What Can Be Done About Depression

The first part of this article comprised definitions and a little epidemiology, pretty much factual and inarguable. It was easy to write. This part is hard. The facts are not as solid or well defined. Some of the conclusions are simplified versions of complex issues. First, a little more about the nature of depression, presented in glorious oversimplification. This section is in the treatment portion because the treatment modalities have cast light on the nature of the underlying disorder.

There have been several classes of drugs that have shown clear efficacy in treating the symptoms that define depression. All of these drugs have something in common. They all affect the action of one or more of a few neurotransmitters in the brain, specifically, norepinephrine, serotonin, and dopamine. Although these transmitters are closely related to each other and, in fact, convert from one to another, they stimulate somewhat different receptor sites in the brain. It appears that increasing the responses of the receptors to these transmitters has effects on many of the symptoms of depression. Different transmitters affect different symptoms, to a greater or lesser degree. All of the chemicals (drugs) that affect the symptoms of depression, appear to increase the available amount of one or more of these chemicals in the brain. In fact, various drugs that are also known to affect these transmitters have somewhat predictable effects on the symptoms, too. Some drugs, used for hypertension, block these receptors and are liable to cause depression in the patient. Similarly, stimulants, used for treatment of attention deficit or hyperactivity (among other things) cause an amelioration of depressive symptoms. They are known to increase the activities of these neurotransmitter receptor cells. They are rarely used as antidepressants, though, for a number of reasons, including the fact that their effect on depression tends to be short lived.