leave patients susceptible to other conditions and place strain on their heart. Furthermore as it effects mood and behaviour it can also have a destructive impact on the social life, career or romantic life of the individual. Depression should not be ignored then, and treatment and help should be sought as soon as the problems arise.

As a mood disorder, the cause of depression is not entirely known. While some cases of depression have a clear cause such as the death of a loved one, other instances of it appear to have no cause and an strike without warning. Psychologists and psychiatrists consider different potential causes of depression depending on the model of the mind they subscribe to and the training they have received; and this will influence the treatment they recommend. With no universal opinion on the treatment of depression then it is important that you understand all the facts before embarking on a course of antidepressant medications.


Psychologists and doctors who recommend antidepressants generally subscribe to a medical model of psychology. As our perception of emotion is caused by a complex interplay of various hormones and chemicals released in the brain it is thought that depression can be caused, and so also cured, by fixing this imbalance. Antidepressant medications are then prescribed to perform just this task causing the brain to produce more or less of certain symptoms. This generally is found to treat the symptoms seen in patients with mood disorders and indeed correlations have been found between moods, mood disorders, and the subjective experiences of the patients.

As any scientist should know however, correlation does not prove causation. What precisely is meant by this statement is that just because depression and certain hormones go hand in hand, it does not mean that depression is necessarily caused by a chemical imbalance. It may be the case that both are caused by a third outside factor, simply run in parallel without affecting one another, or that the hormones are released as a result of destructive thinking patterns as is the view of CBT (cognitive behavioural therapy).

Here depression is explained as a series of learned behaviours and negative and destructive thought patterns and ruminations that lead to the individual developing a negative self image and becoming socially withdrawn. Psychodynamic theory meanwhile (as developed by Freud and furthered by colleagues like Jung) explains most psychological disorders as having their route in childhood experiences. In these explanations it may be that antidepressant medications simply treat the symptoms of depression without tackling the cause. Furthermore, by tampering with the brain chemistry, it may be the case that the brain responds by releasing more or less of certain hormones to account for the outside influence which may further exacerbate the problem, lead to dependence, or result in the patient requiring stronger and stronger doses.

Despite these possibilities, the fact remains that many depressed patients find relief in antidepressant medications and use them to function normally. Often a combination of both antidepressants and therapy is advised, with the drugs used as a stop-gap to immediately lessen symptoms while therapy aims to address the cause of problem. For these reasons you may still wish to use an antidepressant, but should be fully aware of just how it is affecting your brain in order to decide and choose from the options available. A brief explanation of the history and methodology of various forms of antidepressant medications follows.

From early on in history, opiates and amphetamines were used as basic antidepressants. It wasn’t until the 1950s when these were replaced with alternative medications associated with fewer side effects and less addiction. Then in 1951, isoniazid and iproniazid were discovered by Irving Selikoff and Edward Robitzek who were searching for treatments for tuberculosis which was noted to result in ‘general stimulation’ and ‘renewed vigour’. This lead to the drugs being used by Max Lurie in 1952 on depressed patients with great success leading him to coin the term ‘antidepressant’ to describe the first antidepressant medications. Interestingly the exact mechanism by which isoniazid works remains unclear, though it is suggested that it works as a monoamine oxidase A and diamine oxidase inhibitor. At the same time meanwhile, another anti-tuberculosis drug was being tested by Selikoff and Robitzek known as ‘iproniazid’, which showed even more pronounced psychostimulant effects, but at the same time a more pronounced toxicity. Iproniazid was then marketed fiercely and became a highly selling cure for depression until it was recalled in 1961 due to substantial cases of lethal liver damage (hepatotoxicity).

From here on however, many other antidepressants hit the market and medication for mood disorders became popular. From here many more antidepressant medications were discovered and gained acceptance. However at this time it was estimated that only 50-100 people in one million would suffer depression to such an extant that it required medication and it was not until the first patented antidepressant ‘zimelidine’, a tricyclic (or ‘three ringed’ compound) which worked by inhibiting norepinephrine reuptake meaning there was more available in the brain, in 1971 that it became a feasible money maker for pharmaceutical companies.

Today there are many different types of antidepressant medications which work through various different mechanisms. One of the most popular types of medication for depression are ‘SSRIs’ or ‘Selective Serotonin Reuptake Inhibitors’. These work by affecting the ‘5-HT’ system (which is also affected by many recreational drugs and psychedelics) preventing the uptake or serotonin which means there’s more of it free to be utilised by the brain. As serotonin is a ‘feel good hormone’ which also helps the brain to transmit signals between neurons it is thought that this lifts the mood, and some experts suggest that depression could be partially caused by a lack of serotonin. These drugs have fewer undesirable side effects than tricylcics for examples and most of the most popular antidepressants fall under this category including: Prozac (fluoxetine), Paxil (paroxetine), Paxil (paroxetine), Celexa (citalopram), Lexapro (Escitalopram) and Zoloft (sertraline). GABA meanwhile is an antidepressant that also releases growth hormone and can be used as everything from an antidepressant to a sleep enhancer to a bodybuilding drug. Unwanted still do exist however including drowsiness, dry mouth, anxiety, lack of appetite, insomnia and potential loss of sex drive. Many studies have demonstrated the effectiveness of SSRIs, though the link between serotonin and depression is still disputed, and it seems that SSRIs are not effective in as many cases as tricyclics suggesting an important role for norepinephrine.

Hence the next entry: serotonin-norepinephrine reuptake inhibitors, which work by increasing amounts of both norepinephrine and serotonin. These are effective in a wider variety of cases (it is important to consider that individual cases of depression vary greatly) but have slightly more side effects when compared to SSRIs. Additionally they can be more addictive and so dosages need to be closely controlled. Examples of serotonin-norepinephrine reuptake inhibitors include Pristiq (desvenlaxafine), Cymbalta (duloxetine), Effecor (venlafazine) and Ixel (milnacipram).

A newer form of antidepressant medication is noradrenergic and specific serotonergic antidepressants. These have the same aim as SSRIs and SNRIs – to increase the amount of available norepinephrine and serotonin – but do so in a more specific way blocking only certain receptors which is generally more desirable as it will have fewer side effects but at the same time will work on even fewer cases of depression. Examples are Tolvon (mianserin) and Avanza (Mirtazapine). There are a variety of other drugs that interact with serotonin and norepinephrine receptors in various ways.

Finally, monoamine oxidase inhibitors (or MOAOIs) can be used to block the enzyme ‘monoamine oxidase’ which causes the break down of neurotransmitters serotonin, norepinephrine and serotoning – again meaning there are more of these positive chemicals available to the brain. These can be useful when other antidepressant medications fail, but are seldom used as they can react badly, potentially fatally, with certain foods and drinks including wine. Some however, such as Manerix, can be used with less risk and with no specific diet. These drugs also have rapid weight gain as a common side effect.

While doctors or psychiatrists may prescribe on these antidepressant medications, they may alternatively prescribe multiple medications with one acting as an ‘augmenter drug’, meaning that it can further improve the effectiveness of a certain drug. For example sedatives such as benzodiazepines can be prescribed to help with anxiety. Other drugs are utilised not for their main purpose, but for any other side effects that may prove useful in dealing with depression. These can include psychedelics as well as medications intended for other mental illnesses such as schizophrenia. Obviously these will also cause other affects.

In the UK, cases of antidepressant medications being used went up 234% between the years of 1992 and 2002. In the US 11% of females and 5% of males use the drugs. These figures are similar in the rest of Europe. As long ago as 1998 a survey showed that 67% of patients with depression were prescribed antidepressants and this figure will be likely to have risen since then. These shocking figures are even more concerning when we consider that in 2007 a study showed that 25% of Americans were over diagnosed with depression.

While antidepressant medications may well help an individual to deal with the incredibly destructive symptoms of depression then, it is important to be aware of exactly how the antidepressant is working, as well as any potential side effects or threat of addiction. At the same time however it is important not to become dependent on them and to continue to seek therapy of a form that seems to work for you. Antidepressants are generally not curative and patients may well build up tolerance to them, a more permanent solution needs to be found through other treatments. Alternative treatments then include counselling which will attempt to get to the route of the depression and to address destructive thought patterns and ruminations that damage mood and self esteem. A cognitive behavioural therapist will teach depressed patients to be mindful of their thoughts, ‘false hypotheses’ and associations and to recognise them as such. Sufferers of depression can also look at their own lives and attempt to address potential causes and sources of distress – perhaps relationship problems or dissatisfaction at work. Once such problems have been identified it can then be possible to address them (though often there will be no ‘cause’ as such). Furthermore, changes to diet and lifestyle can improve mood – and exercise is one of the best natural antidepressants as it causes the release of endorphins.

In conclusion then, antidepressant medications should be used only in extreme cases of depression and as a last resort. Even for those taking medication, counselling and lifestyle changes should also be sought in order to treat the actual cause of the depression rather than just the symptoms.



Source: Health Guidance