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How Do Antidepressants Work?


Antidepressant drugs, particularly of the SSRI type are used for much more than depression these days.  From uses as disparate as treating migraines and stopping smoking, to pre-menstrual pains, and and weight loss, the list goes on and on.  It seems that just about anything that affects the mind, the first course of treatment that many doctors recommend is to try an SSRI.  Regardless of whether you agree or disagree with the use or over-use of antidepressants, many would like to know; just how do SSRI antidepressants work?  In this article I give a brief overview of the theory underlying SSRI antidepressants and what the process they actually undertake in the brain.

SSRI stands for Selective Serotonin Reuptake Inhibitor.  Researchers have long suspected that the neurotransmitter Serotonin along with other neurotransmitters such as Dopamine and Norepinephrine were heavily involved in a person’s mood and emotions.  The theory underlying SSRI use is that if Serotonin can be increased inside the brain, then a person would feel ‘good’ or at least normal whereas a person that had low serotonin levels feels sad or anxious. 

While there is much debate about how accurate this simplistic theory is, most agree that Serotonin at least plays some part in the emotional well-being of a person.  What is in dispute is what the proper way of boosting serotonin or if it is even right to do so.  Additionally, it is not know what other complex emotions serotonin might play a part in and therefore there are wide reports of other reactions being caused by increasing serotonin.

Serotonin for instance is released naturally in the brain when one does exercise or when one accomplishes a task.  That ‘feeling’ of a job well done is a release of neurotransmitters in the brain, including serotonin.  Additionally, there are many reported incidents of serotonin increases triggering unwanted reactions such as rages or even suicidal feelings.  So just what is an SSRI doing inside the brain to cause all these different reactions? 

The brain is made up of neurons.  Messages travel along these neurons until they must jump a gap to the next one called a synapse.  At this synapse, the brain releases a neurotransmitter, such as serotonin which acts as a bridge to the next neuron but then must go through a process of reuptake where it can be used again.  The theory is that people that have low serotonin levels are not able to freely have these messages travel and therefore suffer from a host of maladies.  SSRI drugs slow down this process of reuptake so that serotonin builds up and the messages between neurons can continue smoothly. 

It is estimated that SSRI drugs can affect as much as 80% of the synapses in a person’s brain so theoretically it can have a tremendous effect on a person who’s serotonin levels aren’t optimal.  The problem is that nobody really knows what else affecting these synapses does.  What other emotions and neurotransmitters are being affected by this process?  Is it right to be manipulating serotonin in the first place?  After all, aren’t sadness and anxiety normal emotions that people need as their warning signs in life that things aren’t right?  

Many people feel ‘dull’ and ‘emotionless’ when on SSRI drugs more than a few weeks and months leading some experts to believe the process of affecting the synapses causes the brain to sense it is backed up with serotonin and causing it to make even less serotonin.  In other people something called ‘serotonin syndrome’ can occur which is when too much serotonin is kept in the brain. Finally, those on antidepressants for long periods of time can suffer horrible withdrawal effects due to the brain becoming dependent on the SSRI drug.  The withdrawal can often be much worse than any initial symptoms the patient experienced before even going on the drug.

Common sense would make one wonder if this is a good thing.  Wouldn’t it make more sense to do what is needed to have the brain make more serotonin naturally through things such as exercise and fixing one’s life rather than to manipulate the system by which it works?   Is this not akin to depriving a vehicle of fuel and putting a smaller engine in it rather than providing the engine that is designed for that car to have the fuel that it needs?  Are we ‘downgrading’ our brain’s potential rather than maximizing it by manipulating the serotonin system this way?  The list of questions is endless and there are no easy answers.

One can see then how taking SSRI drugs is actually a very dicey proposition and that it might actually be detrimental to many people who really have no idea how they really work.  Rather than increase serotonin in the brain, SSRI drugs are actually manipulating how it is used with often detrimental and unpredictable effects.  For more great insight and articles on antidepressants and depression please visit www.SedatedNation.com.


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