Hockenbury Discovering Psychology 5th txtbk

612 CHAPTER 14 Therapiesselective serotonin reuptakeinhibitors (SSRIs)Class of antidepressant medications thatincrease the availability of serotonin in thebrain and cause fewer side effects thanearlier antidepressants; they include Prozac,Paxil, and Zoloft.Table 14.9Antidepressant MedicationsGeneric Name Trade NameFirst-GenerationAntidepressantsTricyclic Imipramine Tofranilantidepressants Desipramine NorpraminAmitriptyline ElavilMAO inhibitors Phenelzine NardilTranylcypromine ParnateSecond-Generation Trazodone DesyrelAntidepressants Bupropion WellbutrinSelective Serotonin Fluoxetine ProzacReuptake Inhibitors Sertraline Zoloft(SSRIs) Paroxetine PaxilFluvoxamine LuvoxCitalopram CelexaEscitalopram LexaproDual-Action Nefazodone SerzoneAntidepressants Mirtazapine RemeronDual-Reuptake Venlafaxine EffexorInhibitors Duloxetine CymbaltaSource: Based on Julien (2008).The Most Commonly Prescribed Class ofMedication: Antidepressants The numberof people treated with antidepressantmedication more than doubled from 13million people in 1996 to 27 million peoplein 2005 (Olfson & Marcus, 2009). Withthe exception of African-Americans, antidepressantusage increased in virtuallyevery demographic group. But during thesame time period, people with depressionwere less likely to undergo psychotherapytreatment with a psychiatrist, psychologist,or other counselors (Mojtabai & Olfson,2008). Ironically, although antidepressantusage has increased sharply, new studiessuggest that antidepressants may not beas effective as pharmaceutical companieshave claimed, especially for cases of milddepression (Kirsch & others, 2008; Turner &others, 2008).In 1987, the picture changed dramatically with the introduction of a third groupof antidepressants, the selective serotonin reuptake inhibitors, abbreviated SSRIs.Rather than acting on multiple neurotransmitter pathways, the SSRIs primarilyaffect the availability of a single neurotransmitter—serotonin. Compared with theearlier antidepressants, the new antidepressants act much more selectively intargeting specific serotonin pathways in the brain. The first SSRI to be released wasfluoxetine, which is better known by its trade name, Prozac. Prozac was quicklyfollowed by its chemical cousins, Zoloft and Paxil.Prozac was specifically designed to alleviate depressive symptoms with fewer sideeffects than earlier antidepressants. It achieved that goal with considerable success.Although no more effective than tricyclics or MAO inhibitors, Prozac and the otherSSRI antidepressants tend to produce fewer, and milder, side effects. But no medicationis risk-free. Among Prozac’s potential side effects are headaches, nervousness,difficulty sleeping, loss of appetite, and sexual dysfunction (Breese & others, 2009).The SSRIs are also helpful in treating anxiety disorders (Davidson & others, 2009).Because of its overall effectiveness and relatively mild side-effects profile, Prozacquickly became very popular. By the early 1990s, an estimated 1 million prescriptionsper month were being written for Prozac. By the late 1990s, Prozac had become thebest-selling antidepressant in the world. Today, Prozac is available in generic form,greatly reducing its cost. But even so, the antidepressants Prozac and Zoloft accountfor more than $4 billion a year in sales in just the United States (NOC Health, 2005).Since the original SSRIs were released, new antidepressants have been developed,including Serzone and Remeron. These antidepressants, called dual-action antidepressants,also affect serotonin levels, but their mechanism is somewhat different fromthat of the SSRIs. They are as effective as the SSRIs but have different side effects.Finally, Effexor and Cymbalta are two newer antidepressants that are best classifiedas dual-reuptake inhibitors, affecting levels of both serotonin and norepinephrine.Possibly because of its dual action, Effexor seems to be somewhat more effectivethan the SSRIs in alleviating the symptoms of depression (see Thase & others,2008; Nierenberg & others, 2007). However, Effexor’s potential side effects includediminished sexual interest and weight gain.With so many antidepressants available today, which should be prescribed? Certainfactors, including previous attempts with antidepressants, possible interactions withother medications, and personal tolerance of side effects, often influence this decision.Currently, medications are typically prescribed on a “trial-and-error” basis—people