Antidepressant Medications
Antidepressant medications are a class of drugs used to treat depression and other mood disorders. They work by balancing the levels of neurotransmitters in the brain, such as serotonin and norepinephrine, which are believed to play a role in regulating mood. There are several types of antidepressants, including selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants.
8 Key excerpts on "Antidepressant Medications"
- Amy E. Wenzel(Author)
- 2017(Publication Date)
- SAGE Publications, Inc(Publisher)
...Christiaan B. Brink Christiaan B. Brink Brink, Christiaan B. Linda Brand Linda Brand Brand, Linda Antidepressant Medications Antidepressant Medications 198 202 Antidepressant Medications Antidepressant Medications, or antidepressants, denote a class of drugs effective in alleviating depressed mood via neuromodulatory action in the brain but without inducing euphoria in an individual who is not depressed. This umbrella term may, however, be somewhat misleading, because these drugs are also effective in the treatment of an array of other mental health and neurological disorders, including dysthymia, anxiety disorders, obsessive-compulsive disorder (OCD), eating disorders, chronic and neuropathic pain, migraine, premenstrual dysphoric syndrome and dysmenorrhea, snoring, attention-deficit/hyperactivity disorder, premature ejaculation, addiction, dependence, and sleep disorders. For some of these other disorders, higher or lower doses are required than for the treatment of major depressive disorder (MDD); for example, higher doses are needed to treat OCD and lower doses are needed for certain types of neuropathic pain. This entry first describes the various types of antidepressants, along with their challenges, and then discusses the use of antidepressants in treating depression. Types of Antidepressants This section distinguishes between several classes of antidepressants, with each of these classes working differently within the brain and therefore also differing with regard to their therapeutic efficacy, side effect profiles, and pharmacokinetics. They also differ regarding their indications for various mental health and neurological disorders other than MDD. Hence, antidepressants are classified according to their mechanism of action (i.e., the neurobiological target where they modulate neurological function) and sometimes according to their chemical structure...
eBook - ePubMending a Broken Mind
Healing the Whole Person Who Suffers with Clinical Depression
- Andrew Adam White(Author)
- 2021(Publication Date)
- Cascade Books(Publisher)
...If an antidepressant has resulted in the remission of all the symptoms of depression, which often occurs with medical treatment alone, the illness of depression has ended. I’m not saying that counseling is not important. It is, but medications really do help most of the time. Also, some counselors exaggerate the side effects of antidepressants (more later). It is well known that part of an antidepressant’s effect is its placebo effect. Just taking a pill, especially if you have confidence in a prescriber who shows real concern for you, often improves depressive symptoms. Because of the placebo effect, some argue against the use of antidepressants, but they do have significant efficacy beyond that of the placebo effect. When one of my depressed patients improves on an antidepressant, it doesn’t matter to me whether it is the placebo effect or the effect of the medication or both. It is impossible to tell. What matters to me is that their mental pain and suffering are being relieved. There are four antidepressant classes of reuptake inhibitors: (1) There are seven selective serotonin reuptake inhibitors (SSRIs) that inhibit the reuptake of only serotonin. (2) There are five inhibitors (SNRIs) that inhibit the reuptake of serotonin and norepinephrine. (3) There is only one norepinephrine and dopamine reuptake inhibitor. (4) There are many tricyclic antidepressants but only five are prescribed with any degree of frequency today. Tricyclic antidepressants work in part on the reuptake of serotonin and/or norepinephrine. Tricyclic antidepressants are not used frequently today because they have more side effects than most other antidepressants. The effectiveness of most Antidepressant Medications is comparable across classes. With your input, your healthcare provider will determine which antidepressant medication is right for you...
eBook - ePubFoundations of Counseling and Psychotherapy
Evidence-Based Practices for a Diverse Society
- David Sue, Diane M. Sue(Authors)
- 2012(Publication Date)
- Wiley(Publisher)
...This condition sometimes continues even after medication is stopped or can spontaneously appear even after the medication has been discontinued. Therapeutic dose —the lowest dose of the medication needed to produce the desired effects. Titration of dosage —a gradual increase or decrease in medication that may occur as the medical professional attempts to find the correct dose. In general, Antidepressant Medications are believed to be effective through their impact on specific neurotransmitters (e.g., dopamine, epinephrine, norepinephrine, serotonin). The availability and use of serotonin has received particular attention, not only pertaining to depression, but also in relationship to anxiety disorders. Newer research has focused on processes occurring within the neuron rather than solely within the synapse, and on the possibility of different subtypes of depression involving various biochemical abnormalities (Rivas-Vazquez, 2001a). Antidepressant Medications are thought to work by correcting chemical imbalances in the brain. They are not addictive, but they do have a variety of potential side effects (American Psychiatric Association, 2000b) including sexual dysfunction, weight gain, dry mouth, dizziness, and constipation. It is important to monitor blood pressure–related side effects such as dizziness or weakness, especially in individuals already taking medication for high blood pressure, since drug interactions sometimes cause a significant drop in blood pressure. Any of the antidepressants can produce a manic or hypomanic response in certain individuals, which may result in the need to discontinue the medication. It is important for clients taking Antidepressant Medications to be aware of the potential effects of combining the medication with alcohol or products containing alcohol, including some cold medications...
eBook - ePubPracticum and Internship
Textbook and Resource Guide for Counseling and Psychotherapy
- Christin M. Jungers, Judith Scott(Authors)
- 2019(Publication Date)
- Routledge(Publisher)
...The following is a representative sampling of the more commonly used medications in the United States. Antidepressant Medications All antidepressants have similar effects, and most have different side effects. About 50% of patients will respond to the medications with some symptom reduction within the first several days to week of treatment. Remission of symptoms is harder to achieve and may take 8 to 12 weeks. Those patients who do not achieve remission of symptoms are more likely to relapse back into depression and are at an increased risk of suicide (Wegman, 2012). There are six classes of Antidepressant Medications on the US drug market: cyclics, selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), norepinephrine reuptake inhibitors (NRIs), monoamine oxidase inhibitors (MAOIs), and atypical antidepressants. Cyclics Tricyclic antidepressants (TCAs): This includes tricyclics and tetracyclics, which have similar chemical structures. TCAs are 65% to 75% effective in relieving the somatic features associated with depression. The cyclics are effective treatments for depression and were used primarily from the 1950s through the 1990s. Unfortunately, they can have serious side effects. They can be dangerous in overdose and can increase the sedative effects of alcohol and cause life-threatening heart rhythm disturbances when taken in overdose (Smith, 2012). Trade Name Generic Name Daily Dosage Anafranil clomipramine 150–200 mg Desyrel trazodone 150–400 mg Elavil amitriptyline 100–200 mg Norpramin desipramine 150–300 mg Pamelor desipramine 75–150 mg Sinequan doxepin 150–300 mg Tofranil imipramine 100–200 mg Note: See Wegman (2012). Selective Serotonin Reuptake Inhibitors (SSRIs) SSRIs, a second-generation antidepressant, have fewer side effects than TCAs and monoamine oxidase inhibitors (see below). Generally, SSRIs cause less weight gain and less sedation and hypotension than TCAs...
eBook - ePub- Roger S McIntyre, Carola Rong, Mehala Subramaniapillai, Yena Lee(Authors)
- 2019(Publication Date)
- Elsevier(Publisher)
...Numerous evidence-based treatments are currently available. In addition, new treatments are currently being investigated that hold promise for improved treatment outcomes. The specific objectives of this chapter are to review evidence-based pharmacological treatments, including recently approved antidepressants, along with promising experimental pharmacological treatments that are likely to be translated into clinical practice in the near future. After reviewing the various drug classes and specific agents, the general principles of pharmacological treatment of MDD will be discussed, including principles of initial antidepressant selection and management of treatment-resistant depression (TRD). Currently Approved Pharmacological Treatments of Depression As shown in Table 8.1, there are numerous different evidence-based antidepressants that are subcategorized into drug classes based on the primary mechanism of action. The main drug classes of antidepressants are SSRIs, selective serotonin and norepinephrine reuptake inhibitors (SNRIs), norepinephrine and dopamine reuptake inhibitors (NDRI), noradrenergic and specific serotonergic agents (NaSSAs), TCAs, MAO-Is, and melatonin modulators (agomelatine). More recently, multimodal serotonin modulator and stimulator (SMS) antidepressants (e.g., vortioxetine and vilazodone) have also been Food and Drug Administration (FDA)-approved, targeting the serotonin transporter (SERT) along with modulating specific serotonin receptors. This section reviews these drug classes and commonly prescribed antidepressants of each class...
- M. O. Faruk Khan, Ashok E. Philip(Authors)
- 2020(Publication Date)
- Bentham Science Publishers(Publisher)
...This medication became the most widely used antidepressant in the U.S. and worldwide. Today, a large number of SSRI antidepressants with differing structures, therapeutic efficacy, and safety are available on the market, with several being the most commonly prescribed medications (Fig. 2). Fig. (2)) Antidepressant agents frequently prescribed. INTRODUCTORY CONCEPTS Affective Disorders Affective disorders are also known as mood disorders. The most common affective disorders are MDD and bipolar disorder. MDD is characterized by depressed mood, loss of interest or pleasure in life, sleep disturbances, changes in appetite, feelings of worthlessness, fatigue or less of energy, diminished ability to focus and frequent thoughts of suicide. Depressed patients can also be irritable or anxious. MDD affects over 150 million people worldwide and is associated with high rates of morbidity and mortality. Pathophysiology - Biogenic Amine Hypothesis The biogenic amine hypothesis (Fig. 3) of mood postulates that brain amines, particularly norepinephrine (NE), serotonin (5-HT) and dopamine (DA), and their overlapping roles, are important in the expression of mood. According to this hypothesis, a decrease in the neurotransmission of NE, 5-HT and DA is thought to result in depression; a functional increase of these catecholamines in the brain synapses results in mood elevation [ 7, 8 ]. Prefrontal cortex, hippocampus, amygdala, and insula are regions in the brain that are involved in the pathophysiology of MDD. Serotonergic fibers in the brain project from the raphe nuclei in the midbrain to the limbic structures in the forebrain. 5-HT in the CNS is important in regulating sleep, appetite, impulsivity, sexual behavior, and aggression. It is believed that impaired 5-HT neurotransmission can decrease cortical responsiveness to emotional reactions and can lead to depression. The locus coeruleus (LC) is the major NE nucleus of the brain...
eBook - ePubCoping with Depression
A Guide to What Works for Patients, Carers, and Professionals
- Costas Papageorgiou, Hannah Goring, Justin Haslam(Authors)
- 2011(Publication Date)
- Oneworld Publications(Publisher)
...They might be taken regularly at first but, as progress occurs, they usually drop by the wayside. There have been a couple of other products released over the years, both of which may help anxiety in some people, but, to be honest, the benzodiazepines remain unchallenged. They are only a symptomatic treatment though and should never be used alone without trying to treat the underlying condition. That would be like using painkillers to mask pain without treating the cause. When it comes to choosing anti-depressants, I have a mental list of the order in which we would normally use them. This is inspired by the algorithm I mentioned earlier, but it is a guide only. There may be reasons to deviate from the guide, depending on the assessment of an individual. This guide puts a structure in place as follows: (1) selective serotonin re-uptake inhibitors (SSRIs), (2) serotonin and noradrenaline re-uptake inhibitors (SNRIs), (3) tri-cyclic anti-depressants (TCAs) and (4) monoamine oxidase inhibitors (MAOIs). Interestingly, all of them have a clue in their name as to how they work except the TCAs, which refers to the molecular shape. The TCAs, in fact, work in a broad-spectrum way on more than one neurotransmitter, like some of the others. To be fair, even the SSRIs will stimulate other neurotransmitter pathways by indirect actions. The general principles are the same for all, with some differentiating features I will mention as we go along. The selective serotonin re-uptake inhibitors (SSRIs) When it comes to it, the SSRIs are the usual starting point. They can usually be very helpful, although dosage might need adjusting along the way. They can be viewed as a mild introduction to the world of anti-depressants. They include fluoxetine, sertraline, citalopram, escitalopram and paroxetine. Their frequency of use is probably in that approximate order...
eBook - ePub- Shoshana S. Bennett(Author)
- 2011(Publication Date)
- For Dummies(Publisher)
...Tricyclics work by beefing up the brain’s supply of norepinephrine and serotonin — two important brain chemicals affecting mood if they’re low. Some of the more commonly used tricyclics are amitriptyline (Elavil), desipramine (Norpramin), nortriptyline (Pamelor), and imipramine (Tofranil). Some psychiatrists like to prescribe these meds during pregnancy and breastfeeding because they’re considered to be tried and true, having been around for so long. These meds are also prescribed for women who don’t respond well to the newer antidepressants, SSRIs (see the next bullet). Selective serotonin reuptake inhibitors (SSRIs): These substances work the brain’s serotonin levels, and have become increasingly more popular since the original SSRI, Prozac, was introduced in the late 1980s. Fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), and fluvoxamine (Luvox) and other SSRIs are the first line of treatment for most women with PPD. A mom with PPD commonly worries that an antidepressant will change who she is or will alter her in some way. If this is you, remember that the PPD has already altered you — you’re already changed by the illness. The antidepressant simply helps you get your real self back. So, in fact, you better hope it changes you — back to you! A woman with a personal or family history of bipolar disorder should be monitored very carefully if she’s given any amount of an SSRI, because an antidepressant may increase the risk of a manic episode in moms whose depression may actually be part of a bipolar disorder (jump to Chapter 3 for a description of a manic episode). Usually these moms are prescribed a mood stabilizer as well, (if they’re accurately diagnosed), which I discuss later in this chapter. Antianxiety meds Anxiety is a frequent and major symptom of PPD (see Chapter 2 for a list of all the other symptoms). Sometimes women who have PPD identify more with anxiety than with depression...
