During depression, chemical imbalances occur in the brain. The circuits that allow neurons to communicate with each other do not function normally, the level of certain “neurotransmitters” is too low. Antidepressants help to overcome it.
The effectiveness of new generation drugs
The latest generation drugs have an action on serotonin, one of the neurotransmitters (hence their name: selective serotonin reuptake inhibitors or SSRIs).
Recent products also act on noradrenaline. And we are waiting for the next release of agomelatine (Valdoxan®) which, by its action on melatonin (a hormone), would allow better regulation of sleep disorders, very common in depressed people.
Which antidepressant for whom?
There are around thirty antidepressants on the French market. “Some products, like fluoxetine (Prozac®) are more stimulating. They are suitable for very tired patients, operating at slow speed, explains Prof. Olié.
Others, such as paroxetine (Deroxat®), have a sedative effect which may be helpful in patients with anxiety or who have trouble sleeping. If a drug does not work after six weeks, it can be changed. Sometimes you have to fumble around a bit to find the right product.
To read on this subject: Suicide prevention, doctors are divided on antidepressants.
Medicines that don’t always work
20 to 30% of patients are resistant to antidepressants. After trying two or three for several weeks, they don’t have any results. This resistance remains largely a mystery.
It can sometimes be explained by a misdiagnosis, as the patient is not really depressed. “In some people suffering from a personality disorder (hyper-emotivity, emotional quest always unsatisfied), it can happen that we make an abusive diagnosis of depression”, explains Prof. Olié. These patients require other treatment.
In children and adolescents
Prescribing antidepressants in younger children is questionable. Only fluoxetine (Prozac®) is authorized in Europe in the treatment of children over eight years of age, after failure of psychotherapy alone.
But studies have shown an increased risk of suicide in these teens on medication. And studies in animals also cast doubt on their sexual maturation.
Despite everything, 10,000 children and 30,000 adolescents in France would receive antidepressant treatment. For Professor Falissard, we must remain very careful: “A teenager with moderate depression is first offered psychotherapy. In fact, teens react to it very well. ”