All About Antidepressants

"When I was depressed, I was always overwhelmed. It took me so long to do any normal job, just brushing my teeth took forever. I felt doomed all the time. After I took Effexor, I felt as if this terrible weight, this slowing down, had been lifted."

—Barbara, 49

There's no best way to treat all types of people and depression. In fact, more and more psychiatrists are coming to the conclusion that major recurrent depression is a chronic disease that may require lifetime medication. And while studies suggest that a combination of psychotherapy and antidepressants is the most effective treatment for depression, for some chronically depressed people talk therapy just doesn't help—and it can foster deep feelings of resentment.

"I spent years in group therapy," says Jan, a 39-year-old Boston nurse. "I spent decades talking to experts. I came to realize that I'd put all the honesty a person could muster into my therapy, and I still wasn't any better. Something always felt physically wrong. I always felt I had a biochemical twist in me that had to be responsible. If I could only tell the hours, years, the money I poured into getting well!"

Finally, a psychiatrist at McLean Hospital in Belmont, Massachusetts, diagnosed Jan as depressed and recommended antidepressants. "Everyone needs a friend," Jan says, "but I think that's where psychotherapy ends—at least for severe depression."

Today there are more than 20 antidepressants on the market, many with fewer side effects than those prescribed a decade ago. Some experts are worried that people will see antidepressants as a quick fix for profoundly complex problems without trying to correct these underlying problems through psychotherapy. Others insist that the drugs simply restore a person's emotional equilibrium, allowing problems to be ironed out without the burden of crushing sadness.

In fact, studies show that combining antidepressants with therapy provides the best chance of treating depression.

Iproniazid: The First Antidepressant

The first of the modern antidepressants—iproniazid—was developed in the early 1950s not to treat depression but to ease the symptoms of tuberculosis. At the time, iproniazid was unmatched as a weapon in the ongoing fight against this deadly respiratory illness, decreasing the number of tubercule bacilli and suppressing their proliferation. But while it was designed to treat tuberculosis, as a side benefit iproniazid also seemed to be a sort of "happy drug," pepping up patients, improving their appetites, and restoring their feelings of well-being.

The drug's positive emotional effects immediately attracted the attention of physicians and depression researchers. The only chemical treatment for depression at that time was opium, a highly addictive substance. The possibility of a more effective—and nonaddictive—drug that could alleviate mood disorders was an attractive thought. Up to that time, some drugs could alleviate one or two symptoms of depression, but none could completely eradicate the condition.