Brain Medicine: MAOIs, SSRIs, and DBT

It is estimated that 5 percent of the world population suffers from depression.  And I'm part of that 5%. From Sigmund Freud's early idea of psychoanalysis to the many specific classifications and treatments we now have for depression, mental health care for the illness has come a long way. Most people with severe depression are recommended two aspects of treatment that work in conjunction - medication and therapy.

That's a lot of people! How can they all cope? 

Today, there are several major types of medications that are used to treat depression. One of the earliest treatments included monoamine oxidase inhibitors (MAOIs). This method was discovered by accident, originally being used to treat tuberculosis in the 1950s when doctors noted its mood-elevating effects and started using it on patients with depressive symptoms.

MAOIs work through preventing an enzyme called monoamine oxidase from removing neurotransmitters involved in good feelings from the brain. Hence the name, monoamine oxidase inhibitor! It makes norepinephrine, serotonin, and dopamine more available to cells and circuits affected by depression. However, this type of medication has been replaced by the much more effective selective serotonin reuptake inhibitor, or SSRI.

My depressed synapses make me want to take a syNAPse. 

SSRIs function in a similar way, but have significantly less side effects. They also target serotonin specifically. Hence the name selective serotonin reuptake inhibitor! (Scientists are good at naming stuff! All the letters have meaning!) When people refer to antidepressants, they are probably talking about an SSRI. The most popular brand names are Lexapro, Zoloft, and Prozac.

Perhaps even more so than medication, therapy is very important in the lives of people with depression. It has been shown that therapy increases metabolism in the hippocampus and dorsal cingulate and decreases it in the dorsal, ventral, and medial frontal cortex. The point is, the brain is so reactive to change that what might seem like just having simple conversations is actually changing the structure and function of your body! A recent study has shown that therapy strengthens certain connections in the brains of people with psychosis and they are associated with the reduction of symptoms on a long-term level, even eight years later. The brain is incredibly plastic (not made of plastic, but meaning it is able to change throughout life).

The brain does some impressive things! Makes you sad, makes you happy, makes you have a sense of consciousness, etc. Wow. 

Most general psychotherapy is talking about problems and trying to figure out how to manage them. In the past few decades, more specialized, highly effective forms of therapy have been developed.  I have found dialectical behavioral therapy (DBT) very helpful to deal with my depression personally! DBT consists of mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. It is useful for people with all kinds of mental illnesses, like bipolar disorder, post-traumatic stress disorder, and borderline personality disorder, not just major depression.

For me, depression sometimes feels abstract and non-quantifiable. It feels like a concept in my life that will never go away. Although it is an extremely personal illness that affects everyone differently for different reasons, it is often helpful to think of it in a scientific way, especially when discussing how to cope with it. After all, my brain just needs some help with the serotonin!