AntidepressantsSelective Serotonin Reuptake Inhibitors

Norepinephrine Reuptake Inhibitors

SSRIs, SNRIs

Antidepressants are the second- most-prescribed-medication in the

United States• 15 million Americans are affected by

depression each year• 7% of all visits to the primary care doctors

involve the doctor prescribing antidepressant medication

• $10 billion dollars a year are spent on antidepressants

Antidepressant are use for the treatment of several different forms of depression

and other psychological disorders.

Psychological disorders that may accompany, precede, or cause depression: Bipolar Disorder, (OCD) obsessive compulsive disorder and (PTSD) Post Traumatic Stress Disorder

Depression is not uniform. Everyone does not experience the same the signs and symptoms. The severity, duration, and triggers of one’s symptoms

depend on the individual person and his or her illness.

What are some common symptoms of depression?

• Constant feeling of sadness, anxiety and emptiness• Feelings of hopelessness• Irritability• Lose of interest in activities or hobbies once enjoyed• Restlessness• Low energy, fatigue lose interest in sex• Complains of aches and pains• General feelings of pessimism• Hard to concentrate, hard to remember details, or make decisions• Sleep disturbance- sleeps too much or too little• Change in eating habits- eats too much or may have no appetite• Suicidal ideations• Complains more of body aches and pains- headaches, cramps, muscle tension.

What causes depression?(Integrated Model)

Experts say Psychology and Biology is a Two-Way Street

Biologic effects may secondarily affect psychological functioning in various ways:• Alter perception biologic effects can contribute to the pessimistic thinking seen in depressive

disorders and the tendency to anticipate fearful outcomes often seen in anxiety disorders.• Increased emotional sensitivity and reduced emotional controls. Increased arousal or pain may

motivate a person to become more socially withdrawn and can often lead to a host of negative conclusions regarding personal competency as in. “What’s wrong with Me? I’m crying like a baby.”

• Decreased energy and arousal, poor concentration, and lowered motivation, which often lead to impaired performance in school and work.

• Sexual dysfunction, which can translate into interpersonal problems in intimate relationships.• Bizarre behavior enacted during a manic or a psychotic episode. This behavior can continue to be a

source of tremendous personal embarrassment and shame long after the psychotic episode is resolved.

Handbook of clinical Psychopharmacology for therapists Sixth Edition (John D Preston, Psy.D ABPP John H. O’Neal, MD Mary C. Talaga, R. PH., Ph. D.)

What is the treatment for Depression?

• Some medications and physical ailments can cause the same symptoms as depression. It is important a full physical examination, interview and lab test completed by a general practitioner to rule out possible medical illnesses. Once medical conditions or pharmacological causes are ruled out, a full psychological evaluation is completed or referral to a mental health specialist is given.

What is the treatment for depression?(Continued)

• Mental health specialist should carry out a MSE (Mental Status Exam). The patient would be asked about Family history of depression or mental illness, when was the onset, duration, and severity of his or her symptoms, does he or she use drugs and alcohol, does he or she have suicidal ideation.

What is the treatment for depression?(Continued)

• The mental health specialist would also take note of how the patient presents during the interview, verbal and non verbal cues: how the patient is dressed, patient’s hygiene, is patient time and place orientated, does that patient exhibit bizarre thought patterns or abnormal speech (salad speech slow, delayed, soft, loud suspicious ) body movement ( rigid, slow, tense, hyper vigilant). The patient attitude toward the interviewer should also be noted.

Medications for Depression

• The Aim of an Antidepressant is to stabilize and normalize the neurotransmitters in our brain. Neurotransmitters such as serotonin, dopamine and norepinephrine play a role in regulating our mood.

SSRIs Selective serotonin reuptake inhibitors

• Celexa (citalopram)- is an antidepressant drug prescribed for the treatment of major depression associated with mood disorders. Celexa is also used on occasion in the treatment of body dysmorphic disorder and anxiety.

• Lexapro (escitalopram)- Lexapro is approved for the treatment of major depressive disorder and generalized anxiety disorder. Social anxiety disorder, panic disorder and obsessive-compulsive disorder are also some of the other indication for Lexapro.

• Prozac (fluoxetine) – Prozac is prescribed to patients suffering from major depression (including pediatric depression), obsessive-compulsive disorder (in both adult and pediatric populations), bulimia nervosa, anorexia nervosa, panic disorder and premenstrual dysphoric disorder. It remains to this day one of the best-known antidepressant brands.

• Zoloft (sertraline)- it has been approved for major depression, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), panic disorder and social phobia (social anxiety disorder).

SNRIsNorepinephrine Reuptake Inhibitors

• Effextor (Venlafaxine)-is primarily used to treat major depression, generalized anxiety disorder, social anxiety disorder, and panic disorder in adults.

• Cymbalta (duloxetine)-used to treat depression and generalized anxiety disorder. Duloxetine is also used to treat pain and tingling caused by diabetic neuropathy (damage to the nerves)and fibromyalgia. Its also used to treat ongoing bone or muscle pain such as lower back pain or osteoarthritis.

OTHER ANTIDEPRESSANTS INCLUDES BRANDS SUCH AS

• Bupropion (Aplenzin, Wellbutrin, Wellbutrin SR, Wellbutrin XL) is used to treat depression. Bupropion (Wellbutrin XL) is also used to treat seasonal affective disorder (SAD; episodes of depression that occur in the fall and winter each year). Bupropion (Zyban) is used to help people stop smoking.

• Tolyon• Ixel• Savella• Remeron• Avanza• Edronax

MAOIs and Tricyclics Monoamine Oxidase Inhibitors

• MAOIs are older antidepressants. They have more side effects than SSRIs and SNRIs.

• When SSRIs and SNRIs have an undesirable side affect MAOIs and tricyclics are used.

• Patients taking MAOIs have to be careful with their diet and other medications. Potentially serious interaction with cheeses, wines and pickles and decongestions. These items are high in tyramine which interact with MAOIs

• Patient may experience significant rise in blood pressure thus increasing the risk of stroke

• Must receive a comprehensive list of foods, medicines and substances you should avoid.

Side Effects of Antidepressants• Most side effects are mild and short-lived. It is rare for a patient to have long-term

side effects. • Most antidepressant side effects subside within the first few days to weeks of therapy.• Sexual dysfunction is a side effect of all serotonin reuptake inhibitors, venlafaxine, and

duloxetine. Bupropion and nefazodone have the lowest risk for sexual side effects.• The risk of suicide may be increased during the first month or so of antidepressant

therapy; physicians, patients, and family members should be vigilant for signs of suicidal thoughts and behavior.

• In elderly patients, serotonin reuptake inhibitors seem to be safer and better tolerated than tricyclic antidepressants. The choice should be made on the basis of side effect profile and drug interactions.

Side effects of antidepressants An overview: Cleveland Clinic Journal of Medicine, Volume 73. Number 4 April 2006 Retrieved January 29,2012 from http://consortiumconcepts.com/Library_files/Antidepressant

Adverse effect of antidepressantsdrugs, based on mechanism of action

• Norepinephrine transporter blockade• Anxiety Augmentation of pressor effects of sympathomimetic amines

Diaphoresis Tachycardia Tremor• Serotonin reuptake inhibition• Anorexia early in the treatment and weight gain later Dose-

dependent increase or decrease in anxiety Ejaculatory disturbances, anorgasmia, and decreased libido Extrapyramidal side effects

• Interaction with monoamine oxidase inhibitors and tryptophan Nausea, vomiting, and diarrhea. Sedation or insomnia Serotonin syndrome

• Dopamine reuptake inhibition

Adverse effects of antidepressant drugs, based on mechanism, of actions

(continued) • Activation and aggravation of psychosis Parkinsonism

Psychomotor activation• Alpha-1 adrenergic receptor blockade• Postural hypotension and dizziness Potentiation of the

antihypertensive effect of other medications Reflex tachycardia

• Dopamine D2 receptor blockade• Extrapyramidal side effects: akathisia, dystonia, parkinsonism,

tardive dyskinesia• Endocrine effects; prolactin elevation

Adverse effects of antidepressant drugs, based on mechanism, of actions (continued)

• Histamine H1 receptor blockade• Drowsiness Falls in the elderly Orthostatic hypotension

Sedation Weight gain• Muscarinic acetylcholine receptor blockade• Blurred vision Central effects: memory and cognitive

impairment, delirium in severe cases Gastrointestinal effects: decreased salivation, dry mouth,

Adverse effects of antidepressant drugs, based on mechanism, of actions (continued)

• decreased peristalsis, constipation Precipitation of narrow-angle glaucoma Sinus tachycardia Urinary hesitancy and retention

Side effects of antidepressants An overview: Cleveland Clinic Journal of Medicine, Volume 73. Number 4 April 2006 Retrieved January 29,2012 from http://consortiumconcepts.com/Library_files/Antidepressant

Benefits from Antidepressants

Take Time To Begin Working• It may take a few weeks before the patient begins feeling any

positive effect from medication • Patients may feel tempted to stop taking medication because it

is not doing anything. • If patient has not received any benefits from medication within

the expected timeframe, patient should talk to doctor about other options or dosage change

• Each person reacts differently antidepressant medication• Communicate with your doctor about your symptoms how you

are reacting to your antidepressant medication for the antidepressant treatment to be successful.

Benefits from Antidepressants(Continued)

• Do not stop taking your antidepressant without consulting your doctor first.

• The combination of psychotherapy and antidepressant has been shown to be very effective in treating depression and lessen the possibility of relapse

When we look at our body for a fix of the mind, then we can have problems. Let me explain. Do we just grab an antidepressant pill when we are just sugar coating the problem and not really investigating why we are feeling the way we are feeling? Is there a deeper rooted, older feeling that is lingering around until today that is manifesting in the way that we respond to the world? When the stock market crashes, do we?

Reinventing the Body, Resurrecting the Soul Part 2 of 9: Flexibility, December 24, 2009 by Dr. Iam Retrieved, January 29,2012, from http://lfp-blog.com/reinventing-the-body/reinventing-the-body-resurrecting-the-soul-part-2-of-9-flexibility/

Benefits from Antidepressants(Continued)

• Not everyone needs and antidepressant you and your doctor should determine if antidepressant medication is right for you.

• Antidepressants are not “magic pills”, they do help patients with the relief from some depression and symptoms when used correctly.