Antidepressants work. Especially for people with serious depression (see The Good News About the “Bad” News About Antidepressants, published on February 12, 2010 in the Huffington Post  Many people ask, how? Many doctors answer speaking about brain chemistry, particularly mentioning brain chemicals, called neurotransmitters, which they say are not doing their job in making brain cells work well together. Some say there is a deficiency of a neurotransmitter, like serotonin or norepinephrine.

Well this is a charming explanation, like saying the sun is a big ball of flames. Indeed, the sun looks like a ball of flames, and you don’t want to get too close, but there is a lot more going on than that. As for what is going on in the brain in people with severe depression, and how antidepressants (ADs) work, no one really knows.  Maybe ADs work by producing greater concentrations of mood altering neurotransmitters, like serotonin and epinephrine, at specific sites in the brain thought to effect mood? Maybe these neurotransmitters permit nerve cells to protect against other cells and transmitters, like glutamate, believed to produce anxious and depressed mood states? Maybe neither of these. In twenty years we will be saying how little we knew twenty years ago.

But not knowing is not a reason for not acting. Much of what is done in medicine is done for what we call ‘empirical’ reasons: namely, studies show it works (empirical means not from theory but from observation and experiment). Empirically, we know that ADs work – and they are often safe and well tolerated. Which is why doctors prescribe them and many, many people take them, with benefit.

The question you or your loved one may want to ask is “do I need an antidepressant?” The answer to that question can be determined by asking: Is this a depression, with its characteristic symptoms, not a passing mood, grief, or another condition? If so, has it persisted for weeks, regardless of what I do to try to beat it? Does the depression affect my ability to function as a family member, at work, at school? And what options exist for treatment of my mood problem, including medications but also counseling, exercise, controlling drinking or drugs that affect mood, and support of family and friends?

Above all, don’t give up. Depression itself produces feelings of hopelessness and helplessness. Depression can be deadly, driving people to suicide and worsening serious medical conditions like heart disease, diabetes and asthma. Up to 75% or more of people with depression, including serious depression, can improve. That may take time and trying different treatments until the right one works for you.

Don’t let depression get you, before you get the best of it.

William Styron’s book “Darkness Visible” is a , short, poetic account of depression and suicidal feelings, which he survived.