HOW DO ANTIDEPRESSANTS WORK ON DEPRESSION Selen AK

HOW DO ANTIDEPRESSANTS WORK ON DEPRESSION? Selen AK 1803337 PSYC-374

Outline • Introduction ▫ Definition of depression ▫ Symptoms ▫ Treatment • How Serotonin& Norephinephrine Works? • Types of antidepressants ▫ TCAs ▫ MAOIs ▫ SSRIs • Tolerance and withdrawal symptoms • Conclusion

Definition of Depression • “An affective disorder characterized by loss of interest or pleasure in almost all a person’s usual activities or pastimes. ”

Symptoms Associated With Depression • Sadness, Despair, Guilt, Pessimism • Decrease in energy • Decrease in sex drive • Insomnia and fatigue • Thoughts of death and suicide • Mental slowing, lack of concentration • Experiments show that low level of serotonin cause these symtoms.

Treatment of Depression • Physiological Treatments ▫ Drug Therapies �Tricyclic antidepressants (TCAs) �Monoamine oxidase inhibitors (MAOIs) � Selective serotonin reuptake inhibitors (SSRIs) ▫ Electroconvulsive therapy (ECT) • Psychological Treatments ▫ Cognitive behaviour therapy (CBT) ▫ Behaviour therapy ▫ Interpersonal therapy (IPT)

Treatment (Cont. ) • Evolution of drug therapy ▫ Antidepressants discovered accidentally while investigating antipsychotic efficacy of modifications of phenothiazines ▫ Imipramine - first antidepressant discovered ▫ Around the same time, monoamine oxidase inhibitors were identified ▫ Second generation antidepressants identified to address problems with first generation antidepressants ▫ Late 1980’s- SSRI’s were developed ▫ Now working on other antidepressant treatments ▫ Also used for treatment of other disorders including: -Anxiety disorders, dysthymia, chronic pain and behavioral problems

Serotonin& Norephinephrine’s Working Principle • Serotonin (ser-o-TOEnin) and norepinephrine (norep-ih-NEF-rin) reuptake inhibitors ease depression by affecting chemical messengers (neurotransmitters) used to communicate between brain cells.

Effects of Serotonin: • Serotonin is involved in: ▫ ▫ ▫ appetite sleep memory learning temperature mood behavior Depression (People with depression have significantly fewer serotonin receptors in the hippocampus) cardiovascular function endocrine regulation regulating aging bone metabolism

Effects of Norephinephrine • Normally produces effects such as: ▫ ▫ ▫ increased heart rate, increased blood pressure, widening of pupils, widening of air passages in the lungs narrowing of blood vessels in non-essential organs. • This enables the body to perform well in stressful situations.

1. Tricyclics Antidepressants � Inhibiting reuptake of norepinephrine and serotonin. TCAs are called tricyclic because their chemical structure contained three rings. �The oldest antidepressants �Take 2 -4 weeks to work fully �Side Effects: weight gain, loss of sex drive, dizziness and nausea, dry mouth, blurred vision, increased heart rate

2. Monoamine oxidase inhibitors (MAOIs) � Inhibiting reuptake of norepinephrine and serotonin � Particularly effective in treating atypical depression � 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 � Used only when other classes of antidepressant drugs have failed • Side Effects: dizziness, insomnia, weight gain, headaches, sexual problems, daytime sleepiness

3. Selective serotonin reuptake inhibitors (SSRIs) �Increase activity of serotonin �The most commonly prescribed class of antidepressants �Milder side effects than other antidepressants �Reduce depressive symptoms more rapidly �Their adverse effects are less severe • Side Effects: nausea, insomnia, dizziness, weight gain or loss, tremors, sweating, anxiety and restlessness, decreased sex drive, drowsiness or fatigue, dry mouth, diarrhea, headaches https: //www. youtube. com/watch? v=G 4 r 3 q. Ck. LUDQ

Tolerance and withdrawal • Both side effects and main effects show tolerance • Withdrawal can happen. . ▫ ▫ Agitation Nervousness Chills Muscle aches • Easier to keep people on SSRIs

Conclusion • Criticisms of Drug Treatments: ▫ Do not “cure” the disorder ▫ Do not teach client coping and problem solving skills to deal with life problems ▫ High relapse rate ▫ SSRIs increase risk of suicide ▫ So, ▫ Best Treatment: both drug & psychological therapies.

References • Dukes, M. , & Garattini, S. (1967). Antidepressant drugs (1 st ed. ). Amsterdam: Excerpta Medica Foundation. • Freberg, L. (2006). Discovering biological psychology (1 st ed. ). Boston: Houghton Mifflin. • Friedman, R. , & Leon, A. (2007). Expanding the black box—depression, antidepressants, and the risk of suicide. New England Journal Of Medicine, 356(23), 2343 --2346 • Gartlehner, G; Hansen, RA; Morgan, LC; Thaler, K; Lux, L; Van Noord, M; Mager, U; Thieda, P; Gaynes, BN et al. (2011). "Comparative Benefits and Harms of Second-Generation Antidepressants for Treating Major Depressive Disorder: An Updated Meta-analysis". Annals of Internal Medicine 155 (11): 772– 85. doi: 10. 7326/0003 -4819 -155 -11 -201112060 -00009. • Kalat, J. (1998). Biological psychology (1 st ed. ). Pacific Grove, CA: Brooks/Cole Pub. Co. • Rickels, K. , Raab, E. , De. Silverio, R. , & Etemad, B. (1967). Drug treatment in depression: antidepressant or tranquilizer? . Jama, 201(9), 675 --681. • Sivagnanam, G (2012). Antidepressants. Journal of Pharmacology and Pharmacotherapeutics 3 (3): 287– 8. • Wheeler, V. , Mortimer, A. , & Tyson, P. (2003). Conventional antipsychotic prescription in unipolar depression, I: an audit and recommendations for practice. The Journal Of Clinical Psychiatry, 64(5), 568 --574.

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