Antidepressants

During the Covid epidemic, rates of depression and anxiety soared, and many Americans turned to antidepressants to help them cope. Even before Covid, one in eight American adults was taking an antidepressant drug. Zoloft is now the 12^th most prescribed medication in the U.S. (Other examples of antidepressants include Lexapro, Effexor, Celexa, and Prozac.) Eighty percent of antidepressants are prescribed by primary care doctors who have not had extensive training in managing mental illness.

Researchers question how well they work. Some even say they’re barely better than a placebo.  Psychiatrists who prescribe them believe they do help most people who take them. They’re most effective in helping moderate, severe and chronic depression, but they don’t tend to help mild depression. In fact, they don’t work for about a third of the people who take them.

Use of antidepressants assumes the “chemical imbalance” theory of depression: low levels of neurotransmitters in the brain. The most prescribed antidepressants are selective serotonin reuptake inhibitors (S.S.R.I.s), which prevent neurons from sucking up the neurotransmitter serotonin, allowing more of the chemical to float around in the brain. Other antidepressants also increase circulating levels of other brain chemicals, such as dopamine.

Research has shown that people with depression consistently have less volume in an area of the brain called the hippocampus that’s important for regulating mood. The current prevailing theory is that chronic stress can cause the loss of connections (synapses) between cells in the hippocampus and other parts of the brain, potentially leading to depression. Antidepressants are now thought to work at least in part by helping the brain form new connections between cells.

Because I’ve been lucky at never suffering from depression, I was curious about the genetic component. When I went to 23andMe to see about that, I got a notice that said “Discover your genetic likelihood of developing this condition” which I could get by subscribing to their “Premium” package. Maddening. No wonder the company is in trouble.

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