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UNDERSTANDING MAJOR DEPRESSIVE DISORDER
SSRIs ANTIDEPRESSANTS SIDE EFFECTS
SSRIs ANTIDEPRESSANTS SIDE EFFECTS:
To start with, what is Depression?
Depression is a natural or inborn state of mind producing serious and long term lowering of enjoyment of life or inability to visualize a happy future due to high levels of negative emotions and low levels of positive emotions. However,it’s a mood disorder that causes a persistent feeling of sadness and loss of interest and can interfere with daily functionality.
CAUSES OF DEPRESSION
It is often said that depression results from chemical imbalance in the brain, but the figures of speech don’t show how complex the disease is. Research suggests that Depression doesn’t result from having too much or too little of certain brain chemicals namely serotonin and norepinephrine, Rather there are many causes of Depression including:
BIOLOGICAL:
– Faulty mood regulation by the brain
– Genetic vulnerability
– Stressful life event
PSYCHOLOGICAL:
– the human strengths
It is believed that several of these forces interact to bring on Depression.
TYPES OF DEPRESSION
There are many types of Depression and they include the following:
- Situational Depression
TREATMENT OF DEPRESSION
There are four major types of treatment for depression. They include the following:
– Medications (ANTIDEPRESSANT)
– Psychotherapy
– TMS therapy (transcranial magnetic stimulation)
– ECT (electroconvulsive therapy)
Note: for this article, we will focus on Medication treatment (ANTIDEPRESSANTS)
ANTIDEPRESSANTS
ANTIDEPRESSANTS are prescription drugs mainly for the relief of depressive symptoms in patients diagnosed with Depression. Though they relieve the symptoms of depression, they do not cure it. They work by increasing neurotransmitters such as serotonin and noradrenaline in the brain. Aside from increasing neurotransmitters, they also disrupt pain signals sent by nerves thereby reducing overall body pain.
Mechanism of action: ANTIDEPRESSANTS inhibit reuptake of neurotransmitters(serotonin and norepinephrine among others) through selective receptors thereby increasing the concentration of specific neurotransmitters around nerves in the brain.
TYPES OF ANTIDEPRESSANTS
– Selective serotonin reuptake inhibitors(SSRIs)
– serotonin and norepinephrine reuptake inhibitors (SNRIs)
– Atypical antidepressants
– Tricyclic antidepressants
– Monoamine oxidase inhibitors (MAOIs)
– Other Medications
Selective serotonin reuptake inhibitors (SSRIs): SSRIs are prescribed to patients diagnosed with major depressive disorder(MDD). Examples of include the following:
– fluoxetine (Brand name: Prozac)
– citalopram (Brand name: cipramil)
– dapoxetine (Brand name: priligy)
And so on…
Serotonin and norepinephrine reuptake inhibitors (SNRIs): this class of antidepressants are effective in treatment of major depressive Disorder, anxiety disorders and nerve pains. While SSRIs act only on serotonin,SNRIs act on serotonin (feel good chemical) and norepinephrine (alertness and energy chemical). Examples of SNRIs include the following:
– desvenlafaxine
– duloxetine
– levomilnacipran
– milnacipran
– venlafaxine
And so on…
Atypical antidepressants: Atypical antidepressants are frequently used in patients with major depressive disorder who have inadequate responses or intolerable side effects during first hand treatment with SSRIs. Examples of Atypical antidepressants include the following:
– Bupropion (brand name: Wellbutrin)
– mirtazapine (Brand name: remeron)
– trazodone
– nefazodone
And so on…
Tricyclic antidepressants: Tricyclic antidepressant is an old treatment of Depression. They increase the level of serotonin and norepinephrine and block the actions of acetylcholine (a neurotransmitter that is released by the nerves that is essential for communication between the nerves and muscles). They treat different types of depression, obsessive compulsive disorder, bedwetting, panic disorder, chronic pain(tension headache), chronic itching etc… Examples of TCAs include the following:
– amitriptyline
– amoxapine
– desipramine
– doxepin
– nortriptyline
And so on…
Monoamine oxidase inhibitors (MAOIs): MAOIs are separate class from other ANTIDEPRESSANTS treating different forms of Depression and other nervous system Disorders such as panic Disorder, social phobia and Depression with atypical features (highly effective in treatment of Atypical Depressions, high levels of anxiety, anergic Bipolar Depression etc). They work by preventing the breakdown of the brain chemicals serotonin, norepinephrine and dopamine. Examples of MAOIs include the following:
– isocarboxazid
– phenelzine
– selegiline
– tranylcypromine
And so on…
Hence, all antidepressants work in relieving the symptoms of depression but never really cure them. For an antidepressant to start work, it usually needs to be taken for 1-2 weeks (without missing a dose) on average before seeing the full effect.
SSRIs ANTIDEPRESSANTS SIDE EFFECTS
To decipher the side effects of SSRIs antidepressants, it’s important to look into the constituents (recipients) of the drug so as to know what causes the side effects experienced in SSRIs antidepressants. For case study, we will use a very common type of SSRIs antidepressant say fluoxetine.
FLUOXETINE SSRIS ANTIDEPRESSANT
name: FLUOXETINE
brand name: PROZAC
Generic name: fluoxetine hydrochloride
DESCRIPTION:
Fluoxetine HCl (hydrochloride) or simply fluoxetine is made up of both active and inactive ingredients just as other antidepressants.
Inactive ingredients and their uses:
1. Corn & pregelatinized starch: binder, disintegrant and filler
2. Gelatin: creating of shell(protecting the content from light, atmospheric oxygen, contamination and microbial growth as well as masking taste and odor)
3. Magnesium stearate: causes ingredients to flow more easily and prevents them, as well as tablets, from sticking to machines during production.
4. Propylene: acts as solvent i.e helps in dissolving other solvents without changing their fundamental structure or composition.
5. Sodium lauryl sulfate: emulsifying agent, modified-release agent, tablet and capsule lubricant.
Active ingredient, description and uses:
FLUOXETINE HYDROCHLORIDE:
Fluoxetine hydrochloride (C17H18F3NO.HCL) is a combination of an organofluorine compound FLUOXETINE and a hydrochloride salt. Fluoxetine with a chemical formula as C17H18F3NO(active) belongs to the group of organic compounds known as trifluoromethyl benzene while hydrochloride salt is an acid salt with a chemical formula as HCL(inactive).
I.e
C17H18F3NO + HCL = C17H18F3NO.HCL(fluoxetine antidepressant)
C17H18F3NO.HCL(FLUOXETINE HYDROCHLORIDE i.e fluoxetine antidepressant) BREAKDOWN OF THE MAKEUP INGREDIENTS
ACTIVE INGREDIENT:
NAME: Fluoxetine
CHEMICAL FORMULA: C17H18F3NO
IUPAC name: N-methyl-3-phenyl-3-[4-(trifluoromethyl)phenoxy]propan-1-amine
PREPARATION & DESCRIPTION: fluoxetine is a chemical compound, a neurotransmitter(serotonin) selective reuptake inhibitor, a low molecular weight, racemic phenoxy phenyl propylamine synthesized/prepared by reaction of p-trifluoromethyl phenol with 3-(chloro)-N-methyl-3-phenylpropylamine in the presence of potassium carbonate.
EFFECT IN DRUG: neuronal serotonin reuptake inhibition ( inhibits the reuptake of serotonin to the neurons thereby making it much available for body system functioning)
INACTIVE INGREDIENT:
NAME: Hydrochloride
CHEMICAL FORMULA: HCL
IUPAC name: hydrogen chloride
PREPARATION & DESCRIPTION: Hydrogen chloride is a hydrogen halide and at room temperature, is a colourless gas which forms white fumes of hydrochloric acid(muriatic acid) upon contact with atmospheric water vapor. Note that hydrochloric acid is the aqueous solution of hydrogen chloride.
In preparation of hydrogen chloride, there are many methods for preparation of industrial HCL, most notably the reaction of salt with sulfuric acid.
But in chemistry(pharmaceutical), hydrogen chloride is an acid salt resulting or regarded as resulting from the reaction of hydrochloric acid with an organic base (e.g. an amine). Because of their important role in drug manufacturing, 15.5% of all drugs contain pharmaceutical HCL.
EFFECT IN DRUG: HCl is mainly used to aid the absorption of medications to the body system.
SSRIS ANTIDEPRESSANT SIDE EFFECTS(as a result of both active and inactive ingredients)
For SSRIs antidepressants, because each type has its characterized side effects, the most common and general SSRIs antidepressants side effects includes but not limited to:
- physical dependency(though not addictive but when used for a long period of time would cause physical dependence due to body system having adjusted to the medication use)
- Headache
- Nausea
- Dry mouth
- Insomnia
- Dizziness
- Diarrhea or constipation
- Sexual problems
- Fatigue
- Weight gain
- Tremors
- Increased sweating e.t.c
WITHDRAWAL TECHNIQUES
- Abruptly stopping: Antidepressant withdrawal is possible if you abruptly stop taking an antidepressant, particularly if you’ve been taking it longer than four to six weeks. Symptoms of antidepressant withdrawal are sometimes called antidepressant discontinuation syndrome and typically last for a few weeks. When experiencing withdrawal symptoms or antidepressant discontinuation syndrome, increasing physical exercise or changing the diet to include more fresh food may help ease symptoms by making a person feel reinvigorated and less lethargic.
- Tapering: slowly cut back your dose under the guidance of your doctor. This is called tapering. Tapering helps your brain adjust to the chemical changes and can help prevent discontinuation symptoms.
SSRIS ANTIDEPRESSANT SIDE EFFECTS
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UNDERSTANDING MAJOR DEPRESSIVE DISORDER
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