Sunday, December 4, 2022

Antidepressants

 I was surprised to learn that, before Covid, 1 in 8 Americans was taking an antidepressant drug. That number rose by 18.6 percent in 2020. Zoloft, an antidepressant drug, is now the 12th most commonly-prescribed drug in the U.S.

Most psychiatrists believe that the drugs do help most people who take them. But there’s some controversy about why and how they work. The most commonly prescribed antidepressants are selective serotonin reuptake inhibitors (S.S.R.I.s), such as Zoloft, Prozac, and Celexa. These drugs prevent neurons from sucking up the neurotransmitter serotonin, allowing more of the chemical to float around in the brain. Other antidepressants cause an increase in other brain chemicals, such as norepinephrine and dopamine. This is the “chemical imbalance” theory of treatment.

Studies show that depressed people don’t have less serotonin than people who are not depressed. Researchers are now looking at other causes. For example, studies have shown that depressed people have less volume in their brains’ hippocampus, an area that’s important for regulating mood. Studies have also shown that chronic stress can cause the loss of connections (synapses) between cells in the hippocampus and other parts of the brain. This type of research indicates that antidepressants work in part by helping the brain form new connections between cells

For people with treatment-resistant depression, ketamine and psychedelic therapy has shown promise in helping the brain create new connections more efficiently. Ketamine, like psychedelics, induces a “dissociative experience” (a trip). Studies have shown that within 24 hours of the first dose, the lost connections start to regrow.   Apparently these interventions improve depression scores in roughly 60 percent of the people who try them. However, they’re seen as riskier and more invasive than antidepressants.

I've never suffered from depression, a situation I attribute to dumb luck.

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