If you have turned on your television in the past few years you have undoubtedly seen an ad for antidepressants. This year, as one of my science credits, I opted to do an independent research project on adolescent depression. So, since October, I have emerged myself in hopefully didactic articles. Needless to say, this search has proven to be very complicated and I have found many articles to be baffling without reading another one as a sort of prologue. At this stage in the search, I have learned the basic facts and narrowed my topic from adolescent depression to the differences in the results between cognitive behavioral therapy (CBT) and medications.

Depression is believed to have three causes: a combination of genetic vulnerability, suboptimal early developmental experiences, and exposure to stress. The symptoms are numerous. An increased or decreased appetite, insomnia or hypersomnia, physical hyperactivity or inactivity, a loss of interest in once enjoyable activities, fatigue, self-reproach, inability to concentrate, and thoughts of suicide or death are all common signs of depression. I was exposed to depression early when my brother was diagnosed manic depressive. Thus, my focus is on adolescent depression and I have found that depression is very misunderstood. Too often parents are making the situation worse. Children feel guilty about how their depression affects their friends and family. So when their parents' response is “I don't like the way you've been acting lately. What's wrong with you? You need to snap out of it”, it does not have a positive affect on the child or situation.

I also have found an interesting link between depression and dreams that could be another cause. When you fall asleep, you have a lot of unfinished tasks still in your brain, such as a fight you had without resolve. While you sleep, your brain creates scenarios allowing these introspections to be resolved, in the form of dreams. Unfortunately, sometimes you spend too much time ruminating (finishing the tasks) that you have too much REM leading to a depleted hormonal system and an exhausted “orientation response”, a brain activity which allows you to change your focus of attention and motivate yourself.

Research on adolescent depression began in the 1980s and since then there are seventeen usual interventions used to remedy the depression. The most common is CBT, or treatment involving the combination of behaviorism and cognitive therapy. Within CBT, there are several different options. The approach can be remedial, which approaches the patient's deficits, or the alternate approach of capitalization. The treatment session can be direct, which provides a set agendas and session goals, or nondirective, which is a more “here-and-now” approach. Then there is option of group therapy versus individual therapy. Perhaps you would prefer the therapist to act more as a teacher, then psychoeducational therapy would suit you. Even the parents can be involved; they would not sit in on their child's session but instead have their own administered in tandem in which they would be taught what their child is learning in hopes that they could be supportive.

The alternate treatment to CBT is medications. There are three types of medications: SSRIs, MAOIs, and Tricyclics. SSRIs, selective serotonin reuptake inhibitors, work by just that. Examples of this are Prozac, Zoloft, and Celexa. MAOIs, monoamie oxidase nhibitors, work by blocking the burning up of monoamines. Once monoamines (serotonin, nor-epinephrine, and dopamine) play their part in sending messages to the brain they are burned up by a protein called monoamine oxidase. Since the MAOIs inhibit this process, it allows for the monoamines to build up. And since depression in associated with low levels of these, the MAOIs ease depressive symptoms. Unfortunately, monoamine oxidase also destroys tyramine, which affects blood pressure. When you eat certain foods (ie: chicken liver, aged cheese, or pickled herring) tyramine floods into the brain. Because of this, patients on MAOIs must fiercely restrict their diet. Tricyclics are based around the parent drug impramine. They increase the brain's supply of norepinephrine and serotonin allowing for the flow of nerve cell impulses to normalize. They do NOT act by stimulating the central nervous system or by blocking monoamine oxidase. On the down side, the cyclics interfere with a range of other receptors, affecting nerve cell communication. The more neurotransmitter systems and receptors affected the more side effects.

The question of which treatment option is better has a convoluted answer.

It depends on the type of depression. Research shows that medications benefit more moderate to severe depression. It also depends on what works for the patient. The Placebo effect describes a situation where a patient is given a pill that looks identical to any depression medication except that it could just be a sugar pill. The patient responds to it positively and improves with no attribute to the medication. There are so many factors in determining which is better, because they work so differently, that the answer is looking more like a riddle wrapped in a conundrum inside an enigma. It is beginning to seem to me like, in the words of Gertrude Stein, “There aint no answer. There aint going to be any answer. There never has been an answer. That's the answer.”