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Old Approaches To Depression Are Coming Back

Posting Date: 09/20/2004

Depression can be a devastating, even life-threatening, disorder. Sadness, loss of appetite, trouble sleeping, low energy and reluctance to socialize are just some of the symptoms of major depression.

Fifty years ago talking therapy was a mainstay of treatment. People confided in family, friends, pastors or health professionals like psychologists, psychiatrists and their family physician. Then along came antidepressant medicines like Elavil (amitriptyline) and Norpramin (desipramine).

Such drugs did not work for everyone, but they often enhanced the response to psychotherapy. Side effects such as dry mouth, constipation, weight gain and sexual difficulties were obstacles to treatment, but many desperate patients were willing to put up with these complications.

Then along came Prozac. In 1987 when it was introduced, this antidepressant barely made a splash. Neither physicians nor patients realized that the new class of medicines called SSRIs (selective serotonin reuptake inhibitors) would go on to change the way depression is treated. By 1990, though, Prozac had taken over the market.

Its unexpected success was due, at least in part, to the perception that it had fewer side effects than traditional antidepressants. Prozac rarely causes dry mouth, dizziness, constipation or sedation. Some patients find it energizing, a welcome effect to counteract the lethargy of depression.

It wasn?t long before other companies brought out competing drugs. Now physicians can choose between Celexa, Effexor, Lexapro, Luvox, Paxil, Serzone, Wellbutrin and Zoloft.

Such meds are being prescribed enthusiastically for a range of mental health problems, such as pre-menstrual distress, shyness or anxiety, in addition to depression.

Almost from the beginning, however, these drugs have been controversial. In the original clinical trial for Prozac, 15 percent of patients in the study dropped out because they felt worse instead of better. Anxiety, insomnia, restlessness, nausea and tremors cause some people distress. SSRIs can also cause sexual dysfunction and a variety of other complications.