A Brief History of Depression Medications


Depression has always been with us. It is an emotion – a real emotion. And like all real emotions, it has a positive side and a negative side.

The positive side of depression is that it is a message to change.

It is a call to action, to make a change in your life.

Just like a marker or a flag or an arrow pointing the way, depression is an indicator, (sometimes a loud one!) that something needs to change in your life.

Maybe it’s the direction your life is taking. Maybe it’s your motivation. Maybe it’s something else. Maybe it’s worthy of your thought.

* * *

The negative side of depression is the side we are all most familiar with.

The sadness…

The resignation…

The apathy…

The lack of enjoyment in living life…

The difficulty in doing anything…

The horrible hopelessness…

The lack of color in the world…

This is the side we know. This is the side we humans have always known. In fact, way back in the Old Testament we have the record of King Saul, who commited suicide because of his depression.

In more recent times, the most common drugs used to combat depression included alcohol, opium, morphine, heroin and cocaine. These were all prescribed by doctors.

Do you remember Sherlock Holmes and “The Sign of Four“? The story contains a vivid description of Holmes repeatedly injecting a seven percent solution of cocaine into his left arm, and many debate that it was for depression.

Until the early 1950′s opium was the way to treat depression. There was little question of it’s effectiveness, and if not for that nasty addictive quality, maybe it would still be used today. Opium gave way toamphetamines and barbiturates, which at the time were not known to be addictive also. The benzodiazepine tranquilizers, such as valium andxanax, soon followed.

The real turning point in depression medications came with the discovery that a certain drug used to treat tuberculosis, iproniazid, had a positive effect on depression symptoms. It was withdrawn from the market a few years later due to certain side effects, most notably severe liver damage.

Since it somewhat inhibited the effects of monoamine oxidase, other drugs were developed to enhance this effect. And thus was born the first class of drugs specifically designed for depression, the monoamine oxidase inhibitors, or MAOI’s.

Because MAO, an enzyme, inactivated the neurotransmitter called noradrenaline, depression was defined as a disease caused by a lack of noradrenaline. (Too much noradrenaline, conveniently enough, was said to cause mania.)

Another class of depression medications, the tricyclics,or TCA’s came on the market a year later. They were developed from antihistimine drugs. Now you could dry not only your nose, but your tears as well, all in one fell swoop. Or rather, in one little pill.

These two classes of depression medications – the MAO inhibitors and the TCA’s – perhaps contributed greatly to the biological theory of depression – “it is a genetically influenced disorder of brain chemistry.” (Best spoken with an authoritative, if not condescending, tone.)

Despite it’s origins and causes, before 1980 almost every expert agreed that 80% of all cases of depression would cure themselves. At the time, MAOI’s and TCA’s were designed to mask symptoms until the body healed itself.

Even relegated to this less important function, these early antidepressants were greeted with much excitement in the 1960′s.

That should come as no surprise, considering the alternatives were opium, speed, tranquilizers and barbiturates!

Also, many psychiatrists were convinced (as some still are) that electroconvulsive therapy was the best way to treat depression.

ECT, or electroshock therapy, rapidly lost favor after the 1975 movie “One Flew Over The Cuckoo’s Nest” The fact that it was so expensive, and often poorly administered (sometimes as punishment) didn’t help it’s popularity either.

At least ECT isn’t as bad as some of the other early treatments for depression, such as lowering blood sugar levels to induce an insulin coma and convulsions. (We now know this is not a wise treatment option.)

These exciting new antidepressants just seemed so much more, well, so much more cut-and-dry. Clean. Cheap. Safe. Just take a little pill! Who could argue with such a simple solution?

The next development in depression medications came with the class of antidepressants called selective serotonin reuptake inhibitors, or SSRI’s. The first SSRI, zimeldine, came onto the market in 1980, but was short-lived due to it’s nasty side effects.

A few years later fluoxetine, another SSRI, came on the market and truly revolutionized depression treatment. You may be more familiar with it’s brand name - prozac.

Prozac created a major stir by the early 1990′s, as the market for depression medications expanded dramatically. Now, depression was labeled a serotonin deficiency disease, as diabetes is an insulin deficiency disease.

This theory remains popular today even though it doesn’t explain why other types of antidepressants that don’t alter serotonin levels work equally as well as the SSRI’s.

In fact, all depression medications seem to have roughly the same level of effectiveness, namely about two-thirds of the patients report varying levels of improvement.

(Placebos generally help half the people who take it.)

The exuberant response to Prozac was no greater than the exuberant response to imipramine, which replaced iproniazid in 1955. Each new class of antidepressants has produced ‘amazing’ results for both professionals and lay-persons alike.

With the onslaught of SSRI’s, depression theory had now firmly shifted to a purely biological disorder. Biological psychiatry, as it came to be known, opened the door to an entirely new way of looking at depression and the medications used to treat it.

Around 1990, depression was redefined to essentially, “a condition that requires antidepressant medication.” Along with the new definition is the requirement that the patient remain on antidepressants, often for years.

Since depression is now a so-called ‘deficiency disease’ treatment has shifted from the psychiatrist’s couch to the medical doctor’s waiting room. There are now many more general practitioners prescribing depression medications as there are psychiatrists.

But is this really a good thing? While diagnosing depression may take thirty minutes or more, the average medical doctor spends five minutes or less with the patient before prescribing depression medication.

In my opinion, antidepressants are powerful drugs that should only be prescribed by someone trained in mental and emotional disorders, such as a psychiatrist or a psychotherapist. Here in Florida, psychotherapists are prohibited by law from prescribing antidepressants.

Medical doctors handing out antidepressants like cotton candy at the state fair probably do more harm than good. The only information most of them know about antidepressants is what they learn from the drug rep. (That fact should scare you!)

 




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