It is estimated that more than 20% of the population of the United States suffers from some form of depression, which has its root cause in the nervous system (specifically neurotransmitters and their associated enzymes/activators/inhibitors). In this paper, answer the following questions:
What are the main types of antidepressant medications?
What is are the main mechanisms of action of antidepressant medications?
Are these medications over-prescribed in modern-day society?
Are there alternative strategies to help treat depression?
Antidepressants are often used to treat anxiety and depression. These are medical conditions that affect 17–20% of the population. It takes a few months for the clinical effects of antidepressants to be demonstrated, indicating that these drugs induce adaptive changes in the structure of the brain affected by depression and anxiety. It is crucial to understand how antidepressants work to develop shorter-acting and more effective drugs for anxiety and depression treatment.
Mechanisms of action of antidepressants
- The hypothalamic–pituitary–adrenal (HPA) axis
HPA axis plays a critical role in organisms’ response to stress, and a hallmark of depression and anxiety is the malfunction of the HPA axis. The hypothalamus secretes corticotropin-releasing hormone under stress condition (Rossby & Sulser, 1997). This hormone, in turn, stimulates the secretion of adrenocorticotrophic hormone from the pituitary. The adrenocorticotrophic hormone then stimulates the release of glucocorticoids from the adrenal cortex.
- GABAergic system
The GABA system is another important system in the understanding of depression and anxiety. The GABA neurotransmitter acts on inotropic GABAA, GABAC, and GABAB receptors. Nakamura, (2012), suggested the involvement of GABAergic dysfunction in mood disorders. He based this on studies with valproate; the mood stabilizer, which effectively treats bipolar patients
- The monoaminergic system
The first effective antidepressants, tricyclic antidepressants, monoamine oxidase inhibitors, noradrenaline augments serotonin levels in the synapse (Nakamura, 2012). This leads to the monoamine hypothesis for the pathology of depression, which showed a deficit in noradrenaline and serotonin in key areas of the affected patient’s brain.
Main types of antidepressants
The first modern antidepressants include tricyclic and monoamine oxidase inhibitors (MAOIs) and which were developed in the 1950s. MAOIs such as phenelzine are rarely used nowadays because they suddenly increase blood pressure if combined with ingesting a significant amount tyramine amino acid. Tricyclic such as Elavil (amitriptyline) at times cause side effects like weight gain and sedation that people do not like.
The newer class of antidepressants includes SSRIs such as Zoloft (sertraline) and Prozac (fluoxetine) (Paul, 2001). They work by targeting serotonin receptors and altering levels of this mood-boosting neurotransmitter. Another class is the SNRIs (serotonin-norepinephrine reuptake inhibitors) -Effexor (venlafaxine), which usually target norepinephrine receptors. There is also Wellbutrin (bupropion), which is thought to work on both norepinephrine and dopamine receptors. Bupropion is mostly used as an augmenting medication in cases of incomplete response to an SSRI.
Rising use of antidepressants
According to Nakamura, (2012), it’s between the years 1988 and 2008 that there was a sharp rise in antidepressants in the United States. It is worth noting that women in the age bracket of 40-60 years constituted the largest population that recorded higher rates of using antidepressants. Records reveal that about 11.0% of Americans use the drugs to treat various depressions related disorders compared to approximately 7.0% in 1999. Sadly, evidence reveals that Americans using antidepressants for over 2 years have risen from 3.0% to 6.0% within the same time frame persons (Qureshi1 & Al-Bedah, 2013).
One of the reasons is the high number of people diagnosed with depression related disorders. Currently, due to various factors and changes in culture, not many individuals can attest to having proper care and support from family members as well as friends. The aging of our population brings about its stresses. Other factors that include social, economic, environmental among others, have been postulated to increase depression cases.
Additionally, Americans culture tends to desire rapid solutions to problems. For this reason, patients suffering from depression disorder are not willing to spend long periods in therapy instead they prefer drugs. Additionally, the majority of individuals do not understand the difference between sadness and depression confusing the former to the later hence seeking medication for a different problem.
Interestingly, doctors and nurses (not psychiatrists) are in most cases the ones conducting diagnosis hence prescribing drugs for depression disorders. The problem is that they frequently have only twenty minutes maximum to see each patient. So when someone comes in and says they are not happy with life or not sleeping well, there is typically an inadequate time to make a comprehensive diagnosis. Instead, antidepressants are administered to such persons (Qureshi1 & Al-Bedah, 2013).
Psychological treatments -They can help a patient change his or her thinking patterns and improves coping skills so that he or she is better equipped to deal with life’s stresses and conflicts (Nierenberg, 2011)
Exercise-Regular exercise can be effective in treating depression through triggering the growth of new connections and brain cells just like antidepressants do (Qureshi1 & Al-Bedah, 2013).
Social support- Strong social networks help to reduce isolation, which is a crucial risk factor for depression. One should be in regular contact with friends and family (Qureshi1 & Al-Bedah, 2013).
Nutrition- According to persons Qureshi1 & Al-Bedah (2013), eating well-balanced diet is crucial for both physical and mental health. Such a diet ensures that apart from keeping mood swings at bay; diseases that can be associated with depression are also minimized.
Individuals suffering from anxiety and depression related disorders have been traditionally treated using antidepressants. The drugs induce adaptive changes in the structure of the brain affected by depression and anxiety. The main mechanism of action of antidepressant includes; hypothalamic–pituitary–adrenal (HPA) axis, GABAergic system and the monoaminergic system. Records reveal that there is a rise in the use of these drugs mainly due to increased cases of anxiety ad depression cases, the desire for quick solutions and diagnosis being made by doctors or nurses and not psychiatrists. There are indeed alternative treatment for anxiety and depression disorders and they include; proper dieting, engaging in physical activities, social support as well as psychological treatments
Nakamura, S. (2012). Antidepressants and morphological plasticity of monoamine neurons. Effects of Antidepressants. Doi: 10.5772/37593
Nierenberg, A. (2011). Alternatives to antidepressants in treating acute bipolar depression. The Journal of Clinical Psychiatry, 72(01), e03. Doi: 10.4088/jcp.9075tx3c
Paul, A. (2001). Calcium signaling cascades, antidepressants, and major depressive disorders. Antidepressants, 63-79. Doi: 10.1007/978-3-0348-8344-3_5
Qureshi1, N. & Al-Bedah, A. (2013). Mood disorders and complementary and alternative medicine: A literature review. Neuropsychiatr Dis Treat. 9: 639–658.
Rossby, P. & Sulser, F. (1997). Antidepressants: Beyond the synapse. Antidepressants, 195-212. Doi: 10.1007/978-1-59259-474-0_11
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