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Spinrad /Psychology

Spinrad /Psychology. Antidepressants AKA: “happy pills”. P rozac. Few medicines in history have attracted more attention inside and outside the medical community than fluoxetine hydrochloride

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Spinrad /Psychology

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  1. Spinrad/Psychology Antidepressants AKA: “happy pills”

  2. Prozac • Few medicines in history have attracted more attention inside and outside the medical community than fluoxetine hydrochloride • Approved by FDA for both adult and geriatric (over 65) population in 1987 Approved also for children for Major Depression • Thoroughly studied: 11,000 patients • Most widely prescribed antidepressant, having been prescribed for more than 22 million people in the US, 54 million in 90 countries

  3. Not just depression • Used for clinical depression, OCD, bulimia, and panic disorder • Side effects are mild and usually go away within a few weeks of starting treatment (unlike antipsychotics), and so most people stay on Prozac

  4. Prozac Nation • Elizabeth Wurtzel wrote about a nearly transcendental experience on Prozac • “It was as if the miasma of depression had lifted off me…”

  5. How it works • New class of antidepressants: selective serotonin reuptake inhibitor (SSRI) • Increases the availability of serotonin in the synaptic cleft • Scientists believe serotonin regulates mood, though depressed patients did not generally have lower levels of serotonin, suicidal patients often did

  6. It’s complicated • Irving Kirsch’s placebo study revisited found that patients with moderate or mild depression received only mild benefits from an antidepressant • But for patients with the most severe forms of depression, the benefit of medications over placebo was substantial • The most severe dips in mood were gradually blunted: “the opposite of depression is not happiness, but vitality.”

  7. Hen house • Rene Hen suggests that antidepressants may increase serotonin, but their effect is scene only when new neurons are born • Might depression be precipitated by the death in neurons in certain parts of the brain?

  8. Helen Mayberg • Examined the subcallosal cingulate, nerve cells that sit near the hippocampus and function as a conduit between parts of the brain that control conscious thinking and emotions • It’s analogous to a traffic intersection between our cognitive and emotional selves • Stimulating this area with electrical current led to powerful changes in depressed patients’ moods

  9. Helen Mayberg (cont) • Serotonin link—the subcallosal cingulate is particularly rich in nerve cells that are sensitive to seotonin • New theory: Perhaps some forms of depression occur when genetics, environment or stress cause the death of nerve cells in the hippocampus • In the non-depressed brain the hippocampus may send signals to the subcallosal cingulate to regulate mood, allowing us to register our own moods or act on them. In the depressed brain, nerve death in the hippocampus disrupts these signals, ultimately registered as grief or anxiety (emotional pain without context)

  10. Is it behavioral? • Perhaps antidepressants (and talk therapy) alter behavioral circuits in the hippocampus (where memories and learned behaviors are stored and organized) and consequently change mood.

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