Gray Matters: Should we take our meds?

Editor’s note: The following article contains discussion of medication usage. Please consult a medical professional concerning decisions related to medication use. Further information on mental health medications can be found on the NAMI website. 

Taking antidepressants can be a tricky thing. Not just for reasons that have anything to do with the medicine, but also because of the personal politics of taking them.

Ironically, I think I can speak for most prescribed people when I say that, generally, the worse we feel, the more we don’t want to take antidepressants.

But of course, if we feel too good, we may feel emboldened to stop taking the medicine. Thus, for many people, there exists a cycle between taking prescribed medication and not taking it.

Furthermore, many people are uncomfortable with this cycle and wish they could once and for all decide whether to remain on or off the medication for the rest of their lives.

The goal of this piece is to go over the ways in which some of the most common medications work in our brains and address some thoughts that I and others have had about mood disorder medication to answer the question: “Should we take our meds?”

First up, we have Selective Serotonin Reuptake Inhibitors (SSRIs), which I’ve mentioned in a prior Gray Matters piece. In this class of happy pills (a misleading euphemism) are absolute celebrities such as Zoloft, Prozac and Lexapro. If you’ve done the psychiatric gamut, these names should be as familiar as Zendaya’s is to the American public.

In order to communicate, one neuron sends chemicals into the space between itself and the next neuron. This space is called a synapse. The next neuron (or postsynaptic neuron) is then tasked with receiving those chemicals with receptors. 

The attachment of these chemicals to receptors is what guides neuron communication. Critically, many neurons have “reuptake receptors,” whose  function is to take chemicals, which were not picked up by the next neuron while in the synapse, back into itself to be reused.

This is how SSRIs work. As the name suggests, the reuptake of serotonin is inhibited, or slowed down. Therefore, serotonin is forced to spend more time in the synapse, increasing the likelihood of reception by the postsynaptic neuron. 

And since serotonin is a mood regulating neurotransmitter, SSRIs are effective at alleviating symptoms of depression and anxiety and are prescribed often.

Another relatively common class of mood disorder drugs are monoamine oxidase inhibitors (MAOIs). Some examples are Marplan, Emsam, and Nardil. MAOIs are generally considered to be more potent than SSRIs, so if you recognize these names, I pity you.

These names are probably as recognizable to the American public as Wes Betley. If you don’t know who that is, my point is proven.

These work by inhibiting an enzyme that breaks down serotonin, norepinephrine and dopamine. 

Yet another class of mood disorder medications are tricyclics and heterocyclics. I think they can be thought of as a combination of SSRIs and MAOIs — they work by blocking reuptake, as in SSRIs, but they act on norepinephrine, serotonin and dopamine, like MAOIs.

SSRIs are very commonly prescribed, but MAOIs, as well as tricyclics and heterocyclics, are generally thought to be much nastier than SSRIs.

By “nastier,” I mean that, since MAOIs and hetero-and-tricyclics act on three neurotransmitters instead of just one, the impact they have on the brain is much more diffuse, and thus, side effects are far more common and severe (or so I’m told).

They are often taken in conjunction with other dietary or otherwise physical restrictions so that the patient remains healthy.

One common fear, and it is a classic one, is that antidepressants will somehow alter or “destroy” the personality of the taker — that taking 25 mg of Zoloft will somehow turn you into a libido-less zombie.

I think what people often neglect to consider is that they can simply stop taking the medication (in consultation with a medical professional) if the side effects are unbearable.

Does it really matter whether we decide, once and for all, to stay on our meds forever or not? I believe that it doesn’t, in many un-extreme cases.

I think the cycle that many people experience between taking and not taking their medication is probably OK and natural. For the most part, as long as people continue having these conversations with and listening to the guidance of their psychiatrists, they are doing alright.

If we can accept that at some points in our lives, our medication will serve us better than at other times, we can begin to acknowledge that the question does not, and maybe even should not, be answered one way or the other.