Antidepressants

What Kind of Drug Is It?

Antidepressant drugs are used to relieve the symptoms of depression and anxiety. Depression is a mood disorder that causes people to have feelings of overwhelming and lasting hopelessness, sadness, despair, and self-blame. The condition can also bring on changes in sleeping and eating habits, a loss of pleasure, feelings of apathy, and even suicidal thoughts. Anxiety is a disorder that causes feelings of being extremely overwhelmed, restless, fearful, and worried. Symptoms of anxiety include loss of sleep, dizziness, sweating, and shaking, among others.

Antidepressants play an important role in the treatment of depression and anxiety. They help to rebalance brain chemistry so the symptoms of depression and anxiety are alleviated. A large number of people take antidepressants. Richard Jerome, writing in People, reported that "133 million prescriptions for antidepressants were written in 2002" in the United States alone.

Overview

Depression is a condition that affects the way people feel, think, and act. "Ten to 20 percent of adults in the United States experience depression at some point in their lifetime," noted Adrienne Z. Ables and Otis L. Baughman III in an article for the journal American Family Physician.

Official Drug Name: Amitriptyline (ammuh-TRIP-tuh-leen; Elavil), bupropion (byoo-PROH-pee-on; Wellbutrin), citalopram (sye-TAL-oh-pram; Celexa), clomipramine (kloh-MIPP-ruh-meen; Anafranil), escitalopram (EE-sye-TAL-ohpram; Lexapro), fluoxetine (flu-AKS-uhteen; Prozac), imipramine (ih-MIPP-ruhmeen; Tofranil), mirtazapine (murr-TAZ-uh-peen; Remeron), paroxetine (purr-OKS-uh-teen; Paxil), phenelzine (FENN-uhl-zeen; Nardil), sertraline (SURR-truhleen; Zoloft), venlafaxine (venn-luh-FAKS-een; Effexor). The twelve drugs listed here are a sampling of the various types of antidepressants in use as of 2005.

Also Known As: Happy pills

Drug Classifications: Not scheduled, psychotherapeutic drugs with "black box" warnings

Sometimes depressive episodes are sparked by an especially upsetting event in life such as the death of a loved one, the breakup of a relationship, a change in jobs, separation from friends or family, or a severe illness. Because depression seems to run in families, scientists are investigating possible biological causes for the condition. The authors of "Depression: Help Is at Hand," a publication of the Royal College of Psychiatrists (RCP), stated that people who have a parent who has become severely depressed "are about eight times more likely to become depressed" themselves. This may be due to an abnormality in the brain involving chemical messengers called neurotransmitters.

Depressed people often have a hard time tracing their sadness to a particular cause. Certain medicines and even some physical illnesses such as the flu can bring on depression, so it is extremely important for people to educate themselves about its signs, symptoms, and treatments.

Symptoms of depression include:

• A long-lasting sad mood
• A change in sleep patterns—either sleeping all the time or having difficulty getting enough sleep
• A change in eating habits—some people eat more when they get depressed, others stop eating altogether and begin losing significant amounts of weight
• A loss of interest in activities or hobbies that used to bring pleasure
• Self-destructive thoughts or actions
• Difficulty making decisions
• A loss of confidence
• Increased irritability
• Problems with school or work
• Problems with friends or family members
• A feeling of hopelessness, as if things will never be any better.

Depression occurs in people of all ages, from small children to the elderly. "In contrast to the normal emotional experiences of sadness, loss, or passing mood states, depression is extreme and persistent and can interfere significantly with an individual's ability to function," stated the authors of the "Depression Research" page of the National Institute of Mental Health (NIMH) Web site.

A study sponsored by the World Health Organization and the World Bank is cited in "Depression Research." The study noted that major depression was found "to be the leading cause of disability in the United States and worldwide." Regardless of what triggers their depression, those who suffer from it require medical assistance. This assistance might include psychotherapy, medication, or a combination of both. Many depressed people from all age groups have responded well to treatment.

Anxiety, which is often associated with depression, can also be helped by medication. Severe anxiety can result in panic attacks. These attacks can make a person feel like he or she is dying. They cause rapid heartbeat, tightness in the chest, shaking, shortness of breath, and dizziness. Antidepressants can help a person focus on dealing with his or her fears before an attack occurs, and the drugs can alleviate the physical symptoms of an attack.

An Accidental Find

Chemists seem to have stumbled upon drugs with antidepressive effects while working on treatments for other medical problems. The very first antidepressants, iproniazid (sold under the brand name Marsilid) and imipramine (sold under the brand name Tofranil), were developed in the 1950s. Since then, great strides have been made in understanding how the human brain works. These strides contributed to the creation of the four main types of antidepressant drugs known as of 2005: 1) tricyclics, 2) monoamine oxidase inhibitors (MAOIs), 3) selective serotonin reuptake inhibitors (SSRIs), and 4) "others," including serotonin and norepinephrine reuptake inhibitors (SNRIs). All of these drugs get their names from the way they act on chemicals called neurotransmitters located in the human brain.

Depression Statistics

Doctors and research scientists continuously seek to learn more about depression. They have learned that:

• Nearly 10 percent of the adult population in the United States suffers from a depressive illness. That is about 19 million Americans over the age of eighteen.
• One in five children and adolescents in the United States suffers from some kind of emotional problem that affects his or her daily life.
• As of 2004, doctors were writing about 11 million prescriptions for antidepressants to teenagers and children each year.
• More women than men have been diagnosed with depression, but that does not necessarily mean that more women are depressed than men. Researchers suggest that women are just more likely to seek help than men.

Tricyclics and MAOIs were available years before the SSRIs came on the scene. Richard DeGrandpre, writing in Nation, stated that "SSRIs have not been clinically proven to be more effective" than the older tricyclics. The SSRIs gained a reputation for safety because they are generally less toxic, or harmful to the body, when taken in overdoses. In normal doses, however, both the new and the old classes of antidepressants have been shown to relieve the symptoms of depression in some patients. Because each patient will respond differently to the various antidepressants, physicians may try several different kinds—or even combine one with another—in the search for the most effective treatment for a particular patient.

The Ultimate Problem Solver?

The most popular antidepressants are the SSRIs. Prozac was the first SSRI approved for use in the treatment of depression. It became available in 1987, received extensive coverage in the media, and within a few years became a household name. Some people were under the impression that Prozac was the ultimate problem solver—a sort of "happy pill" that gave everyone who took it a more positive outlook on life. It had no reported side effects and was even thought to help in weight loss. What most people failed to realize, however, is that antidepressants have no psychological effects on people who don't suffer from depression. They only help depressed patients reach a normal level of functioning.

Still, the market for antidepressants grew wildly in the 1990s and early 2000s. According to The Pill Book, seven of the top fifty prescriptions written by U.S. doctors in 2003 were for antidepressants. Associated Press reporter Bruce Smith, as recorded on the ABC News Web site, noted that 32.7 million prescriptions for Zoloft, another SSRI, were written that year. This made Zoloft the most widely prescribed antidepressant in the United States.

What Is It Made Of?

A variety of substances have antidepressant actions. The anti-depressants available in the United States are classified in two main ways: 1) by their chemical structure, as in the case of tricyclics (three-ring structure), or 2) by their actions on neurotransmitters, as in the case of MAOIs, SSRIs, and SNRIs. Tricyclics work to increase the levels of the neurotransmitters norepinephrine and serotonin in the

brain. These neurotransmitters are usually at low levels in people who suffer from depression. The problem with tricyclics is that they can affect other neurotransmitters as well, causing a number of side effects. MAOIs stop the protein in the brain known as monoamine oxidase from breaking down serotonin, norepinephrine, and another neurotransmitter called dopamine after they deliver their messages to the brain. This leaves high levels of these chemicals in the brain and subsequently keeps depression at bay.

However, MAOIs also keep monoamine oxidase from destroying tyramine (found in various foods), which can cause fatal increases in blood pressure. SSRIs were specifically designed by scientists to stop the "reuptake," or reabsorption, of only serotonin in the brain, allowing levels of serotonin to build and remain high while not affecting the levels of other chemicals. They are the most prescribed forms of antidepressants because they usually have fewer side effects and interactions with other drugs. SNRIs focus on stopping the reuptake of serotonin and norepinephrine so that they both build and remain at a high level.

How Is It Taken?

Prescription antidepressants are taken orally, usually once a day, and usually in capsules or tablets. Some are available in liquid form for swallowing. It is very important that patients on antidepressants take their medications exactly as prescribed, even if the drugs do not seem to be working at first. In some cases, three to four weeks of antidepressant use may be needed before the effects of the drug can be observed.

The usual daily dose prescribed of an antidepressant can differ. For the SSRI Prozac, a patient is typically prescribed 20 to 40 milligrams per day. In higher doses, it has been used to treat obsessive-compulsive disorder (ocd) and the eating disorder bulimia. In 2002, Prozac became available in a once-a-week capsule-form that contains 90 milligrams of fluoxetine granules that are released over time. The effect of one of these capsules is equivalent to seven daily doses of 20 milligrams of Prozac.

Dosages of Zoloft, another SSRI, typically begin at 50 milligrams per day for adults and may be raised to 100 or 200 milligrams per day. When the SSRI Paxil is prescribed for depression, the initial dose is usually 20 milligrams per day. This dose may be increased to about 40 milligrams per day. Citalopram (Celexa) and escitalopram (Lexapro) are SSRIs that are gaining popularity for two reasons. First, their side effects are said to be minimal. Second, the risk of harmful interactions with other drugs is low. As of 2005, drug

researchers noted a definite increase in the number of prescriptions being written for these two particular antidepressants.

Are There Any Medical Reasons for Taking This Substance?

Antidepressants are used mainly to relieve the symptoms of depression, which include feelings of sadness, helplessness, and hopelessness. They may also be used to treat severe anxiety, panic attacks, post-raumatic stress disorder (ptsd), obsessive-compulsive disorders, eating disorders, chronic pain, severe premenstrual syndrome, and postpartum depression. Affecting more than one in ten new mothers, postpartum depression causes sadness, anxiety, irritability, tiredness, interrupted sleep, a loss of enjoyment or desire to do anything, and guilt over not being able to care properly for the baby.

Sometimes severely ill individuals become depressed. The symptoms of depression can have very negative effects on their recovery. stroke patients are especially vulnerable to depression. After-stroke, or post-stroke, effects can include a loss of voluntary movement (usually on one side of the body), a loss of sensation (especially in affected limbs), weakness, and difficulty speaking. The long process of rehabilitation for stroke patients is often hampered by depression. Antidepressants have proven very effective in post-stroke patients. A positive attitude is crucial to recovery and helps patients stick to their intensive and often exhausting physical therapy schedules. Treating post-stroke depression improves the chances of the stroke patient regaining both physical strength and mental sharpness.

Usage Trends

"I think the categorical belief is that depression is something you get over rather than something you take medication for," stated Dr. Zachary N. Stowe in an interview with Laurie Tarkan for the New York Times. Indeed, some "four out of five people with depression will get completely better without any help," noted the authors of "Depression: Help Is at Hand." Episodes of depression frequently last for eight months to a year before going away. For some depressed people, however, the symptoms hang on even longer.

September 11, 2001

Doctors reported that requests for antidepressants increased dramatically after the terrorist attacks of September 11, 2001, on American soil. Fear, depression, and anxiety were common among Americans after terrorists hijacked planes and flew them into the World Trade Center in New York City and the Pentagon in Washington, D.C.

Of the one in five people with depression that does not go away on its own, treatment is recommended. Without help, those people are twice as likely to fall into a pattern of repeated depressive episodes. A 2003 Time magazine article pointed to the potential seriousness of the condition. "Untreated depression has a lifetime suicide rate of 15 percent—with still more deaths caused by related behaviors like self-medicating with alcohol and drugs."

The Debate over SSRI Safety and Suicide Risks in Children and Teens

As more and more children and teens are diagnosed with depression, the effects of the drugs used to treat it must be evaluated in young people. Some experts worry that anti-depressants may act differently in people under the age of eighteen because their brains are not yet fully mature. "Our knowledge of antidepressant treatments in youth, though growing substantially, remains limited when compared with what we know about treatment of depression in adults," stated the authors of the NIMH article "Antidepressant Medications for Children and Adolescents: Information for Parents and Caregivers."

According to Christian Science Monitor correspondent Patrik Jonsson, two separate congressional hearings revealed that the U.S. Food and Drug Administration (FDA) had "known about problems with [antidepressant] drugs since 1996, but failed to take decisive action." These "problems" included higher rates of aggression and an increase in suicidal thinking among young patients being treated with antidepressants. By 2000, even more studies had emerged "showing a possible link between hallucinations and aggression in children and teens taking Zoloft, Paxil, and Prozac," reported "FindLaw" columnist Elaine Cassel on CNN.com. Despite these findings, in January of 2003 the FDA approved the use of Prozac in depressed children as young as seven years old. As of 2005, only ProzachasbeenapprovedtotreatdepressionandOCDinchildren. Zoloft, Luvox, and Anafranil are only approved for children for OCD. As of 2005, no other antidepressant is approved for use in children.

Defining Depression

Depression is hard to define, and not all doctors agree on whether it is a mood disorder or the more serious definition: a disease. In his 2005 book, Against Depression, Peter Kramer notes that his work presents "an insistent argument that depression is a disease." In fact, he calls depression one of the worst diseases to afflict humankind.

Dr. Peter R. Breggin sees the situation differently. In his 2001 work, The Antidepressant Fact Book, he states that "it is a mistake to view depressed feelings or even severely depressed feelings as a 'disease."' He continues: "Depression… is an emotional response to life. It is a feeling of unhappiness—a particular kind of unhappiness that involves helpless self-blame and guilt, a sense of not deserving happiness, and a loss of interest in life…. A human emotion or psychologi cal state—basically, a feeling—should not be considered a 'disease' simply because it becomes extreme."

Treatment for Adolescents with Depression Study (TADS):

To gain more information on the effects of antidepressants in young people, the NIMH spent $17 million on the Treatment for Adolescents with Depression Study (TADS), which was conducted between 2000 and 2003. More than 400 depressed adolescents were divided into groups that received varying forms of treatment. One group was treated with Prozac alone. Another group received a combination of Prozac and cognitive behavioral therapy (bt), a type of psychotherapy that stresses positive thinking. A third group received CBT without the Prozac. A fourth group received only a placebo.

The results of the study were released to the press by the NIMH in August of 2004. The participants were monitored for improvement in their depression and for trends in their suicidal thinking. The combination of medication and therapy proved the most effective in relieving the symptoms of depression. The data concerning suicidal thinking were more difficult to interpret.

The results of TADS revealed that 7 percent of adolescents receiving Prozac either attempted suicide or threatened to do so. Only 4 percent of participants in the placebo group had a suicide-related event. Still, the NIMH concluded that "it is extremely difficult to determine whether SSRI medications do or do not increase the risk of… suicide, especially since depression itself increases the risk for suicide." Experts believe that a larger study is needed to resolve unanswered questions.

Results Lead to "Black Box" Warnings

In 2004, the FDA examined information from more than twenty studies, including TADS, on antidepressants and adolescents. Together, the studies involved about 4,300 patients under the age of eighteen. Overall, the results mirrored the TADS findings. The rate of suicidal thinking or behavior was twice as high among adolescents taking SSRIs as it was in adolescents who were not. This prompted the FDA to announce in late 2004 that "black box" labeling of antidepressants would become mandatory. In "Antidepressant Medications for Children and Adolescents," the authors noted: "A black-box warning is the most serious type of warning in prescription drug labeling." Black box warnings for antidepressants state that the drugs may be linked with an increased risk of suicidal thinking or behavior. On its Web site, the FDA specifies the language to be used on the black box warnings. Part of the standard warning follows:

Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of [drug name] or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber.

According to MSNBC.com, antidepressant use among children and teens has declined by about 10 percent since the information on suicide risks was released.

Testing New Drugs

The word placebo is Latin for "I shall please." Placebos, often called "sugar pills" or "dummy pills," are used in experiments that test the effectiveness of new drugs. Doctors give one group of patients regular doses of a placebo and one group of patients regular doses of the real drug that is being tested for a particular condition. Patients are not told what they have been taking until the testing period is over. After a few months, both groups are compared. A higher rate of improvement among patients in the test-drug group is good news for drug researchers. It indicates that the new drug is truly effective in treating the condition it was designed to treat.

Patients' conditions may improve for a time if they believe they are taking a medication that will relieve their symptoms. In the treatment of depression, an average of 35 percent of placebo-treated individuals will improve, compared with about 60 percent of SSRI-treated individuals.

Effects on the Body

Neurotransmitters, such as serotonin and norepinephrine, are chemical substances that transmit information from one nerve to another. By the middle of the twentieth century, researchers had found that depressed people seemed to have lower concentrations of neurotransmitters coating the nerve endings in their brains. Antidepressants help stop the reuptake of these chemical substances in the brain, creating a kind of bath of neurotransmitters like serotonin for the nerve endings to soak in. Raising the concentration of neurotransmitters in the brains of depressed individuals works to reduce the symptoms of their depression.

The actions of antidepressants on the brain are not fully understood, but scientists are learning more about them every day. Studies show little difference in the effectiveness of the various antidepressants, but some individual patients appear to do better on one drug than another. In the search for the most effective drug for a particular patient, a physician may prescribe various antidepressant drugs or even try some in combination.

General side effects of antidepressants can include stomach upset, agitation, anxiety, dizziness, insomnia, and a dry mouth (which usually increases a user's thirst). Since SSRIs were discovered, the older MAOIs are prescribed less often for the treatment of depression. Side effects of MAOIs can be severe and include a sudden elevation of blood pressure. Tricyclics may cause dryness of the mouth and eyes. A dry mouth can lead to the formation of dental cavities, and dry eyes can result in blurred vision. Use of tricyclics may also result in reduced urine output, constipation, and weight gain. Older patients are cautioned against tricyclic use because the drugs can disrupt the normal rhythm of the heartbeat. SNRIs should not be used by people with heart problems.

The Question of Addiction

Until the early 2000s, antidepressants were not believed to cause addiction in users. A traditional feature of addictive substances is the "high" or "buzz" they cause in users. "Antidepressants will not make you high," stated Andrew Weil and Winifred Rosen in From Chocolate to Morphine.

News from Around the Globe

Depression and anxiety are common problems throughout the world. Were you aware that:

• The National Institute on Mental Health in England (NIMHE) reported that about 1 in every 100 deaths in the United Kingdom is a suicide.
• Canada's labeling of SSRIs carries an additional warning of a potential increase in hostility, aggression, and "harm to others." A reference to harming others does not appear on the black box warnings of SSRIs in the United States, however.

Ables and Baughman mentioned in 2003 that some degree of withdrawal occurs with all antidepressants. This contradicts the belief that antidepressants are not addictive. The withdrawal symptoms, which are usually mild, begin about a week after the antidepressant medication is stopped. They include dizziness, nausea, headache, and flu-like symptoms, but agitation and even panic attacks may occur. Withdrawal symptoms usually end within three weeks for SSRIs. However, "withdrawal from paroxetine [SSRI Paxil]," explained Ables and Baughman, "was shown to cause more severe symptoms that may occur more quickly, even after the second missed dose."

Researchers in the United Kingdom noted similar findings. According to the Royal College of Psychiatrists, "up to a third of people who stop SSRIs and SNRIs have withdrawal symptoms. These include: stomach upsets, flu-like symptoms, anxiety, dizziness, vivid dreams at night, and sensations in the body that feel like electric shocks." These symptoms are more often associated with paroxetine (sold under the brand name Paxil in the United States and Seroxat in the United Kingdom) and venlafaxine (sold under the brand name Effexor in the United States and Efexor in the United Kingdom) than any other SSRIs and SNRIs. Research continues on the still-baffling question of addiction and withdrawal issues among antidepressant users.

Zoloft on Trial

Christopher Pittman threatened suicide and was hospitalized after his parents' final breakup in 2001. Pittman's mother had first left home when Pittman was just two years old. His parents' repeated attempts to get back together failed. After hearing that their relationship was really over, Pittman, then twelve years old, became desperate and ran away from his Florida home. After he was found, he spent a couple of weeks in a psychiatric hospital and was diagnosed with depression and defiant behavior. Doctors put him on Paxil, an SSRI, briefly. Days later he was prescribed Zoloft, a different SSRI. Zoloft was the most widely used antidepressant for both adults and teens in the United States at that time.

Pittman went to live with his father's parents in South Carolina later in 2001. He was there for only a matter of weeks, and life seemed to be going well for him. Then, one day that November, Pittman and his grandfather had a serious argument. They fought about some trouble that Pittman had caused on his school bus. Pittman was told that he might have to return to his father's home in Florida because of the incident. That night, the twelve-year-old boy shot his grandparents to death in their bed, set their home on fire, and drove away in their car with his dog. Pittman's lawyers argued that "the killings occurred for a reason beyond the boy's control—a reaction to the antidepressant Zoloft," noted Barry Meier in the New York Times. "Such defenses," Meier continued, have been used in the past but "have rarely succeeded."

Pittman's case did not go to trial until three years after the tragic incident. While in jail awaiting his trial, Pittman repeatedly claimed that he loved his grandparents. His own father even came to his defense, stating that the boy had always been especially

close to the couple. Pittman told police that on the night of the murders, he had heard voices urging him to kill his grandparents. Those voices in his head, claimed defense lawyers, were caused by the Zoloft, and possibly even the Paxil, he had been taking for depression.

The so-called "Zoloft defense" did not work for Christopher Pittman. On February 15, 2005, he was sentenced to thirty years in prison for the murders of his grandparents.

The Pittman case fueled the growing debate about the safety of antidepressants in children and teens. Between 2001 and 2004, the FDA stepped up its investigations into the effects of antidepressants on patients under the age of eighteen. In June of 2003, the FDA recommended against prescribing Paxil (the first medication prescribed by Pittman's doctors) for depression in children and adolescents.

Reactions with Other Drugs or Substances

Anyone prescribed an antidepressant should consult with a physician before taking any other drug, including over-the-counter medications. Patients taking MAOIs must avoid certain foods such as aged meats, cheeses, and pickles because they contain tyramine, which can cause harmful reactions when combined with MAOIs. These foods should not be consumed until well after a person stops taking the drug.

It is important to know that the effects of alcohol are greatly increased when combined with antidepressants. In addition, combining large amounts of caffeine with antidepressants may intensify the jitters and agitation that sometimes accompany depression.

The reactions of recreational drugs with antidepressants are unpredictable and possibly very dangerous. The symptoms of depression are often intensified by illicit drug use. To help avoid problems, it is important that patients taking antidepressants stick to their prescribed dosage and stay away from other drugs, unless prescribed by a physician. In addition, the effectiveness of a drug can only be measured when the prescription is followed accurately.

Treatment for Habitual Users

Antidepressants are not abused in the traditional sense. This means that they are not taken by users to get high. If antidepressant drug therapy is discontinued, it should be done under a doctor's care using the "stepdown method" in order to reduce the risk of side effects. This method involves gradually lowering the dose of the drug until the patient is weaned off it entirely.

Consequences

Depression and anxiety can interfere with a person's happiness, success, and relationships. The symptoms of depression and anxiety should not be ignored. About 80 percent of people with depression respond very positively to treatment, but that leaves a significant number—the other 20 percent—without help. Thus, an important goal of NIMH research is to advance the development of more effective treatments for depression, especially those "hard-to-treat" forms that don't respond well to currently available medications and/or counseling.

Major depression can occur just once in a person's lifetime, but it is usually recurring. Depressive episodes will interfere with the ability to work, eat, sleep, concentrate, and take pleasure in formerly enjoyed activities. Treatment for depression is often a long-term process, but it can help those with the condition lead fuller and happier lives.

Taking antidepressants for depression and/or anxiety does have consequences. They all have side effects, some dangerous, that need to be monitored. A number of people believe that taking drugs for depression and/or anxiety is not necessary. In fact, they claim, it can even be harmful. In 2005, actor Tom Cruise spoke out against the use of antidepressants, citing vitamins and exercise as better alternatives. However, others state that their lives have greatly improved since they started taking antidepressants.

Alternatives to Medicine

Antidepressants are believed to help relieve the symptoms of depression, but there are other things depressed people can do to feel better. Among these are:

• Talking with trusted friends, family members, and counselors
• Identifying and solving the problem that may have caused the depression in the first place
• Getting regular exercise
• Eating well
• Staying away from alcohol and other depressants
• Practicing relaxation techniques
• Setting time aside for enjoyable activities or hobbies

The Law

Antidepressants are only available by prescription. It is illegal for people to take drugs that have not been prescribed for them. It is also illegal for patients to share prescribed drugs with other people. Since users of antidepressants do not achieve a high with these drugs (as may occur with the stimulant drugs amphetamines and other drugs of abuse), they are rarely abused. No market for the illegal sale of antidepressants has been reported.

For More Information

Books

Appleton, William S. Prozac and the New Antidepressants. New York: Plume, 2000.

Breggin, Peter R. The Antidepressant Fact Book. Cambridge, MA: Perseus, 2001.

Katzung, Bertrum G. Basic and Clinical Pharmacology. New York: Lange Medical Books/McGraw-Hill, 2001.

Kramer, Peter. Against Depression. New York: Viking, 2005.

Morrison, Andrew L. The Antidepressant Sourcebook. New York: Broadway Books, 1999.

Schull, Patricia Dwyer. Nursing Spectrum Drug Handbook. King of Prussia, PA: Nursing Spectrum, 2005.

Silverman, Harold M. The Pill Book, 11th ed. New York: Bantam, 2004.

Weil, Andrew, and Winifred Rosen. From Chocolate to Morphine. New York: Houghton Mifflin, 1993, rev. 2004.

Periodicals

Ables, Adrienne Z., and Otis L. Baughman III. "Antidepressants: Update on New Agents and Indications." American Family Physician (February 1, 2003): pp. 547-554.

Cheakalos, Christina. "A Big Letdown?" People (May 12, 2003): pp. 191-192.

DeGrandpre, Richard. "Trouble in Prozac Nation." Nation (January 5, 2004): pp. 6-7.

Dewan, Shaila, and Barry Meier. "Boy Who Took Antidepressants Is Convicted in Killings." New York Times (February 16, 2005).

Harris, Gardiner. "FDA Panel Urges Stronger Warning on Antidepressants." New York Times (September 15, 2004).

Jerome, Richard. "The Prozac Kids." People (July 28, 2003): pp. 46-49.

Jonsson, Patrik. "'Zoloft Defense' Tests Whether Pills Are Guilty." Christian Science Monitor (February 11, 2005).

"Medicating Young Minds." Time (November 3, 2003): p. 48.

Meier, Barry. "A Drug on Trial." New York Times (August 23, 2004).

"Post-Stroke Depression Impedes Recovery." New England Journal of Medicine Health News (September, 2000).

"Prescription for Suicide?" Time (February 9, 2004): pp. 59-60.

Schuster, Mark A. "A National Survey of Stress Reactions after the September 11, 2001, Terrorist Attacks." New England Journal of Medicine (November 15, 2001).

Shute, Nancy. "Teens, Drugs, and Sadness." U.S. News & World Report (August 30, 2004): pp. 36, 38.

Tarkan, Laurie. "Dealing with Depression and the Perils of Pregnancy." New York Times (January 13, 2004).

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See also: Herbal drugs