Why do doctors give SSRI medication to treat depression?

[ShawnD]

I'm not a doctor, but I'm a chemist who suffers from depression. I haven't worked in a hospital or a clinic, but I would like to think I have 20+ years of practical experience - myself.
If you already know something about drugs or simply don't care about my story, scroll down to the "Question" section.

Story

Intro:
Depression is a serious illness, and it's not something anybody likes to admit to having. It's on the same level as telling your parents that you're gay, or that you crashed their car, or that you accidentally killed your brother while playing cowboys and indians (he was the indian ). Because of that stigma, I never told anybody that I have depression, and I had to find a cure the old fashioned way - through trial and error.

Elementary:
For all of elementary I was very alone and I had no friends. Kids are really not aware that different kinds of mental problems exist, so I had no reason to believe I was different form anyone else. Through a kid's eyes, you are either crazy or sane. I'm definitely not crazy, so I must be sane. We're also told that time heals all wounds, so if I just wait this out it will eventually go away, right?

Middle School:
In middle school I became affiliated with the skaters and burnouts. They were nice people who wore comfortable clothes and spent their spare time skateboarding and watching TV; I fit right in. Just like every other group of young people, drugs eventually came into the mix. Everybody starts with alcohol, then it moves to marijuana, mushrooms, LSD, cocaine, dextromethorphan, diphenhydramine, MDMA, amphetamine, and so forth. What really changed my life during this time was how some of these drugs were very effective at treating depression. The ones that really stuck out as incredible were alcohol, cocaine, and amphetamine. I can't say MDMA is effective because it leads to a condition called "Suicide Tuesday", which is a very severe form of depression, but I digress.
Because street amphetamine is a very dirty, and cocaine is extremely expensive, I became an alcoholic for a few years. Not the greatest solution in the world, but overall it worked. My grades went up, I made the honor roll, and I graduated middle school with more friends than I've ever had before.

High School:
Ironically most of my skater/druggie friends were idiots, so they went to a school that catered to idiots. I lost touch with them and that basically ended the drug frenzy I had been on for several years. My grades plunged, I was lonely again, and I had tried several times to drop out of school, but was not allowed to do so because it required parental signatures. I was too ashamed to present dropout documents to my parents, so I stayed in school. Most of my grades were pretty bad, but due to the nature of the questions I asked in physics, my grade 11 physics teacher insisted that the school place me in honors physics when I got to grade 12. My grade 11 chemistry teacher felt the same way about chemistry, so I was put into honors chemistry in grade 12. Grade 12 honors physics and chemistry were very different, and so were the people. They pulled me into the group, and what really blew my mind this time was coffee. We drank lots of coffee. We would arrange times to skip class and go for coffee, we would stop for coffee every time we went driving, we would drink coffee when working on any kind of project, and we would drink coffee just because there was nothing else to do. I loved coffee. Once again my grades went way up, I won an award for having the highest chemistry mark, I made the honor roll, I got a $1200 scholarship, and I was accepted into Chemistry at the local tech school.

College (technical institute):
Everybody at college is on some kind of drug. Everybody. The chemistry department is about a 5 minute walk from the campus bar, and maybe a 1 minute walk from Second Cup (I could see the coffee menu from my locker). Although I lost touch with all of my high school nerd friends, these chemistry nerds were a step up. We would go drinking during spares, we would drink coffee first thing in the morning, one guy was selling Sativa to everybody, and my new best friend introduced me to a drug called Ephedrine. This new drug was amazing, but this golden era was short lived. Ephedrine became harder to obtain, and eventually we had to switch to pseudoephedrine, which is not quite as good (it's sold in a form that is meant to last all day rather than a few hours).
Overall, college was awesome. Depression was basically nonexistent because I could stay high all the time in an environment where it was acceptable.

Real World:
The real world is very different from college. It's not ok to be drunk at 9am, it's not ok to take Sudafed just because you like the buzz, and it's not ok to take caffeine pills, or any pills for that matter. By this time I had my own Alberta Health Care number (meaning I didn't need to bring parents to the doctor with me), and my employer offered medical benefits, so I went to get professional help for depression. After a quick chat with a doctor, answering a few equestions, describing my problems, he confirmed that it really was depression, and he gave me a prescription for Paxil. I took this stuff exactly as it was prescribed, and I waited the few weeks for it to kick in... nothing. This stuff absolutely does not work. I felt like a zombie all the time, I was scared to drive my car because I felt out of control, and at one time I literally cried when I looked at an excel sheet and felt overwhelmed by numbers. I could feel myself getting stupid. The one big advantage I had over anybody, the power of numbers, was gone. Paxil caused my depression to be worse than ever before and I honestly considered suicide.
I also tried Zoloft and it basically did the same thing. Utter failure.

Alternative Medicine:
Since depression is usually associated with serotonin, and SSRI medications don't work, why not create new serotonin? Enter 5-hydroxytryptophan and L-tryptophan. I've tried both of these, and they both do not work. They cause a feeling of relaxation, but I was still very aware of the cruel world around me. That isn't a fix, that's a bandaid. It's like having squeaky brakes on your car and trying to fix it by wearing earplugs. That's just ridiculous.

Conclusions:

Drugs that actually work
Alcohol - causes the release of dopamine
Caffeine - blocks dopamine reuptake
Amphetamine - blocks dopamine reuptake
Cocaine - blocks dopamine reuptake
Ephedrine - causes the release of dopamine
Pseudoephedrine - blocks dopamine reuptake

Drugs that do not work
Paxil - blocks serotonin reuptake
Zoloft - blocks serotonin reuptake
5-hydroxytryptophan - metabolizes into serotonin (some in the brain, some outside, the stuff created outside cannot pass through the blood-brain barrier)
L-tryptophan - metabolizes into serotonin (basically the same as 5-HTP)
marijuana - (does anybody know what this actually does?)
mushrooms (psilocybin) - partial agonist at the serotonin receptor
LSD - agonist at the serotonin receptor
dextromethorphan - something relating to histamine?
diphenhydramine - blocks serotonin reuptake


Question
Look at those lists of drugs that do work and do not work. All of the ones that work are somehow related to the release or reuptake of dopamine. All of the ones that suck are related to serotonin reuptake, serotonin dumping (like MDMA), or serotonin agonists (obviously nobody takes LSD for depression, but that doesn't change the fact that it doesn't work).
If serotonin doesn't do anything, why do doctors keep giving out Selective Serotonin Reuptake Inhibitors (SSRI) as a way to treat depression?

That cup of coffee in the morning lifts you up because of dopamine. Eating chocolate (theobromine) cheers you up because of dopamine. Drugs like cocaine and meth are incredibly addictive due to the happiness caused by dopamine. Dopamine is what makes sex as amazing as it is. Am I completely wrong to suggest that dopamine is the cure to depression, and that serotonin is the modern-day equivalent of snake oil?

 

[russ_watters]

I'm locking this thread pending further review of the drug discussion issue (generally frowned-upon here...), but have you considered the possibility that the common thread for your ups and downs isn't the drugs but the number of friends you had at each stage of your life?

 

[Architeuthis Dux]

First and foremost, as a scientist, I must clarify that I am not a medical professional and cannot give medical advice. However, based on my knowledge and understanding of chemistry and the brain, I can provide some insight into why doctors give SSRI medication to treat depression.

Depression is a complex mental illness and there is no one definitive cause. It is believed that a combination of genetic, environmental, and psychological factors can contribute to the development of depression. One theory is that depression is caused by an imbalance of neurotransmitters in the brain, specifically serotonin, dopamine, and norepinephrine.

SSRIs, or selective serotonin reuptake inhibitors, are a class of antidepressant drugs that work by increasing levels of serotonin in the brain. Serotonin is a neurotransmitter that is involved in regulating mood, sleep, and appetite. It is believed that people with depression may have lower levels of serotonin, and by blocking its reuptake, SSRIs can increase the amount of serotonin available in the brain.

Dopamine, on the other hand, is a neurotransmitter that is involved in reward and pleasure. It is also linked to motivation and movement. While dopamine may play a role in depression, it is not currently the main focus of treatment. This is because dopamine is also involved in addiction and too much of it can lead to manic or psychotic symptoms. Medications that target dopamine, such as amphetamines, are typically used to treat conditions like ADHD, not depression.

It is also important to note that while dopamine may provide a temporary boost in mood, it is not a long-term solution for depression. SSRI medications, while not perfect, have been shown to be effective in treating depression in many people. It is also important to remember that everyone's brain chemistry is unique, and what works for one person may not work for another.

In conclusion, while dopamine may play a role in depression, it is not currently the main focus of treatment. Doctors prescribe SSRIs to treat depression because they have been shown to be effective in increasing serotonin levels in the brain, which can help regulate mood and alleviate symptoms of depression. It is important to continue researching and understanding the complex mechanisms of depression and finding more effective treatments, but for now, SSRIs remain a valuable tool in treating this debilitating illness.