When the Hype Dies Down - Medications, Part I
It took nearly an entire century for the medical and psychiatric professions to come around to the obvious: namely that depression is not simply a condition of the mind. Rather, it is a disorder of the brain. Whereas the mind does not exist in space, the brain occupies all three dimensions and responds to physical intervention, not unlike the heart or liver, though certainly in a far more complicated manner.
The advent of Prozac and its sister antidepressants in the 1980s blew the lid off decades of wrong thinking once and for all. All this business about depression being all in the mind went right out the window as patients by the millions streamed in from the cold to have the mechanisms in their brains repaired rather than their heads examined.
The psychiatric profession, in turn, responded by becoming a pharmaceutical dating service or sorts, matching patient to medication. There was still a place for therapy of the talking kind, but the task was largely taken over by a different class of professional using approaches that left Freud and his couch far behind.
The first thing to know is that while the right medication can be a godsend, there is no one-drug-fits-all, and the process of finding the one that works for you can sometimes turn into a nightmarish game of hit and miss.
Antidepressants are classified by their chemical structure and how they act. Even the experts do not know exactly how these medications operate, other than they optimize neurotransmitter activity in the brain.
Which class of antidepressant came first is a question lost in time. MAO inhibitors arrived on the scene back in the nineteen fifties, but the first of these drugs were quickly taken off the market. The holdovers from this era are mainly used as a medication of last resort, after the newer varieties have failed. Nardil and Parnate are the best known. They operate by blocking out the enzyme, monomine oxidase, which gives the neurotransmitters a chance to do their work. Because of their action on other chemicals in the body, users must severely restrict their diets, at the risk of an extreme reaction. In addition, MAO inhibitors can be as subtle as the proverbial 800-pound gorilla. Possible side-effects range from nausea to weight gain or loss to insomnia to sexual dysfunction to just about everything in between.
The tricyclic antidepressants were introduced about the same time as the MAO inhibitors. Imipramine (Tofranil) can claim to be the oldest antidepressant still in service. Desipramine (Norpramin), Nortriptyline (Pamelor, Aventyl), and Amitriptyline (Elavil) also fall into this category. They work by preventing two neurotransmitters - norepinephrine and serotonin - from being absorbed by the brain's receptors, and can be a life-saver where other medications have failed. Overdoses can be fatal, and though users don't face the same diet restrictions as the MAO inhibitors, the other side-effects can be just as bad.
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