One major approach for treating depression is the use of antidepressant medications. The older antidepressants include tricyclic antidepressants such as Tofranil (imipramine) and monoamine oxidase inhibitors such as Nardil (phenelzine). Antidepressants approved more recently include the selective serotonin reuptake inhibitors Prozac, Paxil and Zoloft, and the other newer antidepressants Wellbutrin, Effexor, Serzone, and Remeron. The effects of antidepressants on the brain are not fully understood, but there is substantial evidence that they somehow restore the brain’s chemical balance.

These medications usually can control depressive symptoms in four to eight weeks, but many patients remain on antidepressants for six months to a year following a major depressive episode to avoid relapse. Different drugs work for different people, and it is difficult to predict which people will respond to which drug or who will experience side effects. So it may take more than one try to find the appropriate medication. Since the mid-1950s, tricyclic antidepressants have been the standard against which other antidepressants have been measured. Monoamine oxidase inhibitors were discovered around the same time as tricyclic antidepressants, but were prescribed less because, if mixed with certain foods or medications, the drugs sometimes resulted in a fatal rise in blood pressure. Laughren describes Prozac as the “first of a new type of more selective antidepressants.” The older antidepressants had unpleasant and sometimes dangerous side effects, such as insomnia, weight gain, blurred vision, sexual impairment, heart palpitations, dry mouth, and constipation. Prozac, other selective serotonin reuptake inhibitors, and other recently approved antidepressants have had generally safer side effect profiles.

Other types of therapy, such as natural substances extracted from plants, are currently being studied. Although not approved by FDA, some people believe St. John’s wort, for example, is extremely helpful in alleviating their depressive symptoms.

For severe depressive episodes, medications are often the first step because of the relatively quick relief they can bring to physical symptoms. For the long term, however, psychotherapy may be needed to address certain aspects of the illness that drugs cannot. “Although the biological features of depression may respond better to drugs,” Laughren says, “people may need to relearn how to interact with their environment after the biological part of the depression is controlled.”