Medication Still the Norm In Treating Depression

Selective serotonin reuptake inhibitors (SSRIs) have been helping patients for three decades. Today, they are the most frequently prescribed treatment for depression and anxiety disorders.

History and Research

Doctors first started treating depression with SSRIs 30 years ago. At the time, it was a surprising approach to the treatment of mental health conditions, and its mechanisms were little understood. Over the years, studies have helped researchers learn more about the science behind depression and this class of drugs.

Thanks to Positron Emission Tomography (PET), scientists now know that the serotonin neurotransmitter system plays a key role in mood disorders. When this system is disrupted, the result is anxiety and depression.

Some studies have shown that people with depression have lower levels of serotonin transporter in certain areas of their brains. This protein, found in cell membranes, affects how serotonin, a neurotransmitter responsible for feelings of well-being, returns to the cells. Without proper levels of serotonin transporter, neural networks do not function normally.

SSRIs function by influencing this system. They inhibit how quickly serotonin returns to its neuron of origin. Because this reuptake does not happen as rapidly as it would without the medication, levels of serotonin are able to build up, allowing the brain to function more normally, despite overall lower levels of these important chemicals.

SSRIs Today

Thirty years after their introduction to the scene, SSRIs are now prescribed more frequently than any other medication for depression. In fact, 80 percent of people who seek treatment for depression are prescribed SSRIs. They are effective in about 70 percent of patients.

Several different medications, including sertraline, fluoxetine and citalopram, fall into the category of SSRIs. Although each shares similar characteristics and effects, each works in a somewhat different manner.

Because of this, some SSRIs are a better fit for one patient than they are for another. While the first medication prescribed to a patient might not be effective, the next one might do the trick. Finding the best one for a particular person is often a matter of trial and error, and doctors work with patients to adjust dose levels or pinpoint the best medication.

In some cases, however, tests can provide helpful insight before treatment begins. Some blood tests can show which SSRIs might be the best match for a patient’s genetic makeup. And although it’s not mainstream practice yet, doctors may someday use brain scans to determine the best course of action for a patient with depression. Research has shown that PET, the same sort of scans used to study the serotonin neurotransmitter system, can give clues about whether a patient would respond better to psychotherapy or antidepressants.

Perhaps, given another 30 years of SSRI history, we’ll find that pre-treatment brain scans have become common practice.