History of the Treatment for Clinical Depression

Also called "major depressive disorder," clinical depression is a condition characterized by a prolonged period of an extreme sadness that is disproportionate to circumstances. Symptoms include dramatic changes in appetite, difficulty focusing, irritability, fatigue and loss of interest in old hobbies and relationships. Treatment for clinical depression has been through several phases.

Psychotherapy

• Initially, depression was always blamed on some conflict in the individual's life. This could mean emotional conflict or problems with her environment. For this reason, psychiatrists believed that depression could always be dealt with through psychotherapy. Now, though, psychotherapy is often just one part of a more comprehensive program.

Iproniazid

• Originally developed to treat tuberculosis in the early 1950s, it was noticed that iproniazid worked to elevate the patients' moods. In 1957, iproniazid was first prescribed to patients with clinical depression. Studies revealed that the drug blocked the enzyme monoamine oxidase's destruction of norepinephrine, serotonin and dopamine. Eventually iproniazid's use was discontinued due to severe side effects, but it was the first demonstration of the effectivity of medication in treating depression.

TCAs

• A failed attempt at a treatment for schizophrenia, the first tricyclic antidepressant (TCA) was called "imipramine." While this medication helped depressed patients, it had no mood-enhancing effects on nondepressed people. The drug was found to inhibit the reuptake of norepinephrine and serotonin into neurons in the brain, making it the first medication to specifically deal with depression and inspiring important research. TCAs are still used today, but only very occasionally.

MAOIs

• Like tricyclic antidepressants, monoamine oxidase inhibitors (MAOI) decrease the activity of the enzymes that destroy norepinephrine, serotonin and dopamine and are called "monoamines." MAOIs are still in use today, although MAOI popularity is waning due to potentially severe side effects.

SSRIs

• In 1987, selective serotonin reuptake inhibitors (SSRI) came onto the scene. They were the result of research based on what had been learned from MAOIs and tricyclics. To decrease the incidence of side effects, SSRIs target specific monoamines, thus increasing only the amount of serotonin in the brain.

SNRIs

• Serotonin-norepinephrine reuptake inhibitors (SNRIs), released in the 1990s, are very similar to SSRIs, except that SNRIs target both serotonin and norepinehprine. They are beginning to take over for SSRIs, but are still not as popular as their predecessor.