Mythical Monday – misconceptions about antidepressants. What will the future hold?

 

Myth: Antidepressants are all the same. When you tried one, the others won’t work either.

You brain is full of neurons with tiny holes between them called synapses. Neurons communicate by sending chemical messages, called neurotransmitters across the synapses. AD seem to increase the availability of certain neurotransmitters to ease the symptoms of depression but they do this in different ways. And that is the catch! Let’s see what it’s all about.

What kind of AD do we know today?

Reuptake inhibitors prevent the excess of neurotransmitters to be absorbed back into the neuron. They can stay in the synapse longer. The cleaning process happens a bit more relaxed and they have more possibility to work.

The most well-known are SSRI’S or selective serotonin reuptake inhibitors. They prevent the reuptake of serotonin. Examples are Zoloft and Prozac or Seroquel. There are other reuptake inhibitors, SNRI’S which prevent the reuptake of serotonin and the neurotransmitter norepinephrine.  Another category of AD are the tricyclics, which do the same as SSRI’s and SNRI’s but slightly different.

Monoamine Oxidase Inhibitors; they prevent the neurotransmitters in the synaps from being broken down.

Doctors and patients today have a variety of medications disposable to figure out what is the most fitted one to use in a particular situation.

If you want to know more about neurotransmitters, I’ve written a post about it here.

What can the future hold for antidepressants?

Working with biomarkers* is being researched and could be an enormous step for treatment of depression. Now we can link a marker to the response of a patient. When your iron is low, doctors can see that in your blood. They prescribe pills or injections in response of the situation. They expect the treatment to work and to see those results back in your blood. If research can find a marker for depression, maybe for a specific kind of depression, they could prescribe more adjusted medication for your depression and the expectancy of the treatment would be measurable. We are not there yet more knowledge is needed to make that kind of progress but it is not impossible.

Regions of the brain seem to change due to psychotherapy. As a result of cognitive behavioral therapy they measured an increased activity in the prefrontal cortex and decreased activity in other regions. Patients reported decreased symptoms of depression. Those results are not validated yet, so more study needs to be done. If findings are confirmed a doctor could predict your benefits from a certain therapy in function of your brain. Less disappointments could be your share.

Remember I wrote about genes as a possible factor in the onset of depression? If you like, you can read about that here. The GUIDED or Genomics Used to Improve DEpression Decisions study (2019) split over a 1000 patients with depression into two groups. In group 1 doctors paired the treatment of AD to a genetic test that was available. In group 2 the information about genes was not given and doctors prescribed AD the old fashion way, the method I know. In the genetic testing group both patients’ response to treatment and the number of people who experienced remission of their depression symptoms were significantly higher than in group 2.

In the half of the study people were allowed to switch group. They could go from group 2 to group 1 if they wanted. They reported better rates of symptom improvement, treatment response and remission after the switch.

If you are intrigued by the study and the outcomes, you can read it all here ‘Impact of pharmacogenomics on clinical outcomes in major depressive disorder in the GUIDED-trial: A large, patient-, and raterblinded, randomized and controlled study (2019)’. 

Knowledge of  genes can help doctors to treat depression better and of course people with depression can benefit from it. A lot of research is still needed but there is also a lot to be hopeful for. I hope I’ve been able to debunk the myth which started this post – no, don’t go looking for it, forget it –and focus on the future.

When you’re suffering with mental illness, please speak to a certified health professional in the field of psychiatry or psychology. Due to the internet there is a lot of information available but sometimes people who are not qualified to do so, draw conclusions that are just not right. Being right or wrong isn’t even the case here, your health needs to come first. Take care of your mental health and place it in the hands of people you really can trust. Depression can be treated, it can get better there is just not that one miracle cure. Value yourself high enough to get the treatment that is right for you.

 

 

 

Resources.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/

[2] https://www.sciencedirect.com/science/article/pii/S0022395618310069?via%3Dihub

 

* Biomarkers=  can be measured in a lab and contains information about the illness. Think about bloodwork.