How do antidepressants work?


By David Joel Miller.

Here is the best way I have found to explain the way in which antidepressants help. Remember this is an analogy, not a scientific explanation. In a previous post, I talked about the way in which thoughts are moved around in the brain by neurotransmitters and the way in which they might regulate thoughts and emotions.

The most commonly prescribed antidepressants these days are SSRI’s. That stands for Selective Serotonin Reuptake Inhibitor. Complicated name but let’s try to make the idea behind it simpler.

One thing that happens after a message is moved from one neuron to another by a neurotransmitter is that the neurotransmitter needs to be released from its receptacle. The key needs to be removed from the lock otherwise that neuron could never receive that message again. The released neurotransmitter starts floating around and eventually it gets eliminated from the body. If you only got one use out of a neurotransmitter then you might start running out of them really fast. So your brain has a recycling department. The used neurotransmitter is recycled by enzymes and other “stuff” that breaks it down and lets the brain reuse it.

Think of this analogy.

Once in my younger days, maybe more than once, I had this car that kept overheating. I would fill the radiator up and drive as far as I could until it started getting hot. Water leaked out of that old rusty radiator in several places. To go all the way to work or school I might need to carry water or stop a few times to refill the radiator. It was a hassle. A friend of mine suggested I try this product he called “slow leak.” Something like that. You put it in the radiator and it found the places that were leaking and plugged them up. It did not eliminate the leaks completely but I got a lot more miles from my car before I had to stop and put water in it.

An SSRI kind of works like that. It keeps those “packman like” enzymes from finding my brains serotonin and recycling it before I am done with it. It does not put more serotonin in your brain but it helps you get more mileage out of what you have there.

A cognitive behavioral therapist, (wait a minute, that’s me!) might argue that diet, exercise and good thinking could help you make and release more serotonin. Brains like cars differ. Some brains can get more mileage out of their serotonin. Some brains might “leak” the stuff out or overheat and boil it off. You with me so far?

See how keeping the serotonin in my brain longer might improve its performance. That “leak stopper stuff” did a great job on the radiator so some SSRI just might work on my brain.

Now back to that old wreck of a car. You can trade in a car and get a newer one. So far we don’t have brain transplants so we need to take the best care we can of the brains we have.

My car was so much better. I could make it all the way to school without stopping to put water in the radiator. My friends were impressed.

One day some of my buddies were over to the house and I was bragging about that “fixum leaks up” stuff I had discovered. They said they were impressed. From the looks on their faces, I could see they were skeptical. So let’s say I go in the house and get my dad’s old shotgun. Play along with me here. The shotgun is not to scare my buddies; it is to demonstrate the effectiveness of my “Leak fixer upper stuff.”

I fire that old shotgun right at the front of the radiator. Just as expected the water pours out.  I now get out the “leaker solver” can and put some in the radiator. Only this time it no work so good. The thing continues to leak.

Some of you are now asking – who would do a think like that?  Stay with our analogy here. Lots of people do just this thing. After taking all that medication to reduce their depression, they go and drink some alcohol. Alcohol is a depressant drug. So drinking alcohol undoes all the effects of the antidepressant.

Now some of you are arguing about alcohol being a depressant drug. You will tell me that it makes you more energetic. With alcohol in you, you want to party, at least until you pass out. The truth is that you only think that alcohol perks you up. It shuts down the functions of the frontal lobe of the brain and some other parts also. So under the influence of alcohol the part of the brain that tells you “hey stupid – don’t do that!” is not working.

I hope this little tale has offered you a way to understand how an antidepressant might help with depression while not instantly erasing it. Hopefully, you also see how mixing psychiatric meds with alcohol and street drugs might be a bad idea.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog, there is also a Facebook authors page, in its infancy, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. Thanks to all who read this blog.

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