Depression: Causes, Symptoms, and Treatment Options

Antidepressants work by reversing chemicals imbalances in the brain that have accumulated through the development of a disorder like depression. While experts still do not have a clear understanding on how antidepressants improve depressive symptoms, the use of an antidepressant as a first-line treatment is supported by robust evidence for their safety and efficacy in placebo-controlled randomized controlled trials (RCTs) [2]. Two of the most prescribed classes of antidepressants are SSRIs selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).

The rationale behind the use of antidepressants is that their use will help restore balance in specific brain chemicals, called neurotransmitters. In theory, during a depressive episode, the brain has very low levels of a specific neurotransmitter, called serotonin. Serotonin is regularly being released by cells in the brain, but it also gets re-absorbed after a while. A specific gate, the serotonin transporter, re-absorbs serotonin within brain cells. Antidepressants keep serotonin levels higher by blocking this serotonin transporter. This allows serotonin to remain outside the cells, eventually increasing their levels with time, and improving a person’s general mood.

In patients with major depressive disorder, about 20-50% will get back to their normal functioning after 6-12 weeks of an antidepressant treatment [3]. This also means that, for many people, the first medication they try does not bring the expected improvement. Why, then, do some individuals not benefit from the same medication?

Since many mental health disorders share similar symptoms, therapy may sometimes be ineffective due to the diagnosis given. In other cases, genetics can interfere with the effect of antidepressants. Indeed, genetic differences can change how we process and break down medication (aka drug metabolism). Some individuals process certain medications much slower than others, which makes them accumulate their medication over time. After a few days, the concentration of this medication becomes too high and unwanted side effects begin to occur such as nausea, insomnia, headache, dry mouth, and anxiety. This common situation is frustrating and can be discouraging for many. With over 10 possible first line antidepressants to choose from, the usual trial and error method of finding the right one can be long and painful.

A pharmacogenomic test (PGx test) is a saliva-based test that determines how fast (or slow) a person breaks down or metabolizes each one of these antidepressants (and many other medications). By undergoing this test, an individual can find out how their body is built in terms of processing medications. Armed with this information, doctors can make better-informed decision, avoiding those medications that should not be prescribed and prioritizing those that have the best chances of working. PGx is even recommended by the CANMAT guidelines when the initial antidepressant does not result in significant mood improvement or results in side effects [1].

When you feel like you are drowning in your life, exhausted and suffocating, an antidepressant is like a lifebuoy. However, it will not swim you to shore..

Therefore, combining psychotherapy with an antidepressant is essential. The medication stabilizes mood, while therapy helps guide the person towards lasting change. Depression is a complex condition defined by negatively distorted perceptions. Yes, correcting chemical imbalances will have an immediate impact but no pill can undo personal history or even change how its perceived. Real and lasting change happens by working on how you view the world, not just escaping it chemically. This is where psychological counselling comes into play, guiding patients in the right direction based on their personal life experiences.

Sometimes a single step in the right direction can create momentum for continued improvement. Lifestyle factors can have impacts on the risk of both developing depressive disorders and worsening symptom severity. For example, insomnia and cigarette smoking raise the risk of depressive episodes while physical activity, healthy diet, smoking cessation and sleep hygiene reduce the risk [1].

Ultimately, with the right combination of medical care, psychological support, and lifestyle changes, recovery from depression is not only possible but achievable, allowing individuals to regain hope, meaning, and control over their lives.