The second class of antidepressants are the selective serotonin reuptake inhibitors or SSRIs. Classic SSRI are Prozac (Fluoxitine), Paxil (Paroxitine) and Zoloft (Sertraline). Prozac is one of the most prescribed drugs in the Western world, though strangely, there is no firm evidence that it works better than any other antidepressant.

Like the tricyclics, SSRIs keep serotonin levels higher, allowing the balance of neurochemicals to be restored. They are more selective in their action, so they are less sedating than the TCAs. SSRIs are more perscribed than the tricyclics because they have fewer side effects, and are better tolerated by patients. SSRIs are not totally without side effects, and they can be disturbing.

Classic SSRI side effects include dry mouth, excess perspiration, and slight dizziness at the beginning of treatment. These symptoms usually disappear during the course of treatment. Long-term side effects include a frustrating change in sexual function. Many on SSRIs, especially Zoloft and Paxil, find themselves able to become aroused sexually, but unable to achieve orgasm. This can be very disturbing and aggravating for both patient and partner. New studies of antidepressants indicate there may be combinations of drugs that eliminate this. SSRIs often increase appetite, resulting in slight weight gain. Other side effects include constipation, blurred vision and difficulty urinating.

Recently, newer antidepressants have appeared which are purported to combine the effectiveness of the SSRIs and the power of the tricyclics, with fewer side effects. Effexor (Venlafazine) and Remeron (Mirtazapine) are members of this new class of drugs.

All antidepressants are slow acting medications. This means you often have to take the medication for several days or weeks before you notice a change. There is a common misperception that one can take Prozac and feel better the next day. This is a placebo effect, where thinking you will feel better actually makes you feel better.

After taking antidepressants for a few weeks, most patients feel better, less sad, less preoccupied, and more hopeful. Patients suffering from anxiety-related depression often find a sense of calm returns to their life, and they stop obsessing and fixating. Many with sleep-disruption symptoms find their sleep patterns stabilize. Some find they have not been sleeping well for some time, and have increased energy and improved emotional state.

People who have been successfully treated for depression report feeling better, thinking more clearly, loss of obsessive thoughts or behaviours, renewed interest in sex, life, career and relationships. These successes are usually the result of a combination of psychotherapy and medication.

Because antidepressants work directly on brain chemistry, those with a history of seizure disorders, eating disorders (organically derived), or under treatment with certain kinds of blood pressure medication (MAO Inhibitors) should consult with their doctor. Other drugs, including alcohol are not a good idea while on antidepressants. People being treated with antidepressants often find the effects of alcohol intensified. Ecstasy, Acid and GHB are especially bad. These drugs act directly on serotonin levels, and can result in toxic side effects, such as seizure, coma or psychotic behaviour.

Will antidepressants cure your depression? Probably not; Depression may be a medical condition, but there is almost always an environmental component to the illness. The best strategies for treating depression combine drugs and therapy: drugs calm or relieve symptoms so emotional work can be done on the patient's psyche. Once problems surface and are resolved through therapy, medication can often be discontinued. In many cases, therapy alone was shown as effective as medication for dealing with depression.

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