Abnormal Psychology

Mood Disorders and Suicide 211

laypeople raised concerns about whether SSRI use was associated with increased

suicide rates. Studies comparing SSRIs to other antidepressants did, in fact, fi nd a

greater risk for suicidal thoughts and suicide attempts in children and adolescents

taking such medications (Martinez et al., 2005); these fi ndings led to a “black box”

warning label, indicating that the medications may increase the risk of suicide in

children who take them and that the children should be closely monitored for sui-

cidal thoughts or behavior or for an increase in depressive symptoms. Since the

warning label was mandated, additional research suggests that the benefi ts of SSRI

antidepressants for youngsters outweigh any risk of suicide, although people taking

them should continue to be carefully monitored (Bridge et al., 2007). Although stud-

ies of adults did not fi nd an increased suicide risk with SSRIs generally (Fergusson

et al., 2005; Gunnell, Saperia, & Ashby, 2005), they did fi nd an increased suicide

risk with the SSRI paroxetine (Paxil) (Aursnes et al., 2005). Moreover, studies of

SSRI use by adults revealed an increased risk of nonlethal self-harming behavior-

(Martinez et al., 2005; Tihonen et al., 2006).

Medications for depression are continually being developed. Researchers seek

to minimize the side effects of existing medications and to create new drugs for

people who do not get suffi cient relief from existing ones. For instance, some newer

antidepressants, such as venlafaxine (Effexor) and duloxetine (Cymbalta), affect

neurons that respond both to serotonin and norepinephrine; such medications are

sometimes referred to as serotonin/norepinephrine reuptake inhibitors (SNRIs).

Some other new antidepressants that affect noradrenaline (the alternative term for

norepinephrine) and serotonin are referred to as noradrenergic and specifi c seroton-

ergic antidepressants (NaSSAs, where Na stands for “noradrenergic”). The antide-

pressantmirtazapine (Remeron) is a NaSSa.

Clinicians may also prescribe any of the antidepressants discussed above for

dysthymia. The decision regarding which antidepressant to prescribe for any de-

pressive disorder is not yet based entirely on science—it is not presently possible

to predict which antidepressant will be the most effective with the least side effects

for a given individual (assuming that medication is the preferred treatment). Being

able to predict side effects is important because they often lead patients to stop the

medication. In fact, a majority of patients who receive medication for depression

stop taking the medication before it has had a chance to be maximally effective

either within the fi rst few weeks, before it can take full effect, or during an extended

period of better mood (Aikens, Nease, & Klinkman, 2008; National Committee for

Quality Assurance, 2007).

Some people with depression who do not want to

take prescription medication have successfully used an

extract from a flowering plant called St. John’s wort

(Hypericum perforatum). Results of meta- analytic stud-

ies comparing St. John’s wort to prescription antidepres-

sants and placebos indicate that the herbal medication

can help those with mild to moderate depression, and

sometimes—but less commonly—even those with severe

depression (Linde, Berner, & Krison, 2008; Linde et al.,

2005). Patients taking St. John’s wort report fewer side

effects than do patients taking prescription medications

(Linde, Berner, & Kriston, 2008); the most common side

effect is dry mouth or dizziness.

Another medication for which a prescription is not

necessary is ademetionine,orS-adenosyl-L-methionine

(SAMe), which was found to be as effective as the TCA

imiprimine and superior to a placebo (Agency for Health

Care Policy and Research, 2002; Pancheri, Scapicchio, &

Dell Chiaie, 2002). SAMe has been reported to reduce

depression more quickly than other antidepressants—in

about a week.

St. John’s wort, shown here as the plant and in capsule form, may lessen mild to moderate

depression but may not be as effective as antidepressant medication for those with

severe MDD (Linde et al., 2005).

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