How do these antidepressants work?

Celexa Lexapro Luvox Paxil Prozac Zoloft

We don't know for sure.

People who experience depressed moods for an extended period probably have a lot in common and most such depressives have been helped by antidepressants to lift their mood, even though this may take trials of several different medications.

One theory is that depression is a result of an imbalance in a system that is normally at a comfortable equilibrium. However, you can not see this imbalance with the naked eye because it is occurring at a microscopic level.   Also this stuff is incredibly technical and complicated with its own alphabet soup of terms and dictionary of complicated hard to pronounce names.  To simplify the complexity, I came up with the metaphor below which uses two common household items that you encounter every day

: electrical current and electrical outlets.

The figure below shows the brain in its normal state with normal strength current and normal number of outlets:  Note there is a big bolt of electricity and two outlets.


NORMAL BRAIN

                      

Serotonin Current

When you are put under stress, for example, marital conflict or dealing with a difficult personality at work, the current can get weakened. The brain tries to compensate for this weaker current state by INCREASING the number of electrical outlets so that EVERY BIT of current can be utilized. But it doesn't work. And you get depressed.


DEPRESSED BRAIN Note: Now you have a smaller bolt and four outlets and there is no joie de vivre (French for joy of life :))

Serotonin Current

So the question arises, "Why does this happen to some people and not others?".  We don't know. We tend to think of interactions between genetics, and one's vulnerability to a set of particular psychological stresses.

You see a doctor and start (CELEXA, LEXAPRO, LUVOX, PAXIL, PROZAC, ZOLOFT)

Celexa boosts the current quickly; within hours to days the current starts to increase, but there is a time lag before you feel better. However, in this immediate phase, now you have both increased current and increased outlets. It is in this early phase of anti-depressant treatment that you can typically experience side effects. For example, you may feel "wired", more anxious and jittery but it should be mild. The side effect period may last a while- a week or two typically because it takes time for the brain to catch up and realize that the stronger current is really there to stay.

SIDE EFFECT PERIOD May last up to 2 weeks or so

Please note: Now the bolt is back to the normal size, but there are still more than the normal number of outlets, the brain has not reduced them yet 
          

Serotonin Current

The brain says "Hey, We don't need all these extra outlets anymore, the current is OK now. Let's decrease the number of them back to normal."

Your brain adapts. This process may take a couple of weeks to complete and occurs gradually. When it is finished, things are in balance again. The side effects are no longer present and you feel like your normal self.

The typical phrase I hear when it works is : "Doc, the same things are going on now that were going on before, but they just don't seem to throw me like they used to".



NORMAL BRAIN Can take 6-8 weeks or more

Please note: Normal bolt size, normal number of outlets, happy camper!
      

Serotonin Current

The heart of this theory is that there is a deficiency, particularly of norepinephrine and/or serotonin that is corrected by antidepressant medication.

Physicians must make educated guesses about which antidepressant to choose.  It is trial and error.  We simply do not yet have any test or X- Ray that will tell us which type of antidepressant will work for any particular patient.  

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