Medications for Major Depression

Rashmi Nemade, Ph.D., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.

The first medication used to treat depression was "discovered" while researchers were studying another medical disorder. Iproniazid was originally developed as a treatment for tuberculosis in the 1950's. Once it became clear that antidepressant medications were possible, medical science focused attention towards researching and developing depression-specific medications (as well as many other medications useful for treating mental illness)

Modern antidepressant medications are thought to have their effect based on their ability to alter the balance of neurochemicals and neurochemical receptors at the synapse level within the brain. Selective serotonin reuptake inhibitors (SSRIs) and their newer antidepressant cousins, the serotonin norepinephrine reuptake inhibitors (SNRIs), are today considered first choice medication treatment for the treatment of Major Depression. Other medications, including the older tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are used as second-line choices.

Antidepressants are medications and like all medications, they should be used only as prescribed by a physician. Medications can be dangerous and even lethal when taken in a haphazard manner. For example, specific antidepressants are considered unsafe for pregnant or nursing women. You should only obtain medication from a reputable drugstore and only as indicated on a prescription notice from your doctor. Any concerns about the safety of particular medications should be discussed with your doctor.

Even though antidepressants impact a person's levels of neurotransmitters within hours, they usually take several weeks to exert a noticeable effect on mood. This is because antidepressant drugs are thought to cause new receptors to grow within the synapses, and this growth process takes a few weeks. As a result, the effects of antidepressant medications are not instantly apparent, but may take several weeks to build up to levels that impact someone's mood. When treatment effects occur, they occur gradually. Patients often fail to notice the positive effect that the medication is having, but generally family and friends will notice. It is important to keep taking an antidepressant as prescribed for several weeks before making a decision about whether or not it is effective. Up to six weeks may be required to know if a drug will work.

You may have to try several different antidepressant medications before finding one that works well. Even within a family of similar antidepressant medications, some people do better with one than with others. Decisions about when it is time to try new medications are best made when the patient, physician, and the psychotherapist (if one is present) work together as a team. Depressed patients often discount or ignore positive changes brought about by antidepressant medication. Health care professionals can counter this tendency to ignore positive change by offering their more objective observations, while patients can contribute their own impression regarding positive effects and troubling side-effects.

Many people are concerned about having to take antidepressants for the rest of their lives. Typically, individuals begin taking antidepressants when their depression is at its worst. The medication, combined with psychotherapy, will allow most people to get to a point where they can gradually decrease or discontinue their use of antidepressants and maintain well-being by using skills learned in psychotherapy. However, for those individuals whose depression returns when they stop using medication, long-term use of antidepressants may be essential.

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