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Anti-Depressants – Introduction, Types, Applications, Adverse Effects, Practice Problems and FAQ

Anti-Depressants – Introduction, Types, Applications, Adverse Effects,  Practice Problems and FAQ

There was a girl named Rimmy whose age is somewhat around 15 years. He was a “differently abled” child. Children of her age treat him differently and do not involve her in any of the games and sports.

Rimmy was a very humble girl and she always wanted to share the same bond that other child of her age does. Due to being differently abled, she was not treated well among her friends, this made Rimmy feel very hurt and feel depressed.

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Yes, I mentioned depression. What does this word mean? Do you have any idea?

Every person experiences depression in a different way. Nobody, no matter how compelling their example or life experience is, can adequately convey to the world how depression affects those of us who experience it.

To avoid such mental illness, people intake some medicines which give them a sort of relief from their depression. Such tablets which are used to reduce this mental illness are also known as Anti-depressants.

On this page, we will learn more about Anti-depressants, their type and their effects. Let us learn how this works on our body and what chemicals are involved in such kinds of drugs.

TABLE OF CONTENT

  • Introduction
  • Types of Anti-Depressants
  • Application of Anti-Depressants
  • Adverse Effects of Anti-Depressants
  • Practice problem
  • Frequently asked questions-FAQ

Introduction:

A sense of loss and a feeling of hopelessness is felt by almost everybody- rich and poor, old and young, weak and healthy, etc, at some point of time and for some reason. It is a mental status called depression. But most of the people, come out of this soon. But, a few have such despair or depression continued for more time, more frequently or say two weeks and think that they will not able to come out of this. Such people feel sad and hopeless and show a lack of interest in normal day-to-day activities and concentration, insomnia, weight changes, agitation sometimes violence and very poor self-respect. Such a continuous nature of depression is referred to as ‘major depressive disorder or MDD’. Genetic reasons, long illness, chronic pain, and some addictions are all some of the causes of depression.

Pharmacological and nonpharmacological treatments are possible. Nonpharmacological treatments like physiotherapy, talking, and walking do not have any side effects but the efficacy of the treatment can't be guaranteed.

Depression is associated with the reduction in the level of brain neurotransmitters like serotonin, which communicates with the cell of actions. This reduction of neurotransmitters was because of their degradation. The pharmacological treatment involves the prescription of antidepression drugs that either increase the neurotransmitters or control the activity of neurotransmitter destroyers. Antidepressants are effective in giving relief from moderate to severe depression. But they do have side effects like dry mouth, wooziness, headaches, sexual dysfunction, and emotional blunting. Any antidepressant can cause a withdrawal syndrome after quitting use that resembles recurrent depression.

Types of Anti-Depressants:

Antidepressants are frequently divided into distinct categories by doctors. These include Selective serotonin reuptake inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors and atypical antidepressants.

Before that just remember a few points related to the mechanism of action of Antidepressants.

  • Serotonin and noradrenaline concentration are crucial for many biological moods. The inhibitor interferes with reabsorption or reuptake receptors of these transmitters to maintain their concentration to pre or post-levels and thus elevate the biological moods of the person to normal,
  • Tricyclic antidepressants work by influencing around five separate neurotransmitter pathways. Serotonin and norepinephrine are more concentrated in the synaptic cleft as a result of their ability to prevent their absorption in presynaptic terminals.

Selective serotonin reuptake inhibitors (SSRIs)

Examples of SSRIs include:

  • escitalopram (Lexapro)
  • citalopram (Celexa)
  • fluvoxamine (Luvox)
  • fluoxetine (Prozac, Sarafem)
  • sertraline (Zoloft)
  • paroxetine (Paxil)

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

Compared to SSRIs, SNRIs are a more recent class of anti-depressants. They function similarly, though.

Doctors may prescribe SNRIs for

Obsessive-compulsive disorder (OCD)

  • attention deficit hyperactivity disorder (ADHD)
  • menopausal symptoms
  • anxiety disorders
  • chronic neuropathic pain
  • Fibromyalgia

Tricyclic antidepressants (TCAs)

For patients with fibromyalgia, depression, various forms of anxiety, and chronic pain, doctors may advise using TCAs.

Examples include:

  • Amitriptyline
  • Clomipramine (Anafranil)
  • Amoxapine
  • Doxepin (Sinequan)
  • Desipramine (Norpramin)
  • Nortriptyline (Pamelor)
  • Imipramine (Tofranil)
  • Trimipramine (Surmontil)
  • Protriptyline (Vivactil)

Application of Anti-Depressants:

Major depressive disorder (MDD) and other ailments, such as anxiety disorders, some chronic pain problems, and some addictions, are all treated with antidepressants. Antidepressants are frequently taken in conjunction with other medications.

People with MDD who are also anxious or irritable should be treated with norepinephrine reuptake inhibitors, and those who experience a loss of energy and enjoyment of life should be treated with norepinephrine and dopamine enhancing medications, according to proponents of the monoamine hypothesis of depression.

Major Depressive Disorder: MDD is classified into many types for treatment as follows.

a) Generalized anxiety disorder

The National Institute for Health and Care Excellence (NICE) advises using antidepressants to treat generalised anxiety disorder (GAD) when more traditional treatments like education and self-help activities haven't worked. GAD is a prevalent disorder with excessive concern about a variety of situations as its main characteristic. Excessive anxiety about a variety of situations and problems, as well as trouble controlling worrying thoughts that last for at least six months, are key indicators.

b) Social Anxiety Disorder

Although some antidepressants are used to treat social anxiety disorder, their effectiveness is not clear because few antidepressants were found effective in treating this illness. For this illness, the FDA originally approved paroxetine as a medication. Although not everyone responds well to the medicine, its efficacy is seen to be advantageous. Escitalopram is used off-label with good efficacy, although sertraline and fluvoxamine extended-release were eventually approved for it as well. Citalopram's effectiveness in treating social anxiety isn't supported by enough research, and clinical trials of fluoxetine showed that it was no more effective than a placebo. SSRIs (selective serotonin reuptake inhibitors) are used as a first-line therapy for social anxiety, but not everyone experiences success with them.

c) Obsessive-Compulsive Disorder

SSRIs are used as a first-line treatment for adults with moderate or severe functional impairment due to adult obsessive-compulsive disorder (OCD) and as a second-line treatment for those with modest functional impairment. SSRIs are used as second-line therapy in children with moderate to severe impairment, closely monitored for any negative psychological consequences. Both short-term treatment trials of 6 to 24 weeks and cessation trials of 28 to 52 weeks have shown efficacy.

d) Post-traumatic stress Disorder

One therapeutic option for PTSD is antidepressants, however, it is unclear how effective they are. The FDA has approved the use of paroxetine and sertraline, both members of the serotonin reuptake inhibitor class, for the treatment of PTSD. Sertraline and paroxetine both have slightly greater rates of response and remission for this illness, although neither medication is regarded as being particularly beneficial for a large patient population. Off-label usage exists for venlafaxine and fluoxetine. Fluoxetine has had unfavourable mixed effects.

e) Eating disorders

In the course of treating bulimia nervosa, antidepressants are suggested as an alternative to or additional first step to self-help programmes. Because of their greater symptom-reduction in short-term trials and higher acceptability and tolerability than other antidepressants, SSRIs—particularly fluoxetine—are chosen over other antidepressants. Long-term efficacy is still not well understood. Due to an increased risk of seizures, bupropion is not advised for the treatment of eating disorders.

f) Neuropathic pain

The antidepressant duloxetine has been shown to be effective in treating pain brought on by diabetic neuropathy, according to a 2014 meta-analysis from the Cochrane Collaboration. The same group also looked at data for amitriptyline's use in treating neuropathic pain and discovered few useful results from randomised clinical trials. The group was concerned about the possibility of overestimating the amount of pain relief provided by amitriptyline and highlighted the fact that only a small number of people will experience significant pain relief by taking this medication. They came to the conclusion that the long history of successful use in the community for the treatment of fibromyalgia and neuropathic pain justified its continued use.

Adverse effects of Anti-depressant

Anti-depressant side effects can initially be problematic, but they typically improve over time.

Even if you experience adverse effects, it's crucial to continue treatment because it will take many weeks before you start to feel its benefits. You should eventually discover that the advantages of the medication outweigh any negative side effects.

You will often visit your doctor or a specialised nurse at least once every two to four weeks throughout the first few months of treatment to assess how well the medication is working.

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) can have a variety of adverse effects, such as

  • indigestion and stomach aches
  • feeling agitated, shaky or anxious
  • loss of appetite
  • not sleeping well (insomnia), or feeling very sleepy
  • headaches

Practice Problems

Q1. Of the following, which one is not an antidepressant?

A. Venlafaxine
B. Imipramine
C. Clarithromycin
D. Sertraline

Answer: C

Solution: Whereas the other drugs are used to treat depression, clarithromycin is an antibiotic.

Q2. An antidepressant has an impact____________

A. Soon after administration
B. A day later
C. After 6 months of the administration
D. After 2 to 4 weeks of administration

Answer: D

Solution: Before an antidepressant can work, it must be taken consistently for two to four weeks.

Q3. The older antidepressants like imipramine and amitriptyline have side effects that include

A. Dry mouth
B. Sedatio
C. Both of the above
D. None of the above

Answer: B

Solution: Sedation, a dry mouth, blurred vision, constipation, urine retention, a drop in blood pressure, irregular heart rhythms, and the onset of seizures are side effects of older antidepressants. Different medications have different adverse effects, varying in severity.

Q4.Drugs resembling serotonin syndrome are observed with______________

A. Fluoxetine
B. Bupropion
C. Amitriptyline
D. All of the above

Answer: A

Solution: When someone using a selective serotonin reuptake inhibitor (SSRI) antidepressant like fluoxetine also consumes a serotonergic medication, serotonin syndrome develops. The symptoms include agitation, restlessness, sweating, twitching, and convulsions.

Frequently Asked Questions-FAQs:

Q1. What should one avoid while taking antidepressants?
Answer:
Avoid operating machinery or a vehicle. Avoid alcohol, smoke, and caffeine. Drink a lot of water. If your doctor permits, take your antidepressant right before night.

Q2. Why are antidepressants exhausting to use?
Answer:
Antidepressants make people tired. Norepinephrine and serotonin in particular are neurotransmitters that are acted upon by some antidepressants, causing them to stay in the gaps between nerve cells where they carry out their function of regulating mood.

Q3. What occurs when a normal individual takes antidepressants?
Answer:
Most antidepressants work by raising serotonin levels in the brain to improve mood and lessen depressive symptoms. Although this is advantageous for someone who is sad, taking antidepressant medicine can result in serotonin syndrome in someone who does not have depression since it causes serotonin to build up in the body.

Q4. What are the positives of taking antidepressants?
Answer:
Antidepressants balance chemicals in your brain called neurotransmitters that affect mood and emotions. These depression medicines can help improve your mood, help you sleep better, and increase your appetite and concentration.

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