In 1988, the antidepressant Prozac was brand new to the market, and within a few years, it seemed like everybody had a prescription.

Because Prozac became so widely used, it seemed to make people more open to talking about mental health. But at the same time, it also lulled some into believing all you need to do for mental health challenges like depression is pop a pill. Some even derisively called Prozac the “happy pill” because it works as a selective serotonin reuptake inhibitor (SSRI), the first of a new class of drugs that affect a neurotransmitter in the brain. SSRIs increase the level of serotonin, which can boost a patient’s overall mood.

“When Prozac came on the market, it was kind of this breakthrough moment that there was something that could treat depression but didn’t carry with it this heavy side effect profile,” says C. Sophia Albott (M.D., ’11), an assistant professor of psychiatry and behavioral sciences at the U of M Medical School and a psychiatrist at M Physicians St. Louis Park Clinic. “That really ushered in the current era of antidepressant medication. Almost all of the medications that have come to market since Prozac have been variations on a type of medication that acts on certain brain transmitters.”

Doctors and pharmacists don’t always use brand names for drugs, but may instead refer to the generic names of these SSRIs, the most commonly prescribed class of medications for depression: fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), citalopram (Celexa) and paroxetine (Paxil). Originally approved by the Food and Drug Administration in 1987, Prozac—or fluoxetine—has proven broadly useful. It has since been approved for other conditions including obsessive compulsive disorder, bulimia, and panic disorder. It can also be used in combination with another medication, Zyprexa (olanzapine), to treat mania or depression stemming from bipolar disorder.

But despite the wide range of applications of these drugs, no single medication is magic. “If you have a holistic approach to treatment, I never say ‘this pill is going to be the only thing that we’re going to rely on,’” says Mark Schneiderhan, associate professor in the Department of Pharmacy Practice and Pharmaceutical Sciences at the U of M-Duluth. “The person’s going to have to do things like get out of the house, exercise, try to do their part…. They may have to stop smoking, they may have to change their lifestyle as far as diet.”

The once-in-a-lifetime conditions of the pandemic— which have brought about extended periods of isolation combined with fear of contracting the Covid-19 virus, possibly mixed with economic stress—have driven an increase in people grappling with mental health issues.

From August 2020 to February 2021, the Centers for Disease Control and Prevention (CDC) found the percentage of adults reporting recent episodes of depression or anxiety increased 14 percent to a total of 41.5 percent. The largest increases were seen in younger adults aged 18 to 29.

Albott says she has seen an uptick in patients since the start of the pandemic.

“We have seen more difficult-to-treat depression in our clinic over the past year,” she says. “The wait list to get into our clinic is really long.” She believes that the most effective first-line treatment is a mix of medication and therapy, since therapy offers what a medication can’t: human connection.

“I think psychotherapy is a really important piece. I think it’s really important these days to have someone to be talking to about our emotions,” says Albott. “I think our brains need interaction with people.”

The trend today towards personalized medicine includes finding the best medication for a patient. Personalized medicine refers to doctors analyzing a patient’s genes to gauge what drugs might be most effective, as well as which medications might be less effective. It’s something of a new medical frontier. “Having a personalized approach to medication treatment might be something to think about,” says Schneiderhan. “Right now, it’s mostly used when things fail.”

Schneiderhan stresses that just a mild improvement for a patient is not a success. “One thing that we have to do is [not] settle for just improvement of depression,” he says. “We want to shoot for remission … just ‘OK’ is not good enough. I think there’s a lot of stigma towards depression and suicide still. Tremendous stigma. That makes it hard to talk about.”

Albott specifically works with patients who have already tried medications and therapy and are not feeling any better; they experience what’s called treatment-resistant depression. “Up to one-third of people who attempt treatment with medications and therapy don’t respond,” says Albott.

One of the novel treatments offered to that group involves no medication at all and sounds a bit like science fiction, something called transcranial magnetic stimulation (TMS). In this treatment, magnetic fields stimulate parts of the brain which are underactive when people are depressed. The noninvasive procedure does not require sedation.

TMS was initially approved by the FDA in 2008; the University of Minnesota opened its clinic in 2015. Trying this treatment is a big commitment, however: Patients must report to the clinic five days a week for eight weeks for sessions that range from 10 to 40 minutes.

“It’s a completely different way of thinking about depression,” says Albott. “When people are done, they are good to go. We’ve had a lot of success with it.”

Burl Gilyard (B.A. ’92) is a Minneapolis-based writer.