Beating the blues

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The blues, the doldrums, being in a funk—no matter what you call it, mild to moderate depression affects us all at some point in our lives. Feelings of worthlessness or deep sadness, apathy, irritability, sleep disturbances, and changes in appetite can all signal a bout of depression. Approximately 19 million Americans are diagnosed with depression each year, with women being twice as likely to suffer from “the blues” as men. Possible causes include stressful events such as losing a loved one, chemical imbalances in the brain, nutritional deficiencies, thyroid disorders, or even food allergies.

Instant karma

Until the 1950s, conventional treatment for mild to moderate depression was limited to psychotherapy—a remedy that could keep a patient on the couch for months, even years, before any improvement was made. But the invention of antidepressant drugs ushered in a new era of conventional therapy that worked in a matter of weeks. The first antidepressants were tricyclics, drugs that enhance the concentrations of norepinephrine and serotonin, two neurotransmitters that affect mood. Next came the monoamine oxidase (MAO) inhibitors, which boost mood by reducing the amount of MAO, an enzyme that transports neurotransmitters to the neurons in the brain. Today, the most widely prescribed antidepressants are the selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Zoloft, and Paxil. SSRIs work by preventing nerve cells from absorbing the serotonin that is already circulating, leading to a sense of well-being. SSRIs are also used to treat conditions from postpartum depression to seasonal affective disorder, and even everyday maladies such as shyness and perfectionism.

Possible side effects

While these mood-enhancing drugs can be effective, numerous studies confirm that their use can come with a price. Common to all three types of antidepressants are sexual side effects, including reduced sex drive and impotence. According to Joseph Glenmullen, M.D., author of Prozac Backlash (Simon & Schuster, 2000), sexual dysfunction affects 60 percent of Prozac users. But other troubling side effects can also surface. Tricyclics may cause drowsiness, heart irregularities, blurred vision, confusion, nightmares, and anxiety. The use of MAO inhibitors can result in insomnia, dizziness, weight gain, and an elevation in blood pressure. The highly publicized SSRIs can cause headaches, hallucinations, anxiety, nausea, insomnia, drowsiness, diarrhea, sweating, tremors, and rashes. And like all medications, antidepressants can interact with other drugs. There have also been cases where some antidepressants, including Prozac, have been linked to an increase in uncontrollable agitation, violent outbursts, and suicidal tendencies when improperly administered to persons with a manic-depressive illness. There is some debate, however, whether antidepressants can precipitate mania in someone who would otherwise not have a manic component to their illness.