Summary: The effects of antidepressants are sometimes perceived in a simplified way. According to this kind of view, by raising the level of monoamines – serotonin, noradrenaline, dopamine – they “chemically” lead to improved mood, and more generally to resolving the symptoms of depression syndrome. On the other hand, mood improvement and remission of depression symptoms do not always occur after their administration. What is currently known about the mechanisms of their action? In particular, how do these mechanisms look in the light of neuropsychology and how are they mediated in the psychological and social situation of the subjects?
The paper discusses the report of a patient treated with trazodone, about his subjective experiences connected with treatment. It describes changes in the processing of emotionally salient information during treatment with this drug, changes in coping with stress, and drug modification of dimensions of aggression and anxiety.
Based on the literature, the cognitive neuropsychological hypothesis of antidepressant action is discussed. According to this hypothesis, medication changes the processing of emotionally salient information early in the course of treatment (within hours). However, mood improvement is not a direct result of its action. This decrease of the negative bias in the processing of emotionally salient information is then experienced in relations with the social environment. Repeated positive interactions with others lead to the development of new positive associations and a gradual improvement in mood. A similar process can be observed with eliminating the symptoms of anger/aggression and irritability. Resolution of these symptoms leads to improvement in social interactions and is followed by improvement of mood. The action of the drugs takes place in two phases. One is directly related to their impact on automatic brain and psychological information processing relevant to depression. In the second phase, a new, more positive bias needs to be “enacted” by interactions in the social environment.