Rabbi Azriel Hauptman
Since ancient times, people have looked to substances to alleviate their depression. One needs to look no further than the book of Mishlei (31, 6) that states, “Give strong drink to the hapless, and wine to the embittered.” The Chovos Halevuvos also writes, “Your drinking should be only water, unless your intent in drinking wine is to benefit your body, or to remove distress from your heart.”
Unfortunately, alcoholic substances have troubling side effects, which include a wide array of physical illnesses and also depression itself! Although wine might offer some short-term benefits for a depressed mood, it can also be a trigger for severe depression. Our Sages cautioned us about this inconvenient truth when they said (Sanhedrin 70b) that nothing bring wailing upon a person more that wine. Hence, the adage that alcohol is both the cause and the solution of life’s problems. Humanity has, therefore, been in engaged in pursuit of the magic pill that treats depression without all of the side effects. The history of that search is quite fascinating.
Opioids have been used since ancient times to treat depression and many other maladies. Opium spurred lucrative international trade that even led to the Opium Wars in the nineteenth century. Many types of opioids were developed throughout the nineteenth century that led to widespread use for all kinds of aches and pains, both physical and emotional. During the American Civil War, opioids, especially morphine, were extensively used to treat wounded soldiers. Many of these soldiers developed addictions in the years following the war. Only in the twentieth century was the non-clinical use of opioids criminalized.
Amphetamines were the next fad in the treatment of depression. Amphetamine started being marketed in the 1930’s and remained unregulated for many years. As the years passed, the addictive and harmful nature of this drug became known, and finally, in the 1970’s, amphetamine was declared as a Schedule II drug and became unavailable without a prescription.
In the 1950’s, a class of medication known as MAOIs (monoamine oxidase inhibitors) was discovered to have antidepressant properties. It was originally used in the treatment of tuberculosis. When depressed patients reported that the medication improved their moods, it became clear that this drug can be used as an antidepressant. In the 1950s and 1960s, MAOIs were very popular, but as time went on it became clear that there were very troubling side effects, and that some of the side effects could be fatal. MAOIs are still used as a last line of treatment under the watchful eye of a psychiatrist when other antidepressants have failed to be effective.
Another early class of antidepressants were the tricyclic antidepressants (TCAs), which are named after their chemical structure of three rings of atoms. As with many antidepressants, the medication was being studied for other purposes, and its antidepressant properties were discovered by accident. TCAs had their drawbacks as well, as it can be toxic if taken in too large of a dose. Hence, the world still kept on searching for that perfect antidepressant.
All of this changed with the development of the SSRIs (selective serotonin reuptake inhibitor). The first one to be marketed in the late 1980s was fluoxetine, better known by its brand name – Prozac. Within one year, annual sales in the United States alone was $350 million, and worldwide sales eventually reached $2.6 billion per year. Since then, other SSRIs have been developed, and their names are commonly known. They include citalopram (Celexa), escitalopram (Lexapro), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft).
Although SSRIs have their fair share of potential side effects, they are not toxic or addictive. The relative safety of the SSRIs created a revolution in psychopharmacology. Whereas in the past, only a psychiatrist would dare prescribe a psychiatric medication, now regular physicians felt safe in prescribing these medications. Additionally, in the past, only severely depressed patients were prescribed psychiatric medications. Now, even mildly depressed patients are sometimes taking medication.
Another factor in the “Prozac Revolution” is that before the emergence of Prozac, the pharmaceutical companies never advertised to the general public. This changed after Prozac, and now it is commonplace for “Big Pharma” to advertise in all kinds of mediums to the general public. Of course, they always conclude their advertisement by saying, “Ask your doctor…” It is now estimated that approximately twelve percent of the population above age 12 is currently taking antidepressants.
Where does this leave us? We live in a world that has medical options that our predecessors wished they had. Countless people literally owe their lives to antidepressants such as Prozac. It is still not the magic bullet, as not every medication works for everyone and there can be side effects. Finding the right medication at the right dose can sometimes be a real journey. If you are suffering from depression and your clinician advises you to use medication, do not be ashamed. Just like if you are shortsighted it is not a crutch to wear glasses, similarly if you are suffering from depression, it is not a crutch or a sign of weakness to take medication.
