Antidepressants and Other Treatment Options

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It's important to know your options and talk with your health care professional, especially if you continue to experience depression symptoms.

Antidepressants and How They Work

Though not well understood, the causes of depression seem to involve an imbalance of certain brain chemicals, called neurotransmitters. These act as messengers between parts of the brain, or between the brain and the body. Serotonin (5HT) and norepinephrine (NE) seem to play an important role in depression.

Nerve cells in the brain send out these neurotransmitters to deliver messages, and then take them back in (reuptake) and break them down. Antidepressants are used to try to slow down this process. This is believed to make more neurotransmitters available in the brain, which is believed to relieve symptoms.

Classes of Antidepressant Medications

Over the years, scientists have developed several kinds, or classes, of antidepressant medications. These medications may have different effects on different people, and many people may try more than one before they find one that works for them.

There are four main classes of antidepressants:

Tricyclic antidepressants (TCAs).
These medications were developed in the 1950s and 1960s. They help prevent reuptake of 5HT and NE, but they also affect other neurotransmitters and can have serious side effects. They are not as commonly prescribed in the United States as are newer classes of antidepressants.
Monoamine oxidase inhibitors (MAOIs).
The MAOIs were developed at about the same time as the TCAs, but they are believed to work differently. They seem to stop the brain from breaking down 5HT and NE after reuptake. People taking MAOIs should be careful about their diet and other medications to avoid problems.
Selective serotonin reuptake inhibitors (SSRIs).
The SSRIs seem to help prevent reuptake of neurotransmitters in the brain. The SSRIs are called selective because they focus on serotonin. Although the various SSRIs seem to work in basically the same way and have similar side effects, people seem to respond differently to different SSRIs.
Serotonin-norepinephrine reuptake inhibitors (SNRIs).
Developed in the 1990s, Effexor XR® (venlafaxine HCl) was the first SNRI. It affects 5HT, like an SSRI, but it also helps prevent reuptake of NE. It is an important treatment option for some people with depression.

Treatment Options: Talk Therapy

Many people with depression also benefit from talk therapy (psychotherapy). Talk therapy helps you work toward changing the way you view the world around you and how you react to it. Talking with a psychiatrist or another qualified health care professional can help you explore your relationships, feelings, and experiences in a meaningful way, which can help you interact with others and begin to enjoy your normal activities again.

There are three main types of talk therapy:

  • Cognitive-behavioral therapy (CBT) — helps a person recognize negative thought patterns and behaviors and replace them with positive ones. CBT can quickly bring important changes to a person's daily life and outlook for the future.
  • Interpersonal therapy (IPT) — focuses on working through troubled personal and social relationships that may contribute to a person's condition. By learning how to deal with others more effectively, a person may be able to reduce conflict in daily life and gain support from family and friends.
  • Psychodynamic therapy — helps a person look within himself or herself to uncover and understand emotional conflicts that may be contributing to his or her condition.

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