Brief overview of antidepressant medications
Antidepressant medications have evolved significantly since their inception in the 1950s, when the first antidepressant, iproniazid, was discovered while treating tuberculosis. This marked the beginning of pharmacological approaches to treating depression, shifting away from solely psychotherapeutic methods. The initial monoamine oxidase inhibitors (MAOIs) led to the development of tricyclic antidepressants, such as imipramine, which were effective for many patients but often caused various side effects. In response, researchers developed selective serotonin reuptake inhibitors (SSRIs) in the late 20th century, with fluoxetine (Prozac) being among the first and most widely used.
Further advancements led to dual reuptake inhibitors, like serotonin-norepinephrine reuptake inhibitors (SNRIs), which target multiple neurotransmitters without significant side effects. Atypical antidepressants, such as bupropion (Wellbutrin), also emerged, offering additional options for patients. In addition to prescription medications, various natural remedies, including St. John's wort, are marketed for depression, although their effectiveness and safety remain a topic of ongoing research. Overall, the landscape of antidepressant medications reflects a growing understanding of the biological underpinnings of depression and the need for diverse treatment options.
Brief overview of antidepressant medications
- TYPE OF PSYCHOLOGY: Biological bases of behavior; psychopathology; stress
Patients with depression were routinely treated with psychotherapy until the 1950s when the first antidepressants were developed. Many medications have been developed to treat depression, with varying degrees of effectiveness and various side effects.
Introduction
In the early 1950s, was being used to treat people with major , but researchers were looking for more effective means of treatment, including pharmaceuticals. The first antidepressant, iproniazid, was discovered accidentally while it was being used to treat tuberculosis. This monoamine oxidase inhibitor (MAOI) was found to improve the mood of the patients it was used to treat, and this suggested that depression could be treated through pharmacological means. When this first antidepressant was found to cause damage to the liver, it was replaced by imipramine, the first tricyclic antidepressant. Although imipramine was effective in treating nearly two-thirds of the cases of major depression, it was accompanied by a number of side effects, including sleepiness, palpitations, dry mouth, and constipation.
Second-Generation Antidepressants
Over the next quarter-century, there were many attempts to synthesize antidepressants that were not fraught with side effects. It became apparent that both MAOIs and affected multiple and thus had numerous side effects. Therefore, researchers directed their attention to the development of a medication that would affect a single neurotransmitter only. In 1971, the first antidepressant medication to block the uptake of only one neurotransmitter was released in the form of fluoxetine (Prozac). This medication, still widely used, was the first selective serotonin reuptake inhibitor (SSRI). Since the 1980s and 1990s, the second-generation antidepressants Prozac, paroxetine (Paxil), and sertraline (Zoloft) have been the most commonly used antidepressants, although newer SSRIs, such as escitalopram (Lexapro) and citalopram (Celexa) are also used.
Additional Antidepressants
The pharmaceutical industry has improved technology to the point where drugmakers are capable of producing antidepressant medications that act on more than one neurotransmitter without causing large numbers of side effects. This category of drugs is commonly referred to as dual reuptake inhibitors. The most common of these dual reuptake inhibitors are the serotonin-norepinephrine reuptake inhibitors (SNRIs). SNRIs include venlafaxine (Effexor) and duloxetine (Cymbalta). These SNRIs increase the levels of both serotonin and norepinephrine (noradrenaline) in the brain by inhibiting the reabsorption of these neurotransmitters by brain cells. Although the mode of action by which these dual reuptake inhibitors function is uncertain, it is believed that the increased levels of serotonin and norepinephrine in the brain enhance the transmission of , thereby improving and elevating the patient's . These and other modern antidepressants fall into the category of atypical antidepressants. Medications that are considered atypical antidepressants do not easily fit in any other category of drugs while inhibiting the uptake of several neurotransmitters within the brain. Another commonly used drug in this category is bupropion (Wellbutrin). These medications are typically taken orally and in pill form.
Natural Antidepressants
There are dozens of over-the-counter remedies and supplements that are marketed as antidepressants. There is little, if any, evidence of the safety or effectiveness of many of these substances. One herbal supplement, St. John’s wort, is quite commonly used to counter depression and has been shown to be highly effective in some studies. This herbal remedy comes from a plant with yellow flowers. Derivatives of this plant were first used medicinally in Ancient Greece. Although St. John’s wort was initially used to treat pain or for sedation, it has come to be used mainly as an over-the-counter antidepressant. Studies are ongoing to determine if St. John’s wort really has antidepressant effects or if people are merely responding to their own expectations (creating a placebo effect).
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