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Antidepressants

Treatment

There used to be a lot of stigma around taking antidepressants, but as mental health has shifted from a taboo topic to something more people are comfortable discussing openly, that has changed. Now, up to 19% of people in the U.S. take an antidepressant every month, and usage is on the rise. So, if you’re taking meds for depression, you are not alone. A quick rundown on the science of these medicines: Most antidepressants work by targeting specific neurotransmitters in your brain, the chemical messengers that transmit signals from one nerve cell to the next. Antidepressants affect the ones that control mood and emotion, like serotonin, norepinephrine, and dopamine. The most commonly prescribed antidepressants are called SSRIs (a lot easier to remember than selective serotonin reuptake inhibitors!). They work by increasing levels of serotonin in the brain. You’ve probably heard of common SSRIs, like Prozac (fluoxetine) and Zoloft (sertraline), but there are others—as well as SNRIs (serotonin-norepinephrine reuptake inhibitors), like Cymbalta (duloxetine), which boost serotonin and norepinephrine. There are still more antidepressants, which work in different ways or don’t fit neatly into another category. So...why are there so many different types? Good question. First, depression is a huge challenge personally and globally, as it’s the leading cause of disability worldwide. (Check out our entry on depression in Symptoms to learn more.) Second, many people try several different medications before landing on one that works for them. Finally, antidepressants can work for a while and then stop being effective, leaving some to explore other options. But prescription drugs aren’t your only choice for treating depression. Some people find St. John’s wort, an herbal supplement, helpful for mild depression (but be aware that it interferes with several common meds, including birth control!). Omega-3s in fish, nuts, and seeds, or in capsules, may be a possible depression treatment. Early studies show a link between the amino acid 5-HTP and improved serotonin levels, but again, be careful: This one can also be risky when combined with certain antidepressants. Then there’s DHEA, a synthetic hormone similar to one your body makes that may help improve symptoms of depression. If you want to experiment with a natural remedy to fight depression, talk to your practitioner so you can avoid mixing meds that don’t belong together. Don’t try to figure that out alone!

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Understanding Antidepressants

New update: Now includes two new antidepressants approved by the FDA in March 2019: esketamine, taken as a nasal spray, for persons who have not responded to previous medicines, and brexanolone, the first antidepressant specifically for postpartum depression. Overview: About 16 million Americans experience a major depression each year, and at any given time about one in ten adults is taking antidepressants. There are many different ones, in what can seem like a bewildering variety. In this book, Dr. Mendelson makes sense of the many treatments for depression, and shows that understanding how antidepressants work can help in making better decisions. The book begins with a non-technical, lavishly illustrated introduction to how antidepressants affect the brain, and a more general presentation of how drugs are absorbed and processed by the body. The second section describes the various classes of antidepressants, including how they work, how long they stay in the body, their interactions with other medicines, side effects, and things to consider when choosing a particular one. The third section provides guidance if things are not improving, such as changing or adding medicines, as well as non-medication alternatives including psychotherapy and transcranial magnetic stimulation. Finally, there is a presentation of related depressive disorders such as seasonal affective disorder, dysthymia, and premenstrual dysphoric disorder. Written with both scientific rigor and compassion, Understanding Antidepressants is a useful guide for anyone suffering from depression, as well as their families. It is written broadly enough to be a helpful introduction for students and trainees, and mental health workers with non-technical backgrounds who wish to learn more about these commonly used medications. About the author: Wallace B. Mendelson MD is a Professor of Psychiatry and Clinical Pharmacology (ret) at the University of Chicago, and a Distinguished Fellow of the American Psychiatric Association. He has authored or co-authored four books and numerous scientific papers, primarily in the fields of psychopharmacology and sleep medicine. His most recent book, The Science of Sleep (available on Amazon), shares with Understanding Antidepressants the goal of providing the scientific background of a group of disorders in a non-technical and very readable manner.

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