31 May Antidepressants & Substance Abuse
“The silence depressed me. It wasn’t the silence of silence. It was my own silence”
The History of Antidepressants
Isoniazid, iproniazid, and imipramine are names most people may not be familiar with in the general population. These were medications that were produced to help treat tuberculosis. Before the 1950s, the most commonly prescribed antidepressant medications were opioids and amphetamines. There use was soon restricted due to the vast amount of addictive properties and severe side effects they caused. Soon after, extracts from the herb St. John’s Wort was used as a “nerve tonic” which helped alleviate depression.
Then came the connection with anti-tuberculosis medications. In 1951, Irving Selikoff and Edward Robitzek began their clinical trials on two new medications that would help treat tuberculosis. These agents where known as isoniazid and iproniazid. Their trials proved successful for the treatment of tuberculosis, but they also noted that patients presented with “a subtle general stimulation” and renewed vigor. In 1952 a psychiatrist by the name Max Lurie began testing isoniazid when he learned of the stimulating effects. Within a few years he and his colleague, Harry Salzer, reported that isoniazid improved depression in two thirds of their patients. The term “antidepressant” was then coined to describe the medication’s action. Similar effects were seen by a doctor in France named Jean Delay. How exactly this medication helped with depression was unclear and it was thought its effects were due to the inhibition of diamine oxidase, coupled with a weak inhibitory effect of monoamine oxidase. Monoamine oxidase is an enzyme the body uses to help in the synthesizing process of neurotransmitters such as norepinephrine, dopamine, and serotonin. Later on it was discovered that iproniazid was a potent monoamine oxidase inhibitor. The medication showed promise and marketability, until it was recalled in 1961 due to lethal toxic effects on patient’s livers, also known as hepatotoxicity.
Antidepressant medications started to be prescribed in the 1950s. Back then, it was estimated that no more than 50 to 100 people per million suffered from the kind of depression that merited the use of these drugs. New drugs were developed known as the monoamine oxidase inhibitors and were said to be safer due to their affecting only the MAO-A subtype specifically. By the 1960s more evidence of the mechanism of tricyclic drugs began to be more comprehensive as they were thought to affect serotonin, a neurotransmitter in the brain that affects mood.
The Picture of Antidepressants Today
In 2013, antidepressants were the most prescribed medications in the United States. About 70 percent of the 16 million long-term (24 month or longer) users were female. This number nearly doubled in a decade according the National Health Service, in the UK. Reports in 2014 showed that the number of antidepressants dispensed annually went up by 25 million within 14 years between 1998 through 2012. The numbers rose from 15 million to 40 million. This high increase was noted during the recession in 2008.
Substance Abuse and Depression
It’s common for depression to sometimes be an underlying condition of substance abuse or alcoholism. It is important to have a general understanding as to how these medications affect people’s brain chemistry and when and if they should use them. Please consult with your primary M.D. should you have any questions. An incomplete understanding of the brains’ network on how it controls mood has led scientists to only develop antidepressant medication that helps control the neurotransmitters that affect mood, thus rendering these medication ineffective in certain cases. In either case it is important to understand how these medications affect the brain.
New Generation of Antidepressants
Selective Serotonin Reuptake Inhibitors (SSRIs) known as Prozac, Celexa, Paxil, and Zoloft are new generation antidepressants that may sound more familiar to some.
This is a chart of the various antidepressants available and their side effects.
Many who suffer from substance abuse, also suffer from depression. Though there are many factors that can create depression, it is valuable to have an understanding of different medications, and how they can be used to help people with dual-diagnoses. Please consult with your psychiatrist should you have any questions regarding depression or any depression medications.