Depression can be caused by many factors which could impact on the type of treatment prescribed. Watch this video to find out about the differences.
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Do drugs that treat both mechanisms, the dual reuptake inhibitors, work better than those that affect only one mechanism? Herndon P. Harding: First of all, when you consider that one out of five persons will experience depression over the course of their life that would necessitate medical treatment, you are talking about a lot of people. When you consider that 1 out of 10 people at any point in time are on an SSRI-type medication, you are talking about lots and lots of people, and you are talking about lots and lots of variations on depression. So when you say depression, it's not like we are talking about just one thing. You may have a depression that is mediated by there being too little of a chemical, or it could even be too much of one, so that it's basically balancing out and getting in the way of the other chemicals doing their job. So that there are a variety of explanations as to why there may be depression, which is why you have different kinds of medications and treatment modalities, because they are not all going to work on any given depression, because not all depression is the same. You have to find out what flavor it is. David Hellerstein: With the antidepressants that became popular in the last 10-15 years: Prozac, Zoloft, Paxil, Effexor, which affects serotonin; those are very effective for treatment of depression, but what can happen for some people is that they may lose the benefit that they had with a serotonin drug alone. And it's kind of like the brain can adjust or accommodate to the blockage of the serotonin system and the depression can come back. So what has been discovered is that drugs that affect serotonin and norepinephrine can be more effective to prevent depression. Herndon P. Harding Jr.: Classically, the SSRI is the serotonin reuptake inhibitor that only affected serotonin. Now, they were never really that clean, some more clean than others. And sometimes the more dirty ones worked better, because they actually did affect other systems. So there are places for the ones that are super clean and just do serotonin, if that's the neurotransmitter that seems to be the one that's modulating this depression, but if that isn't the case, if there are multi-systems involved, you may do far better if you have a dual acting-type medication. David Hellerstein: They have the advantage over older drugs, because they are less toxic. They are less likely to cause serious health consequences, if someone took an overdose, for instance. The tricyclics which were around 30-40 years ago, if someone took a week's supply of the medicine, it could lead to a fatal heart attack. And the newer class of drugs, which includes the serotonin and norepinephrine drugs are very safe compared to that. They are also easier to tolerate. They have less side effects, like weight gain, sedation, and so on. So people can tolerate them better. They have the other advantage that they are kind of designed to work very specifically in the brain on transmitters, norepinephrine and serotonin, so they don't have as much spillover affecting other transmitter systems. So they are thought of as being cleaner and just affecting the transmitters that we want to help.