CONTROVERSY has surrounded the most popular class of antidepressants ever since their development in the 1990s. Initially seen as wonder drugs, we have since come to realise that these selective serotonin reuptake inhibitors, or SSRIs, don’t help everyone and can cause unpleasant side effects.
The most recent cause for concern is that the once widely accepted explanation for how SSRIs work – namely by mitigating a lack of the brain chemical serotonin – is no longer thought to be correct. The unsettling conclusion is that, although the drugs work for many, we don’t know why.
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It is clear that depression is a lot more complicated than we thought and that developing better treatments is therefore going to be more complicated too. For one thing, it seems that there may be many different types of depression, each underpinned by different mechanisms.
But there are reasons to think we are taking the first tentative steps into a new era for the treatment of depression. Several fresh ideas about its biological causes are on the table, some of which have already led to new treatments, as we explore in our feature “Fresh ideas about the causes of depression are bringing new treatments”. Researchers are also developing tests for “biomarkers” that would tell people which kind of depression they have and which treatment is most likely to benefit them.
Another cause for optimism is that stigma around seeking medical or psychological help for depression is starting to fade. Although there is still some way to go before mental health conditions are viewed in the same way as physical ones, these days, more people are open about their mental health issues and this may encourage others to seek help when they need it.
One thing is for certain: a revolution is sorely needed. Depression has always been part of the human condition and it can be just as debilitating as more visible physical health problems. There are no simple solutions and it won’t happen overnight, but the sooner we have a wider range of more effective treatments, the better.
