1. The End of Anti-Depressants as We Know Them

    November 26, 2013


    How the future of antidepressants is diverging from its scattershot past


    The End of Anti-Depressants as We Know Them

    by Amy Maxmen

    Sixty-one years ago, in a Staten Island hospital complex, doctors testing a new drug on tuberculosis patients observed a strange side effect: While the drug, known as an MAO inhibitor, was no miracle cure

    for the hospital’s debilitated residents, it seemed to have an energizing, almost magical effect on their mood. One report noted that patients were “dancing in the halls tho’ there were holes in their lungs.’

    The early history of what would come to be known as antidepressants is dominated by such stories of serendipity, and many pharmaceuticals prescribed for depression today are, by and large, descendents of these decades-old happy accidents. Newer drugs replaced old ones because they were safer, not more effective, explains William Potter, senior advisor to the director of the National Institute of Mental Health.

    Now, as psychiatry inches toward a more refined understanding of the neurochemistry of depression, the course of drug discovery is changing. Roughly half of all clinically depressed patients fail to respond to available antidepressants-all of which target one neurotransmitter or another-and the lack of relief provides an important clue: Depression is not a monolithic disease, but a set of symptoms that can spring from a variety of causes. A treatment may work, scientists are finding, only when it is tailored to the type of depression found in a particular patient. “Today’s antidepressants seem to change the brain only slowly and indirectly,” explains Olivier Berton, a neuroscientist at the University of Pennsylvania.

    How the future of antidepressants is diverging from its scattershot past

    Because doctors knew that some early antidepressants boosted serotonin, they hypothesized that the neurotransmitter may be linked to depression. But a person’s outlook doesn’t start to shift until a month after beginning serotonin-altering drugs like Prozac, even when they work. The delay suggests another process is involved. Enter neural plasticity. Researchers have long observed the growth of new brain cells following antidepressant use. It may be that the sluggishness and stunted outlook that characterize depression at bottom  reflect a failure to generate  new nerve cells, and yet the role of serotonin in neurogenesis is indirect, at best. The chain of reactions that link them remains largely unknown.

    Recently, however, new research has begun to point to substances in the brain that act closer to the scene of neurogenesis, suggesting  more logical drug targets.  In June, researchers reported one important step in Nature Medicine. After mice took Prozac-Iike antidepressants, the levels of a fat molecule in the brain called ceramide plummeted.  Ceramide normally stalls brain cell growth;  by blocking ceramide, the drugs presumably  jump-started  neural regeneration.  New drugs that inhibit ceramide  could  work  faster than  drugs that  act on serotonin   because  they  are more directly linked to neurogenesis, the authors suggest.

    Others   are  entirely    abandoning approaches related to serotonin. Researchers know that individuals who are obese or who take immune-altering   medications may not respond to antidepressants. What such people have in common  is chronic inflammation,  explains Emory University psychiatrist Andrew  Miller. He believes that inflammation   is a particular  path to depression  that  stems from  a beneficial adaptation. Depression is often characterized by what are called sickness behaviors – withdrawal  from others, loss of appetite, lethargy.  These are typical  responses  to physical  injury  and infection, and, in the short term, may foster recovery. Such responses become a problem, Miller says, only when the inflammation   is chronic. Then the depressive behavior endures.

    Earlier this year, Miller investigated whether a drug  currently used to tame inflammation in rheumatoid arthritis might  help people  who found  no relief in antidepressants   and failed to respond to talk therapy. The drug indeed  helped depressed patients with excess inflammation and did little for those without.

    Depression  that stems from trauma can  also be especially resistant   to conventional    antidepressants. Scientists believe that trauma  may cause epigenetic changes-lastingly modifying molecules that  turn  mood-  and  behavior-related genes on or off. The upshot  may be that those who experience trauma early in life may be unable to bounce back from later hardship the way other people can.

    Penn’s   Berton  recently studied trauma-induced depression in  mice. Bullying – one type  of trauma, easily modeled  in animals – typically causes a meeker mouse to act asocial, refrain from favored foods, and scare easily-behaviors analogous to those of depressed humans. But when Berton blocked a particular protein in the bullied  mice, they showed no such symptoms.  Berton  is now collaborating  with  a pharmaceutical  company to develop  a drug  that  blocks  the same protein. Other researchers are also experimenting  with drugs that block different proteins that may act as on/off switches for the genes affected by trauma.

    “For  a long  time,  people  focused only  on serotonin,   and  that  inhibited new avenues  of investigation,” Berton says.  Now that the variety of mechanisms underlying depression is becoming clearer, a one-size-fits-all approach may soon be a thing of the past.

    (article originally published at Psychology Today – Nov/Dec 2013)

  2. Anti Anxiety Medication List – Benefits, Disadvantages, Side Effects

    November 15, 2013

    Anti Anxiety Medications

    Almost everyone suffers from anxiety at some point in their lives. Yet, if you are among 3.1% of Americans who suffer from Generalized Anxiety Disorder, medications could be a necessary component of your multimodal treatment. Anti anxiety medications should never be considered a permanent solution, regardless of what your doctor tells you. These could be used to control your condition, while you are working with a therapist and learn to manage your repetitive, negative, and often irrational thoughts. Psychotherapy is the only  permanent solution for anxiety, and it works best when combined with meditation, yoga, and regular physical exercise.

    Once you have been diagnosed with a Generalized Anxiety Disorder and it has been decided (by your physician or psychiatrist) that you need to take anti anxiety medication for  your treatment, it is important to know and understand all of the options available. The following is an anti anxiety medication list containing information about medications commonly used to treat anxiety. We describe here specifics of each medication, their benefits, disadvantages and possible side effects.




    *Xanax – panic, generalized anxiety, phobias, social anxiety and OCD

    *Klonopin – panic, generalized anxiety, phobias and social anxiety

    *Valium – panic, generalized anxiety and phobias

    *Ativan – panic, generalized anxiety and phobias

    *Serax – generalized anxiety and phobias

    *Librium – generalized anxiety and phobias


    Benzodiazepines are psychoactive drugs whose use results in sedative, hypnotic, and muscle relaxant properties. In general, these types of drugs are safe and effective for the short term. You can take benzodiazepines as a single dose therapy or several times a day for months at a time. Studies suggest that they are effective in reducing symptoms of anxiety in about 70% of patients. They are very quick acting, tolerance does not develop, and overdose is not dangerous. Generic alternatives are available which can greatly reduce cost.


    Sometimes patients experience side effects such as drowsiness, lethargy, difficulty with speech, a decrease in coordination, unsteady gait, and headache. These types of side effects tend to be present the first few weeks of treatment, but usually clear up. Some patients experience irritability and agitation. Taking benzodiazepines can increase the effects of alcohol. Long-term use is still controversial due to possible psychological and physical effects. It can cause tolerance in some people as well as dependence and withdrawal symptoms. Benzodiazepines are also controversial for use in pregnant women.




    *Inderal – social anxiety

    *Tenormin – social anxiety


    Beta blockers help to treat the physical effects of anxiety such as trembling, shaking, uncontrolled blushing and controlling rapid heart beat in anxious social situations for several hours. They are safe for most people with few side effects. Beta blockers are also non-habit forming.


    Sometimes the social anxiety symptoms present are so strong that beta blockers cannot provide sufficient relief. They also tend to lower blood pressure so those with a heart condition or low blood pressure may not use them. Beta blockers are not recommended for anyone with diabetes or with respiratory issues such as asthma.




    *Tofranil – panic, generalized anxiety, PTSD and depression

    *Norpramin or Pertofrane – panic, generalized anxiety, PTSD and depression

    *Aventyl or Pamelor – panic, generalized anxiety, PTSD and depression

    *Elavil – panic, generalized anxiety, PTSD and depression

    *Sinequan or Adapin – panic and depression

    *Anafranil – panic, depression and OCD


    Tricyclic antidepressants are among the earliest antidepressants developed. They are effective, but have been generally replaced with other types of antidepressants that cause fewer side effects. They are effective in reducing panic attacks and in elevating depressed moods. They are usually given in single daily doses with no tolerance development or withdrawal symptoms.


    Taking tricyclic antidepressants have a delayed onset of 4-12 weeks. Possible side effects include insomnia, tremors or both and both can last up to three weeks. Overdose is a dangerous issue with thee medications and the side effects are considered to be significant.




    *Lardil – panic, generalized anxiety, social anxiety, depression and OCD

    *Parnate – panic, generalized anxiety, depression, OCD and PTSD


    MAOIs reduce panic attack, elevate depressed moods and increases confidence. These medications are well researched, cause no tolerance development and are non-habit forming.


    There are some dietary and medicinal restrictions that must be adhered to when taking MAOIs. Thee can be inconvenient for many patients. Aged cheeses and meat as well as certain medications need to be avoided when taking this medication. There can be significant agitation during the first days of treatment. There can also be a delayed onset of weeks to months and they are very dangerous in overdose. Patients that take MAOIs need to be extremely responsible.




    *Prozac – panic, generalized anxiety, social anxiety, depression, OCD and PTSD

    *Luvox – panic, generalized anxiety, social anxiety, depression, OCD and PTSD

    *Zoloft – panic, generalized anxiety, social anxiety, depression, OCD and PTSD

    *Paxil – panic, generalized anxiety, social anxiety, depression, OCD and PTSD

    *Lexapro – panic, generalized anxiety and OCD

    *Celexa – panic, generalized anxiety, depression, OCD and PTSD


    SSRIs are a newer type of medication introduced in the 1980’s. They assist the brain in maintaining enough supply of serotonin in the brain. A deficiency of serotonin is associated with many anxiety disorders.  They are a well-tolerated medication that is safe for medically ill or frail patients. They are safe in overdose with no withdrawal symptoms unless abruptly stopped. No dependency develops and they do not promote weight gain.


    There is a delayed onset of 4-6 weeks  and full range effect can take up to 12 weeks. A worsening of anxiety symptoms can happen during the first two weeks of treatment.




    *Effexor or Effexor XR – panic, generalized anxiety, social anxiety, depression and OCD

    *Cymbalta – panic, generalized anxiety, social anxiety and OCD


    With Cymbalta, therapeutic response can take up to 4-6 weeks and alcohol must be avoided. Nausea and dizziness are common side effects. SNRIs are more expensive than most anxiety medications.


    Image Credit:  http://www.flickr.com/photos/54111420@N00/2763358057/


  3. Should You Take Medication for Anxiety?

    April 9, 2013

    Should You Take Medication for Anxiety?

    by Robert Davies

    Whilst we all experience a touch of anxiousness or stress from time to time, for sufferers of Generalized Anxiety Disorder, anxiety can be crippling. Anxiety can lead to sleep deprivation, fear of social engagement, incapacity at work or physical illness. Psychotherapy provided by a clinical psychologist or psychotherapist is commonly used to treat anxiety yet. in severe cases the medication may be necessary to alleviate anxiety symptoms.

    Certain medications may be useful as a way to contain and improve symptoms of anxiety. Keep in mind that medication does not cure anxiety and that it is used primarily for symptomatic treatment, i.e. to alleviate anxiety symptoms. Ideally medication should be used under the supervision of a psychiatrist or a doctor and in conjunction with counselling.

    Listed below are the types of medication that are normally used to treat severe anxiety or mild depression:


    In addition to supporting sufferers of depression, anti-depressant medication was also found to be effective for the treatment of anxiety. This category of medication includes tricyclic antidepressants, MAOIs and SSRIs, which are the most popular anti-depressant commonly used in the treatment of anxiety.

    Anti-depressants typically take more than 4 weeks to start alleviating the symptoms of anxiety and they must be taken every day. They cannot be taken on an ‘as needed’ basis.

    SSRIs – Selective Serotonin Reuptake Inhibitor

    This type of medication increases the amount of serotonin in the brain. Serotonin is a neurotransmitter that is involved with mood regulation and feelings of well-being. Low levels of this chemical in the brain can cause anxiety and depression.

    Common medications that fall under this category include Celexa, Cipramil, Lexapro, Cipralex, Prozac, Luvox, Paxil, Aropax and Zoloft.


    Tranquillizers are useful for short-term anxiety issues, such as occurs in a person who has a fear of flying. Tranquilizers can be used on a ‘as needed’ basis, for e.g., when you need to fly. Tranquilizers include barbiturates, azapirones and benzodiazepines, which is the type most commonly used for anxiety treatment.


    Benzodiazepines start to produce an effect very fast, i.e., in about 30 minutes after the intake. The intensity of the effect will depend on the dose and also if the medication was taken on an empty stomach or not.

    These medications work by calming the nervous system. They also produce muscle relaxation.

    The following medications fall within this category: Alprazolam (Xanax), Chlordiazepoxide (Librium), Clonazepam (Klonopin), Diazepam (Valium) and Lorazepam (Ativan).


    Beta-Blockers are a type of medication used mainly to treat diseases related to the heart and high-blood pressure. Beta-Blockers can alleviate symptoms of anxiety such as shaky hands, sweating and pounding heart. Because of that, it helps anxious people to concentrate better on the task being performed.

    This medication can be used as an aid for social anxiety treatment and also to help with performance anxiety.

    Beta blocker medication that is utilized for anxiety includes Propranolol (Inderal) and Atenolol (Tenormin).


    Side effects of anxiety medication will vary from person to person and will depend upon the specific medication being taken. Listed below are some common side effects for each different category of medication:


    • Dry mouth
    • Weight gain or loss
    • Suicidal thoughts
    • Restlessness
    • Aggressiveness
    • Insomnia
    • Drowsiness
    • Nausea


    • Dizziness
    • Drowsiness
    • Decreased alertness
    • Decreased concentration
    • Slower reaction
    • Slower thinking
    • Paradoxical reactions (aggressiveness, irritability, impulsivity, etc.)


    • Weakness, dizziness
    • Cold hands and feet
    • Fatigue
    • Dry mouth, eyes, and skin

    It is essential that anxiety medication is only taken with a doctor’s prescription and under supervision of a mental health professional. Consult your doctor if you think that anxiety treatment medication might assist in managing your anxiety.

    Image Credit: http://www.flickr.com/photos/xlordashx/861956277