Antidepressant medications are not a quick fix for depression–but for some people, they give the brain a helpful nudge in the right direction. These drugs work by balancing “neurotransmitters,” chemicals that carry signals between brain cells and affect your mood, concentration, and appetite. Some people with depression notice their symptoms improve after a few weeks on the first antidepressant they try, while others may feel better after taking a few different antidepressants.
But if you’ve been trying antidepressants for a while and have found them to be more frustrating than helpful, you’re in good company. An NIH-funded study of 4,000 people with depression found that 50-66{2997f8544d703ffd995cbf0748d9148f9150b33c2eb54c93a5197645ffc3f066} are not able to fully recover by taking antidepressants.
A major reason why treating depression can be so difficult is that scientists still don’t completely understand how it works–but they are realizing it doesn’t work the same way for everyone.
The most commonly-prescribed antidepressants are selective serotonin reuptake inhibitors (SSRIs), which increase the amount of the serotonin neurotransmitter in the brain. Serotonin is believed to help maintain your mood, in addition to helping with sleep and digestion. The popular drugs citalopram (Celexa), fluoxetine (Prozac), and sertraline (Zoloft) and others are all SSRIs. Although these medications are often used as a first line of defense for people with depression, the U.S. Food and Drug Administration has reported that patients who take them may only improve about 20{2997f8544d703ffd995cbf0748d9148f9150b33c2eb54c93a5197645ffc3f066} more than patients who just take a placebo (a pill that has no effect). There is even research suggesting that some people with depression have higher levels of serotonin in their brains–so low serotonin must not always be to blame.
There are a number of other messenger cells in the brain that can trigger depression (as well as other mental illnesses). Too much norepinephrine raises blood pressure and heightens anxiety. A lack of dopamine can bring you down, while too much can toy with your sense of reality. The right amount of acetylcholine boosts your memory, but in excess it can darken your mood. However, the cause of depression in some people may go well beyond neurotransmitters. Researchers are learning that depression can have a medley of different causes, including: genes, stress, traumatic experiences, other medical problems, and a number of medications. There may actually be many different paths that lead to similar depression symptoms.
Just like in other areas of medicine, scientists are hopeful that doctors will be able to prescribe individualized treatments for depression in the not-so-distant future. We’re not quite there yet–although in 2016 researchers at King’s College in London did develop a blood test to predict which people probably will not benefit from taking antidepressants.
Until depression is better understood, many people may still need to go through some trial and error to find the best treatment for their depression (and its particular blend of causes). It can be frustrating when one or even several treatments don’t work. However, it is important to remember that depression is different for different people, so common antidepressants aren’t going to work well for everyone. Fortunately, they aren’t the only options. There are also safe and effective treatments available that don’t involve medication, including TMS and talk therapy.
Most importantly, if you are struggling to find a treatment for your depression, don’t give up. It may take time, but your doctor can guide you towards a variety of treatment options that may help you feel like yourself again.