19 Apr 2012 01:43 UTCThu 19 Apr 2012 - 1:43 am UTC
In the brain, does depression manifest itself in only one way, or can depression manifest itself differently in different people (ie in women due to hormones, etc)? The reason I am asking is because I am curious as to why different treatments for depression are effective for some people and not for others. Is there a reason that Prozac would work more effectively than Wellbutrin? Is it because certain forms of depression respond better to different drugs? Or, is all depression the same and the selection of drug is simply a matter of deciding which side effects are the most tolerable for you as an individual?
19 Apr 2012 13:36 UTCThu 19 Apr 2012 - 1:36 pm UTC
You've asked about a topic that is both very complex and poorly-understood. These two Wikipedia articles do a good job of describing depression and the role of antidepressant medicines:
In a nutshell, depression involves a lot of biochemical pathways in the brain and elsewhere in the body. Different drugs interact with these pathways at different points and with varying outcomes. Doctors have not had a great deal of success predicting which drug (or drug combination) will be most effective for a given patient, so it really becomes a matter of trying the drugs with the least serious side-effects, and then progressing to other medicines if the first batch doesn't help.
Let me know if that's the sort of information you're seeking.
20 Apr 2012 12:51 UTCFri 20 Apr 2012 - 12:51 pm UTC
Let's address the easy question first:
> is all depression the same and the selection of drug
> is simply a matter of deciding which side effects are
> the most tolerable for you as an individual?
All depression most certainly does not have the same underlying cause. There are multiple aspects of brain chemistry that are associated with depression. For each of these there is a corresponding set of drugs which affect that biochemical pathway. Unfortunately, there is no physical test that can isolate these biochemical imbalances in a living person.
Although the choice of drug could be made on the basis of expected side-effects, this is problematic. Some of the side-effects are rare but very serious, and it is difficult (if not impossible) to quantify how tolerable they would be for an individual (prior to the actual occurrence of a side-effect).
Instead, it's more likely that the initial choice of drug will be made on the basis of which depressive symptoms are present in the patient.
It's not possible to review the entire science of depression within the scope of a $10 question (or even a question at Uclue's maximum price). Instead, I will point you to a one-hour lecture by Professor Robert Sapolsky of Stanford University.
In this video lecture Sapolsky addresses most of the points you raised in your question. He explains the nature of depression, the biochemical pathways behind it, and the drugs associated with those pathways. He is one of the leading researchers in the field, and he has a very clear style of explanation:
YouTube - Stanford's Sapolsky On Depression (Full Lecture)
Sapolsky is sometimes criticised for the implication that a biochemical cause suggests drug treatment as a response. Indeed, there is evidence that depression can be reduced by means of exercise, sunshine, therapy, and the cultivation of circles of friends. This approach also avoids the problems associated with coming off anti-depressants at the end of a successful program of drug treatment.
Related to that, here's another long video. It's an interview by Stefan Molyneux (who describes himself as a philosopher) of Dr Greg Siegle, an Associate Professor from the Dept of Psychiatry at the University of Pittsburgh School of Medicine:
YouTube - Anxiety, Depression, Autism
Dr Siegle explains Cognitive Therapy, an alternative to drug treatment.
I hope that within these two videos you can find answers to the questions you raised. If there are any points that are not addressed, let me know and I'll look for additional resources.