The main drugs used to treat depression are a range of antidepressants but they do not suit everybody and they can take 2-4 weeks before they become properly effective. Although they can have side effects, they are not tranquilizers and are not believed to be addictive. Nevertheless it is recommended that when you are ready to come off an antidepressant you do so slowly, over a matter of weeks, to ensure minimal withdrawal effects.
This group of drugs works by increasing levels of a group of chemicals in the brain called neurotransmitters. Certain neurotransmitters, such as serotonin and noradrenaline, are known to improve mood and emotion.
The most common side effects of these drugs are:
- Dry mouth
- Blurred vision
- Sexual dysfunction
These usually lessen and disappear after a few days as the body becomes used to the drug. The most common antidepressants on the market at the moment are:
Fluoxetine – also known under the trade names of Prozac, Sarafem, Ladose and Fontex, it is one of the selective serotonin reuptake inhibitors (SSRI) class of antidepressant. It can be quite slow in beginning to take effect so it is important to continuing taking the recommended dose for a couple of weeks before judging whether or not it is working. Most commonly used for depression, obsessive-compulsive disorders and panic disorders.
Citalopram (Cipramil) – is another SSRI antidepressant which is usually used to treat major depression. It should be taken at the same time every day. It is commonly used for panic disorders, depression, and anxiety disorders.
Paroxetine (Seroxat, Paxil) – an SSRI used to alleviate major depression, obsessive-compulsive disorder, panic disorder, social anxiety, posttraumatic stress disorder and vasomotor symptoms such as hot flashes associated with menopause. It is the only SSRI with possible links to birth defects, and it is known to sometimes cause weight gain.
Sertraline (Lustral, Zoloft) – this is an SSRI which was first produced in the early 1990s, however research has suggested that for some subtyped of depression it works better than fluoxetine, particularly in decreasing panic attacks.
The use of this therapy has more than halved since the turn of the century, probably because of improvements in drug treatments. ECT has always been controversial, it works by passing an electrical current through the brain to produce an epileptic fit. This is believed to change the blood flow within the brain and stimulate the production of certain beneficial chemicals which lead the patient to feel better following the fit. However, this is a radical treatment which is only used in cases of severe depression that is life-threatening.
Transcranial Magnetic Stimulation
This is a far softer option to the one above. It is a non-invasive method which uses an electromagnetic coil to induce week electric currents using a rapidly changing magnetic field. The UK’s National Institute for Health and Care Excellence (NICE) gives this warning, “current evidence suggests that there are no major safety concerns associated with transcranial magnetic stimulation (TMS) for severe depression. There is uncertainty about the procedure's clinical efficacy, which may depend on higher intensity, greater frequency, bilateral application and/or longer treatment durations than have appeared in the evidence to date. TMS should therefore be performed only in research studies designed to investigate these factors.”
This drug is the psychiatric world’s hot potato of the moment. Generally known as a horse tranquilizer and a recreational drug that has recently had its status in the UK increased from a Class C drug to a Class B category, researchers are having increasingly impressive results when using the banned substance in trials on depressed patients.
It has been found to be particularly useful in patients with strong suicidal feelings. These depressive troughs occur regularly for some bipolar sufferers and doctors have not previously had a drug that worked quickly at reversing these moods. A 2012 double-blind, randomized, crossover, placebo-controlled study of the use of ketamine to treat bipolar depression found that a single intravenous infusion of either ketamine hydrochloride (.5 mg/kg) made depressive symptoms and suicidal idealisation considerably improved within 40 minutes. A further 2014 study replicated these results and concluded that “intravenous ketamine produces rapid reductions in suicidal cognition over and above active placebo. Further study is warranted to test ketamine's antisuicidal effects.”
This is an experimental surgery for deep brain stimulation which involves putting metal electrodes deep inside the brain. Due to being invasive and experimental, this is currently only used in the most extreme of cases. Pioneered at the Emory University in Atlanta, it claims to work by short-circuiting the area of the brain responsible for depression and is said to work like rebooting a computer. Studies to date have had generally favourable results to this treatment but considerably more research and development is needed before it becomes a common viable option for depressed patients.