Antidepressants work by creating chemicals in the brain, explains Dr. Lipkowitz. The functions of the brain (such as thoughts and emotions) are controlled by chemicals, each of which has a specific function.
One of the most important of these chemicals is called serotonin. It was discovered that all drugs that relieved depression increased the amount of serotonin in the brain, and this led to the theory that people who suffered from depression did not have enough serotonin.
The next step was to discover medications that increased the amount of serotonin in the brain and these were the SSRIs, or Selective Serotonin Reuptake Inhibitors.
The SSRIs are particularly helpful in heading off depression in the early stages, before it becomes deeply rooted. Recent studies suggest that SSRIs are ideal for those people with minor depressive illness but they can be used for major depression too.
"The SSRIs are not more effective than some of the older drugs used for depression, but they have fewer serious side effects," says Dr. Lipkowitz. "There is no question that antidepressants can be very effective. However, they are most effective if used together with regular psychotherapy."
Before the discovery of antidepressants, there weren't many options to treat the problem. Major cases were treated through electro-convulsive treatment or electric shocks - sometimes still practiced today after medication fails.
Depression is a very human condition that comes in many forms. At one time or another, most people have experienced some of its symptoms, such as chronic unhappiness, anxiety, inability to concentrate or lack of energy. But if they occur frequently or last for a long time, a health professional should be consulted.
The doctor may prescribe SSRIs. There are many on the market. The most well known is Prozac. But there are others such as Paxil, Zoloft, Celexa and Luvox. The newest one, Lexapro, a modification of Celexa, was just introduced. It can be given in lower dosages and is presumed to have fewer side effects. If this is true, it is important since side effects are the main reason that only about 40 percent of those who seek treatment for depression complete the recommended therapy.
Some of the ide effects from taking SSRIs may include sexual dysfunction, nausea, insomnia and drowsiness.
"Some people may find that they have some of these side effects when they take Prozac, for example, but not when they take Paxil," said Dr. Lipkowitz. "A patient needs to be diligent and tell his doctor if he is feeling any of these things. The doctor may decide to change the dose or try a new medication."
Some people can take these medications for one course of treatment. Some require a second if the depression recurs. The usual course of treatment lasts about six months after recovery from the depression. In some people, the depression will return if the drugs are stopped. They may have to think of these medications the way most people think of vitamins: Take them every day, and let them help you so you can enjoy your life.
Depression doesn't just strike adults. It can be a serious concern in children and adolescents. The suicide rate for children younger than 12 doubled in the past decade and the rate for teen-agers rose to equal that of adults.
SSRIs are equally effective and show the same side effects in children as in adults. They are safe, according to Dr. Lipkowitz. However, the fear among many child psychiatrists is that the drugs will be misused as quick fixes for symptoms of other conditions, such as disinterest in school or social activities, learning disabilities or emotional problems.
"The drugs are not for shortcuts. It is tempting to use them as shortcuts, because they tend to bring faster results than therapy or counseling," said Dr. Lipkowitz. "No depressed child should be treated by drugs alone."
Some patients who discontinue using SSRIs report some unusual and alarming side effects. There's been growing criticism lately by patients who complain they've been having side effects such as anxiety and feeling like they are being shocked with electricity when they stop taking Paxil. In response, the FDA has posted a labeling change regarding discontinuation of the drug. Similar events have been reported for other selective SSRIs but none of these drugs should be suddenly stopped. They should always be discontinued very gradually.