Anti-depressant medications are some of the most common medications a family physician like me will prescribe. I’ve noticed that there are some very prevalent myths about these medications, often propagated by internet and word-of-mouth rumors. Before discussing these myths, I’d like to review how these medications actually work, especially since many people perpetuating these myths have little understanding of their mechanism of action.
There are different types, but the most common anti-depressants prescribed today are the selective serotonin reuptake inhibitors (SSRIs), and the selective norepinephrine reuptake inhibitors (SNRIs). Some SSRIs you may have heard of are Prozac, Zoloft, Celexa, Lexapro, and Paxil. Effexor, Cymbalta, and Pristiq are SNRIs. They are both “reuptake inhibitors,” but what does that mean?
In your brain, nerves are constantly firing and transmitting messages that control your thoughts and actions. Brain chemicals called neurotransmitters such as serotonin and norepinephrine are released into the synapse (the space between nerve cells), to fire an impulse to the next nerve cell and transmit information. These chemicals then experience “reuptake.” This means that once they have fired the next cell, the nerve cell that released them will remove them from the synapse by taking them back into the original cell (aka reuptake). This ensures that the neurotransmitter will stop firing the next cell. People with depression and anxiety typically have lower levels of serotonin and norepinephrine, so certain nerve pathways are not being fired as strongly or as often as others. The anti-depressant medications inhibit the reuptake of these chemicals so they can “hang out” in the synapse and continue to fire the nerve pathways. This allows the pathways to function more like a normal brain.
Now that I’ve explained how they work, I’m going to dispel some myths. Here is a list of the most common myths about anti-depressants:
1. Anti-depressants are addictive. The pathways described above are not related to the addictive pathways of the brain. You cannot get “hooked” on Prozac. Some people who have a strong tendency for depression will find that they don’t feel normal unless they are on a medication. This person is not “addicted” to the medication any more than a diabetic is “addicted” to insulin. They need the medication to be normal. Other people will only have temporary symptoms of depression (and a temporary decrease in critical brain chemicals), and will only need the medication for a short period of time. This latter group can come off the medication after a period of time and feel fine.
2. Anti-depressants will change your personality. This is exceedingly rare and not the intended effect. In fact, I tell my patients that if people tell them they are behaving strangely, they need to come off the medication. The goal is for the patient to be the normal, positive version of him- or herself. People should still have the normal highs and lows, but every day should not be a struggle.
3. Taking a medication for a depressed mood means that you are weak. Clearly changing thought processes can help you to handle situations better, and I always encourage counseling along with medication for treatment, but it’s often very hard to manipulate these chemical levels without medication. This is particularly true if you are genetically pre-disposed to depression. Actually it requires a tremendous amount of strength to walk into a doctor’s office and acknowledge there is a problem.
4. If you take an anti-depressant, you will not “work through” your problems. Again, I typically encourage people to pursue counseling to help them deal with problems, but this process is actually often augmented by medication. In other words, medication can help people approach their problems with a clear focus and positive attitude. Nothing will hinder creative problem-solving more than the apathetic, hopeless cloud of untreated depression. The studies are consistent: patients treated with both counseling and medication do better than either treatment alone.
Anti-depressants are not for everyone, but the decision to take (or not take) one should be based on facts, not myths or rumors. Thankfully, we have a strong armamentarium of safe and effective drugs for people who struggle with depression. . .