Treatment of depression

2021-07-14 04:15 PM

Two classes of drugs aim to increase serotonin levels by inhibiting its reuptake at the presynaptic terminus: tricyclics

Drugs that increase epinephrine: MAOIs

The most powerful antidepressants developed are monoamine oxidase inhibitors (MAOIs). These drugs prevent monoamine oxidase from breaking down norepinephrine in the synaptic cleft and help maintain its effects. As in many cases of psychotherapy, the discovery of the antidepressant effects of MAOIs was accidental. They were initially used to treat tuberculosis, but it was found that the patient's mood also improved. Since then, MAOIs have become commonly used drugs to combat depression. Its success rate is around 50%.

However, there are some points to keep in mind when using MAOIs. As in the brain, they block the production of monoamine oxidase in the liver and intestines. When broken down into tyramine, the substance can cause a sudden, fatal increase in blood pressure if it accumulates in the body. To avoid that risk, people taking MAOIs should abstain from cheese, red wine, marmite (a jam made from yeast or fruit used to spread on cakes - ND), bananas, and certain types of fish. contains tyramine. When eating these foods, there is a risk of a sudden increase in blood pressure to a fatal level. To avoid such problems a number of new MAOIs have been produced called selectively inverted MAOIs. However, recent studies show that serotonin plays a more important role than norepinephrine in the cause of depression.

Serotonin-boosting agents: tricyclics and SSRIs

Two classes of drugs aim to increase serotonin levels by inhibiting its reuptake at the presynaptic terminal: tricyclics (eg, imipramine, amitriptyline) and SSRIs (eg, fluoxetine, sertraline). Tricyclics also increase levels of norepinephrine. Initially, the first tricyclic, imipramine was also used to treat schizophrenia but was ineffective, but it did reduce depression in many people. Approximately 60-65% of people taking tricyclics experience improvement in symptoms (Hirschfeld, 1999). Its results are evident after about ten days. This may be because it initially reduced the amount of serotonin produced at the presynaptic terminal in response to the requirement in the synaptic cleft. The improvement in mood occurs after the system accepts the drug and begins to release serotonin at normal levels again. prevent reuptake and ultimately increase the required amount of serotonin. It is important that, after improvement in mood, the treatment regimen should be maintained for several months: approximately 50% of relapses within 1 year are due to early discontinuation of the drug (Montgomery et al., 1993). 

Side effects:

SSRIs are currently the preferred pharmacological means. It increases serotonin levels but has no effect on norepinephrine levels. Although they may not be more effective than tricyclics. But they have fewer side effects, such as constipation, dry mouth. They are also less dangerous when overdosed. Rocca et al. (1977) determined that 56% of people taking the tricyclics experienced dry mouth, while this figure in those taking SSRIs was only 8%. Currently, tricyclics and SSRIs are the treatment of choice for depression. MAOIs may be effective for some individuals who do not respond to these medications. However, the potential risk of using them makes them a second choice.

Side effects like dry mouth are minor for some people, but for drug users, they can be significant. Some users of the drug said:

The worst thing when I take this medicine is the feeling of dry mouth. When I say “dry mouth” I know very well what I mean. My mouth and lips are always dry. I always want to drink to prevent a dry mouth. However, drinking does not help much. I eventually switched to chewing gum. I chew all the time and I'm tired of chewing gum. This didn't seem like such a big deal, but when he felt like he was on the verge of collapse, it only got worse.

Another woman who took SSRIs with good results reported fewer side effects.

It's been great taking this medicine - I feel so much better. However, there is a problem… When I am depressed, what I want is to have sex with my husband. Now I can't wait…but the annoying thing is that I can't have an orgasm. It's like a joke, but it's annoying.

Prozac story:

Prozac (also known as fluoxetine) is a commonly prescribed SSRI, although it is still one of the most controversial psychoactive drugs. Eli Lilly, its creator, describes it as the number one new-generation antidepressant with no side effects. It should also be added that it is gaining popularity rapidly not only because of its antidepressant effects but also because it helps to improve the quality of life of people who are not depressed. This seems to increase trust, be more socially popular, and reduce anxiety and shyness around people. As a result, it has been widely prescribed in the United States for not only people suffering from depression but also those wishing to relieve emotional stress.

Initial success was immediately undermined by a series of complaints that Prozac had more side effects than the manufacturer claimed. Most worrisome is that the person taking the drug can lose control of their behavior and lead to self-harm or trouble with others. Lipinski et al. (1989) reported significant hyperactivity (akathisia), even in cases of agitation. These phenomena account for about 10-25% of Prozac users. This may have potential links to suicide and aggression. There are many historical cases where there have been risks associated with the use of Prozac. Rothschild & Locke (1991) reported three cases of suicide and attempted suicide while taking Prozac. Perhaps the worst thing about Prozac was that of Joseph Wesbecker, shot 20 people, including 8 who died at work before committing suicide. During this time Wesbecker was taking Prozac (Geoffrey, 1991). It is particularly noteworthy that although there are few case studies and sensational stories that cannot prove the connection between Prozac and dangerous behavior, it has attracted more public attention. to drug prescribing.

Empirical studies have shown that the potential risk associated with Prozac is smaller than in previous studies and as such, it also entails different explanations. Jick et al. (1995) followed 170,000 people who took 1 of 10 antidepressants for 5 years. The authors then compared suicide rates for different drug users. The rate is calculated per 10,000 people/year. The lowest rate was 4.7 among Lofepramine users, with an average suicide rate of 10.8 per 10,000 people per year. The highest rate is among Prozac users: 19.0/10,000 people/year. The authors suggest that the risk of suicide in people taking Prozac is due to a variety of factors, not just the drug itself. Among them are the poor effectiveness and the feeling of wanting to die when taking other antidepressants. After calculating each factor separately, there was a marked reduction in suicide risk among Prozac users, however, the suicide rate was still slightly higher than average. Despite such notices, in the US in cases where people who are using Prozac commit illegal acts, they are still prosecuted as usual.