Antidepressants: Who Needs Them?

July 18, 2007 — -- A woman who had been depressed for 20 years with frequent thoughts of suicide started Prozac, and, 10 days later, said "it felt like a switch was flipped. I felt normal for the first time."

Another woman had sunk into depression after the birth of a child, and had begun to think she was a bad mother, as she could not enjoy her baby. She started the antidepressant Remeron, and within two weeks was feeling cheerful and spirited again.

Antidepressants are truly miracle drugs for some patients.

Last week, a number of major media outlets highlighted a 2004 report from the Centers for Disease Control (CDC). The report showed that antidepressants were the most prescribed medication class, surpassing nonsteroidal anti-inflammatory drugs and anti-asthmatics.

Should this surprise us? Are antidepressants being overused?

Fifty years ago, there were no antidepressant medications. In 1957, Roland Kuhn in Switzerland reported that the chemical N-(gamma-dimethlaminopropyl)-iminodibenzylhydrochloride, which came to be called imipramine, had a striking effect on patients with depression.

"They again become interested in things, are able to enjoy themselves, despondency gives way to a desire to undertake something, despair gives place to renewed hope in the future," he wrote.

In the same year, iproniazid, a tuberculosis (TB) drug was reported to lift the moods of some TB patients who were depressed. These two medications were the first of the tricyclic and monoamine oxidase inhibitor (MAOI) antidepressants, which were widely prescribed for the next 30 years.

But these medications have important side effects that made physicians cautious about their use. The MAOI antidepressants can cause dangerous, even lethal, changes in blood pressure in patients who consume foods such as aged cheeses, drinks such as red wine, or medications such as other antidepressants that interact with the MAOIs.

Similarly, the tricyclic antidepressants can be lethal if used in excessive amounts as happens when patients intentionally take an overdose, which depressed patients sometimes do.