Antidepressants help some depressed patients and do not help others. Why not? The most popular antidepressants, selective serotonin reuptake inhibitors, increase serotonin concentration in the interneuronal gap. But serotonin as such has little effect on mood. So why does depression recede? And most importantly, why do some meta-analyses show low efficiency of antidepressants? And what are we treating anyway?
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The theory of chemical imbalance
Depression is a brain malfunction and imbalance of chemical neurotransmitters. This is what the most popular, monoamine theory of depression says. The malfunction looks like this. There is a biological neural network – layers of interconnected neurons of the brain and spinal cord of the central nervous system. They receive signals from the external and internal environment and transmit commands to the muscles and each other. The genome of each neuron contains instructions on how to transmit the signals. When neurons transmit information (and this happens all the time), they are as if transferring messages strictly according to this instruction.
So, neuron #1 synthesizes neurotransmitters and packages them into vesicles – such “balls” of dopamine, serotonin, noradrenaline and other monoamines are obtained. The balls fly through the space between neurons and each of them gets into its own basket – receptor-synapse on the neuron shell #2. According to the message, the recipient neuron amplifies or suppresses its functions. The balls lie in the synapse, the message is received and the instruction is executed. Then monoaminoxidase comes into play: it removes – oxidizes a part of the neurotoys. The rest of the neurotransmitters are returned to neuron #1 to reuse them. And the game continues.
But sometimes there is a failure in neuron #1. Most likely, bugs have gotten into its genome. Now neuron #1 synthesizes few neurotransmitters, and its partner, neuron #2, does not receive them. The game didn’t work out: due to the lack of neurotransmitters, the connection between the neurons has been broken, which means that the most important parts of the brain, namely the hippocampus, which is responsible for memories and their emotional coloring, the prefrontal cortex, which processes information, and the amygdala, which regulates the feeling of fear, can’t hear each other. And so on the stage comes the depression: there is no mood, no strength, the future is hopeless, nothing brings pleasure, anxiety and wine reign.
Antidepressants do not cure the reason: they can’t fix the gene instruction so that neuron #1 creates and passes more neurotransmitters. Instead, they prevent neuron #1 from taking the neurotransmitters back or preventing monoamine oxidase from disposing of them. Neuromediators are trapped in gaps between neurons and lie in neuron #2 baskets. The neural network works properly again. Cells communicate, hippocampus, prefrontal cortex and amygdala understand each other again. Depression is going away.
All this does not explain why antidepressants only work after two weeks of intake, and sometimes do not help at all. It is difficult to prove the chemical imbalance in the brain: even to simply establish changes in serotonin concentration directly in synapses, you need to get inside the head. Therefore, many people doubt that the cause of depression is serotonin, dopamine and noradrenaline deficiency, but it is difficult to deny the effectiveness of drugs. You can find excellent medications this site.