Key idea: A biological treatment changes the body to change the mind. Antidepressants change the chemistry of the synapse.
Antidepressant medication
What it does
SSRIs, such as fluoxetine, block the reuptake of serotonin, so more stays in the synapse.
How long
Mood usually starts to lift after two to six weeks, not at once.
Side effects
Nausea, poor sleep or lower sex drive for some people; stopping suddenly can cause problems.
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Cipriani and colleagues (2018) combined 522 trials with about 116,000 adults. All 21 antidepressants they studied worked better than a placebo for major depression, though the average benefit was modest.
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Key idea: Antidepressants beat a placebo in large trials; the questions are how much, for whom, and for how long.
Strengths
- Randomised, double-blind trials show an effect
- Cheap and widely available
- Can help severe depression quickly enough to start therapy
Limitations
- Average benefit is modest
- Side effects lead some to stop
- Relapse is common after stopping
The TADS trial (3.1.9) found teenagers did best with medication and therapy together: drugs often work best as one part of treatment.
Watch out: 'Works' needs a comparison. Say better than what: a placebo, therapy, or nothing.