Antidepressants for depression

How effective are antidepressants?

Whether treatment with antidepressants is a viable option depends largely on the severity of the depressive episode [7]. In controlled trials, no significant effects of antidepressants could be found for forms of mild depression. However, for moderate to severe depression, treatment with antidepressants have been shown to be slightly to moderately superior to treatment with a placebo [14].

Nowadays, there are many different antidepressant medications. While studies have not found large discrepancies in their efficacy, potential side effects and interactions with other medications can vary greatly [1]. Which substance is ultimately “the best” (i.e. achieves the greatest effect with the fewest side effects) should be examined together with the attending physician. In some cases, several different medications may need to be tested.

How do antidepressants work in the brain?

The brain consists of billions of nerve cells. In order for information to be processed and passed on in the brain, it needs certain messenger substances that communicate between the nerve cells. These so-called neurotransmitters are released from one neuron into the synaptic cleft (junctions between the nerve cells) and bind themselves to special receptors (docking sites) of the other neuron, thus transmitting information from one nerve cell to the next, via biochemical signal transmission [11, 15, 16].

Nowadays, it is assumed that the neurotransmitters serotonin, dopamine and norepinephrine play an important role in the development and maintenance of depression. Research suggests that the typical symptoms of depression are often associated with a disbalance of these neurotransmitters, namely that individuals suffering from depression show a lower activity of these neurotransmitters, compared to healthy individuals. Antidepressants influence the way neurotransmitters work and help the brain to restore the balance and thereby alleviate the symptoms of depression (e.g. a lighter mood and higher motivational drive). However, not all antidepressants are similarly effective for all patients or work in the same way in all individuals [17].

One distinguishes between first and second generation antidepressants, which differ primarily in terms of their side effects and possible interactions with other medications. Some antidepressants specifically target the release of only one neurotransmitter group, such as serotonin (SSRI) or norepinephrine (SNRI), while others are less specific and target multiple neurotransmitter systems simultaneously (e.g. TCA, MAOI). Due to more severe side effects and a higher risk of toxicity, first generation antidepressants are rarely prescribed nowadays [18].

Published on 06.04.2022

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