Pharmacotherapy & Depression

Disclaimer: I am not a medical doctor, this blog post was put together by the information I’ve gathered from research, my education, presentations from mental health professionals, and my own experience working with individuals who have depression. This blog post explores the use of medication to treat depression.  Medication is not the ONLY treatment for depression.  Before using medication, I would suggest talking to your doctor, doing some research on your own, and trying other forms of treatment first like counseling, exercise, diet, and etc.

Understanding Depression & the Brain

The human brain operates, much like your car, it runs on fluids called neurotransmitters. Just as your car needs brake fluid, antifreeze, transmission fluid, and oil – your brain runs on these neurotransmitters and need them to run optimally.

The brain neurotransmitter most often associated with depression is called serotonin. Serotonin is the brain’s “oil”, a rather slow-acting neurotransmitter that is associated with sleep, appetite, energy, alertness, and mood. Using the car example, if we drive our car to California at a speed of 120 mile per hour, running the engine hot for a long time, it would obviously use more oil. As long as we provided gas, however, it would continue to run. Now suppose in our trip that for every two quarts of oil we burn, we only replace one quart. By the time we reached California we’d be several quarts low and our engine would be obviously overworked and overheated.

During long-term high stress, the brain burns its’ oil, serotonin, at a higher rate. In terms of depression, the brain and stress,  the brain burns up more serotonin than it can replace.  In the end result, after many months of severe stress, the brain is using serotonin faster than it can create/replace it. Your neurochemical level of serotonin drops and you become depressed.

Depression, at some level, will hit every adult eventually at some point. While most depressions are brief, with our serotonin gradually returning as stress decreases, some individuals may need professional treatment to recover. It’s also important to know the difference between stressed or depressed.

Symptoms of Stressed:                                                              Symptoms of Depressed:
-Feeling overwhelmed and burned out                                 -Feeling sad and hopeless
-Feeling irritable                                                                        -Withdrawing and isolating from others
-Feeling tired and a lack of energy                                         -Insomnia or Hypersomnia
-Trouble sleeping                                                                       -Anhedonia: loss of pleasure in activities
-Trouble functioning in class, work, home                           -Difficulty with Memory and Concentrating

If you think you may have depression, obtain an opinion from a mental health or medical professional. The right medication regimen may give the foundational stability emotionally and mentally that individuals may need. 

Antidepressants

The two main neurotransmitters with depression are serotonin and norepinephrine.  The basic idea is that the areas of the brain that process and dictate mood and the perception of events around mood are highly influenced by how adequately they are stimulated by these neurotransmitters.  Most antidepressants relieve depression by affecting these neurotransmitters.

Classes of Antidepressants

  • Selective serotonin reuptake inhibitors (SSRIs). Most commonly prescribed.  These medications are safer and generally cause fewer bothersome side effects than other types of antidepressants. The SSRIs include drugs such as Prozac, Zoloft, Cipralex, and Paxil.  The SSRIs are preferred over older classes of antidepressants such as tricyclic antidepressants and MAOIs because their adverse effects are less severe.  SSRIs work by blocking the reuptake of serotonin, so serotonin stays between the synapses longer.
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs) are among the newer types of antidepressants. As the name implies, they block the reuptake of both serotonin and norepinephrine. They include Cymbalta, Effexor, Khedezla, Fetzima, and Pristiq.
  • Norepinephrine and dopamine reuptake inhibitors (NDRIs) are another class of reuptake inhibitors, but they’re represented by only one drug, Wellbutrin. It affects the reuptake of norepinephrine and dopamine.
  • Tricyclics antidepressants.  Older class of antidepressants. They work by inhibiting the brain’s reuptake or serotonin and norepinephrine. They also partially inhibit the reabsorption of dopamine. Because the tricyclics have such a broad mechanism of action, they tend to cause more side effects than the other classes of antidepressants. For this reason, the SSRIs and the atypical antidepressants are usually prescribed first.
  • Monoamine oxidase inhibitors (MAOIs). are the oldest class of antidepressants. MAOIs have severe interactions with certain foods, drinks, and medications. Combining MAO inhibitors with foods or drinks containing tyramine can result in dangerously high blood pressure, which can lead to a stroke or heart attack. Because of this danger, MAOIs are not typically chosen as a first-line depression treatment.

Recommendations

  • Begin with a low dose and go slow. Monitor your physical and mental health. These medications take up around 4-8 weeks to work.  Things will most likely happen backwards so don’t let it alarm you.  You may experience the side effects first until the medication starts to work.  Side effects vary, depending on what type of medication you are taking, and may improve once your body adjusts to the medication.
  • Give one medication sufficient time before giving up.   It can take some time to see any positive effect.  So it’s important to not give up right away and give each medication a fair try.  If you decide to stop taking your medication, it is important that you gradually reduce the dose over a period of time recommended by your doctor. The side effects almost always come before the benefits
  • Give the anti-depressant at least 6-12 months after fully recovering from a depressive episode before tapering off.
  • Remember that about 70% of the time depression will re-occur during a person’s lifetime. 
  • Medication treatment should not be considered the only treatment but should be done in conjunction with counselling and social supports.

References

Carver, J. (n.d.) Depression, Causes, Symptoms, and Treatment. Retrieved from http://www.drjoecarver.com/

Mayo Clinic (2014). Antidepressants: selecting one that’s right for you. Retrieved from http://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046273

Noah Liguori, RPN & Jayeson Shaffer, MEd, BSW, RSW (Personal Communication). A brief overview of medications used in psychiatry, April 2015.

 

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