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Treating Depression » Antidepressant Medication

What you'll learn this session

Study time: 30 minutes

AQA spec: 3.2.4.5

How antidepressant medications such as SSRIs work in simple terms
How long they take, their side effects and why relapse can happen
How drugs improve mental health, and why they are a reductionist treatment
What reductionist and holistic mean

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Treating depression with drugs

When someone has unipolar depression, a doctor can offer different kinds of help. One of the most common is medication. The drugs used for depression are called antidepressants. A doctor (usually a GP or a psychiatrist) decides whether they are right for a person and checks how they are getting on.

The most widely used type is the SSRI. Examples include fluoxetine (better known as Prozac) and sertraline.

Key terms:

SSRI: short for selective serotonin reuptake inhibitor, the most common type of antidepressant.
Relapse: when symptoms of depression return after a person had started to get better.
Holistic: looking at the whole person, including their thoughts, behaviour, relationships and situation.

How SSRIs work

Remember, the biological explanation says low serotonin may be linked to depression. SSRIs are designed to deal with exactly that.

Remember from the neurons lessons that neurons pass messages across the synapse using neurotransmitters. Normally a neuron releases serotonin into the synapse, it passes the message on, and the first neuron then takes some of it back in. That last step is reuptake.

An SSRI slows down reuptake. So the serotonin stays in the synapse for longer, and there is more of it available to pass messages between neurons. The aim is that mood, sleep and appetite start to improve.

🧠 Without an SSRI

Serotonin is released, passes its message, and is quickly taken back in. Less is available in the synapse.

💊 With an SSRI

Reuptake is slowed down. More serotonin stays in the synapse, so more is available to pass messages on.

How drugs improve mental health

If the drug does its job, the person may notice some changes:

their mood lifts and they feel less sad or empty
they sleep better and their appetite returns
they have more energy to go to school or work

This matters, because feeling better makes it easier to take part in life again. A person might start seeing friends, or be able to go to a talking therapy session, which they could not manage before.

Time, side effects and relapse

⏳ How long?

They do not work straight away. It usually takes a few weeks before someone feels the benefit. People are told to keep taking them even if nothing seems to change at first.

🤢 Side effects

Some people feel sick, get headaches, have trouble sleeping, feel dizzy or get a dry mouth. Many of these ease after the first few weeks, but not for everyone.

🔄 Relapse

If someone stops taking the drug, the depression can come back. This is called relapse. Stopping suddenly can also make a person feel unwell, so they should talk to their doctor first.

Because every person is different, a drug that helps one person may not help another. Sometimes a doctor has to try a different one.

Reductionist and holistic

You need two words for evaluating treatments.

A reductionist approach explains a problem, or treats it, by breaking it down to one simple cause or level. Antidepressants are reductionist because they focus on one thing: brain chemistry. They treat depression as if the main problem is how much serotonin is available.

A holistic approach looks at the whole person. It asks about their thoughts, behaviour, relationships and situation too.

🔍 Reductionist

One level, such as the brain. Simple to explain and easy to test. Antidepressants are an example.

🌎 Holistic

The whole person and their life. Covers more, but harder to test. Treating the person's thoughts and situation as well as their brain is more holistic.

Drugs and other help

Doctors do not usually see drugs as the only answer. A person taking an antidepressant may also be offered a talking therapy, which you will meet in the next lesson. The drug can lift mood enough for the person to take part in it. Doctors also check in regularly, to see whether the drug is helping, whether side effects are a problem, and when it is safe to stop.

It is also worth remembering that depression is different for each person. Someone whose low mood started after a very hard year may need different help from someone whose symptoms have no clear trigger. That is why a treatment that looks at one level only can leave part of the problem untouched.

Worked example

Maya has been taking an SSRI for three weeks. She feels sick in the mornings and says her mood has not changed, so she wants to stop. What would you tell her? Side effects are common early on and the drug usually takes a few weeks to work, so it is too soon to judge. Stopping suddenly could make her feel unwell, so she should speak to her doctor first.

Strengths and weaknesses of drug treatment

Strengths

Drugs are easy to take, usually a tablet each day. They can help many people feel better, and that can make other help easier to use. They do not need the person to talk about their feelings, which some find hard.

Weaknesses

They take time to work. They have side effects. They do not work for everyone. They may not deal with the reasons the depression began, such as exam pressure or moving house, so symptoms can return when the drug is stopped. Because they are reductionist, they ignore the thoughts and life events that other approaches look at.

Common mistakes

Saying SSRIs "add" serotonin. They do not add any, they slow reuptake so the serotonin already there lasts longer. Another slip is writing that they work straight away. Finally, do not say "holistic" just means "all-round". You must say it looks at the whole person, such as their thoughts and situation.

Exam-style question

Ben has unipolar depression. His doctor gives him an SSRI.

(a) Describe how an SSRI works. [2 marks]

(b) Give one side effect of antidepressants and one reason why Ben's depression might return. [2 marks]

Model answer

(a) It slows down the reuptake of serotonin (1), so more serotonin stays in the synapse and is available to pass messages between neurons (1).
(b) A side effect is feeling sick or getting headaches (1). His depression might return if he stops taking the drug, which is relapse (1).
(c) They explain and treat depression as one cause, brain chemistry (1). They do not look at his whole life, such as his thoughts or relationships (1).

Exam tip

In "describe how it works" questions, name the two key ideas: reuptake is slowed, and more serotonin is available in the synapse.

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