Trying to be happy in the midst of depression is the hardest thing you’ll ever do. It’s like trying to see a crack of sunlight in a cave buried 1,000 feet below the surface of the earth. Or like trying to see the color in a black and white world. Living with depression is excruciating. And yet, that’s exactly what more than 16 million adults in the U.S. had to do in 2015. Yep, that’s almost 7 percent of all American adults. Getting treatment for depression is difficult. First, you have to know you’re depressed. Then, there’s the “crazy” stigma to wrestle with, along with finding and talking to a therapist. But for many, the real struggle is wrapping their brains around taking SSRIs or other antidepressants. After all, taking a drug that affects your mind is a scary concept.

Here’s what you need to know about antidepressants and how they treat depression.

What is Going On in a Depressed Brain?

To say that depression is simply a chemical imbalance is cliché, not to mention somewhat misleading. In fact, depression is much more complicated than one chemical level being too high and another too low. The real culprits are neurotransmitters. Well, kind of…

Connections between nerve cells (neurons), nerve cell growth, and circuits, in certain areas of the brain, play a major role in depression. Neurotransmitters — much like tiny smartphones — are chemicals that send messages between the neurons. When the neurotransmitters’ signals aren’t firing correctly or aren’t very clear, the brain doesn’t function at its best and low moods result.

The hippocampus, an area close to the center of the brain, is responsible for long-term memory and also seems particularly important to depression since it is found to be 9- to 13-percent smaller in depressed women.

Genetics, stress, other medications, and medical history can also have a major impact on depression. For example, stress can slow down or stop the production of new neurons, and research suggests that the process of generating new neurons (called neurogenesis) is helpful in improving symptoms of depression.

Clearly there is room for more research. Here’s what we know:

What are Antidepressants?

There are many types of antidepressants out there. Some are more targeted or more powerful than others, and some can have ugly side-effects depending on the person.

Different types of antidepressants include Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), Tricyclic antidepressants, Monoamine Oxidase Inhibitors (MAOIs), and Selective Serotonin Reuptake Inhibitors (SSRIs).

One of the most common entry-level treatments for depression is Selective Serotonin Reuptake Inhibitors, or SSRIs. These are believed to cause less problems than other antidepressants and can be taken in higher doses than some other treatments.

So What Do SSRIs Do Anyway?

In the hot mess that is depression, one thing seems to be clear: neurons need to be able to talk to each other. Remember those tiny chemical messengers called neurotransmitters? Antidepressants treat the symptoms of depression by upping the concentration of neurotransmitters, thereby helping the neurons to communicate better.

So, when things are working well, neuron A releases the neurotransmitter (aka the messenger) to neuron B. When neuron A gets feedback that neuron B received its message, neuron A stops releasing the neurotransmitter and starts to reabsorb (or ‘reuptake’) the neurotransmitter.

Serotonin is one type of neurotransmitter that regulates sleep, appetite, mood, and pain. In a depressed brain, neuron A may be over-zealously reuptaking the neurotransmitter serotonin, which means that the message neuron A is trying to send is not being received completely by neuron B.

SSRIs help this by stopping the reuptake of serotonin, making serotonin more available to deliver neuron A’s message.

What are the Most Common SSRIs?

Navigating the world of prescription antidepressant medication is a little bit like shopping for groceries in a foreign language. You know the gist of what you need, but finding and choosing the exact right ingredients is super hard. How can you get what you need when you don’t know the right words for what you need?

A psychiatrist or even your general practitioner can help you choose the right treatment for your symptoms, medical history, and current situation. But just in case you forget what you talked about, here’s a cheat sheet of the most common names for SSRIs so you can do your own research and “shop” the Rx lane intelligently:

  • fluoxetine (name brand: Prozac).
  • paroxetine (name brand: Paxil, Pexeva)
  • sertraline (name brand: Zoloft)
  • citalopram (name brand: Celexa)
  • escitalopram (name brand: Lexapro)

How Effective are SSRIs in Treating Depression?

Okay, honestly antidepressants don’t help everyone — sometimes they can just be a bad mixer in an already bad cocktail. And side effects can be undesirable, including drowsiness, nausea, diarrhea, weight-gain, and nervousness.

But SSRI’s are effective treatment for many people with depression, especially people with moderate to severe depression. The right blend of antidepressants improves symptoms 20 percent of the time. Twenty percent may not sound like a lot, but that’s 20 people out of 100 who can now see the sunlight. Also, people who take an SSRI for the long haul are less likely to relapse 27 percent less likely, in fact. So for the chronically depressed, investing in a good treatment of SSRIs can be life-changing.

Now What?

Depression is complicated. But with the right combination of treatment, neurons can start talking to each other again and depression can get better. And now that you feel more comfortable with the medications available to treat depression, it’s important to take the next step in connecting with a therapist. A good therapist will walk with you through the fog of depression and help you make good choices for treatment.

Too busy to make the visit to a therapist’s office? Teletherapy provided by services such as ThriveTalk can connect you with competent certified therapists via video conference.

author avatar
Angel Rivera
I am a Bilingual (Spanish) Psychiatrist with a mixture of strong clinical skills including Emergency Psychiatry, Consultation Liaison, Forensic Psychiatry, Telepsychiatry and Geriatric Psychiatry training in treatment of the elderly. I have training in EMR records thus very comfortable in working with computers. I served the difficult to treat patients in challenging environments in outpatient and inpatient settings

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