Depression and the history of antidepressants
Posted on 14 May 2018
The search to find a cure for mood disorders mirrors a journey deep into the workings of the brain.
Despite a history that stretches back to the 1950s, antidepressants might be the most misunderstood and yet most prescribed medication in modern medicine.
Even today they are often prescribed as a quick fix for a variety of complex conditions and can be both over utilised and ineffective as a result, especially if the diagnosis was not properly made.
On the other hand, the SA Federation for Mental Health estimates that although a third of all South Africans will suffer some sort of mental health issue in their lives, most mental health patients will go for many years without receiving the help they need.
To appreciate the crucial and positive role these drugs can play in many people’s lives, we need to look at where they come from – and why they exist at all.
Antidepressants in the 1950s: Signs of Life
The process of developing a drug to treat depression has been a journey to understand the brain, and how it works.
In the 1950s, doctors on opposite sides of the globe made a similar discovery. Researchers in Staten Island, New York, found that the drug iproniazid caused previously depressed people to experience bouts of euphoria, while at around the same time, Swiss researchers discovered imipramine had a similar effect on their own patients.
But these drugs showed wildly inconsistent results, even in patients with similar symptoms. And even the 60 to 80% of patients who were helped by imipramine experienced a range of side effects: sluggishness, weight gain, even fatal overdoses.
Antidepressants in the 1960s: Rapid Growth
Just a decade later, these findings had fundamentally altered the way doctors thought about the inner workings of the brain – specifically, the way signals were carried from one nerve cell to the next. With new evidence suggesting that “messages” were transmitted from one neuron to another by chemical neurotransmitters, researchers with an interest in depression began to focus on serotonin, an important neurotransmitter.
Some drugs in use in the 1960s were known to change the concentration of serotonin inside the brain. This changed how signals were transmitted and had a dramatic effect on patients’ mood.
The debate over the cause and possible treatment of depression now revolved around serotonin and why some people may have lower levels than others.
Antidepressants in the 1980s
In the late 1980s, several drugs were created to correct this chemical imbalance. These were called selective serotonin reuptake inhibitors (SSRIs).
One of them, fluoxetine hydrochloride, with brand names such as Prozac, Zoloft, and Paxil, was able to cut out the side effects of previous antidepressants and quickly became popular. Research cited by The University of California: Berkeley showed that the use of these antidepressants spiked 400% in the two decades between 1988 and 2008.
It is estimated that one in six South Africans suffers from anxiety, depression or substance abuse problems. This number does not include other rarer mental health conditions such as bipolar disorder or schizophrenia.
But not all of them will receive the medication they need to manage those conditions effectively.
Today, antidepressants are among the most popular medication of all time. A report by the Centers for Disease Control and Prevention in the United States suggested that this prevalence has a lot to do with how the medication is prescribed.
A 400% spike in usage should be read as a 400% jump in prescriptions, the report suggests – especially as research shows two-thirds of people who suffer from depression do not take antidepressants at all.
Of the nearly nine million South Africans on private medical aid in 2016, over a million are on some form of antidepressant, according to one pharmaceutical survey. This does not take into account those who are not covered by medical aid – and does not reflect the true number of depressed people in the country.
Depression in South African men is particularly rife: The SA Depression and Anxiety Group warns that the number of depressed men in the country has never been higher. One reason given for this rise is their reluctance to talk about the problem until it is too late.
From an accidental discovery in the 1950s to issues of over-prescription and common misunderstandings around depression, antidepressants have seen a meteoric rise in just a few decades.
‘Depression wears different masks, making it different from person to person. Depression in the elderly and children is particularly difficult to treat,’ explains Dr Owen Wiese a GP at Intercare Tygervalley.
The diagnosis of depression is ever-evolving and more research is needed as well as a greater understanding of how mental illness is different for each individual. This will help doctors tailor their patient’s treatment plans in order to better meet their specific needs.