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Depression
Published in Henry J. Woodford, Essential Geriatrics, 2022
The majority of antidepressants are believed to act by potentiating the effects of serotonin and/or norepinephrine within the brain. There is insufficient evidence to reliably compare all of the available antidepressant medications with one another. Meta-analyses suggest that the differences in efficacy and adverse events between serotonin specific reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs) and atypical agents may only be small.24 However, a review of studies performed in primary care suggested that SSRIs are better tolerated than TCAs.25 The decision on which agent to choose may be based on adverse effect profiles (seeTable 8.1). Those with more anticholinergic properties (e.g. TCAs; see page 47) are usually best avoided in older people. Another factor is whether it would be beneficial to stimulate or sedate the patient, depending on presenting symptoms. Those with insomnia may benefit from a sedating drug such as mirtazapine at night, whereas those with lethargy or withdrawal may be more suited to a non-sedating drug such as sertraline.
Drug evaluation in children
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
The use of antidepressants in children is increasing, although the evidence for the effectiveness and safety of pharmacological treatment of depressive disorder in children and adolescents is scant [33] and widely debated, particularly for SSRIs [34]. To date, the data available on safety and efficacy in the paediatric population are limited. SSRIs are more effective than placebo for the treatment of obsessive-compulsive disorder [35] and the American Academy of Child and Adolescent Psychiatry stated that SSRIs could be considered first-line drugs on the basis of their fewer side effects and lower toxicity profile with respect to clomipramine [31]. Concerning the treatment of major depression, a systematic review of the literature did not find a statistically significant difference between tricyclic antidepressants and placebo [36], while a few randomised controlled trials showed a better response with SSRIs compared to placebo [37–40]. However, solid evidence of the efficacy of psychotropic medications in treating depressed youths is still lacking [41]. Furthermore, the effectiveness of these drugs could have been overestimated due to publication bias [42].
Understanding and using anti-depressant medication
Published in Chris Williams, Roch Cantwell, Karen Robertson, Overcoming Postnatal Depression, 2020
Chris Williams, Roch Cantwell, Karen Robertson
Anti-depressants are not addictive in the way that some other drugs are, but stopping them in one go may cause you to have unpleasant withdrawal effects. You don’t get addicted to modern anti-depressants in the same way as you can to alcohol or tablets such as benzodiazepines (see below).
SSRI withdrawal syndrome in children and adolescents: a narrative literature review
Published in Expert Opinion on Drug Safety, 2023
Yasser Saeed Khan, Mohamed Adil Shah Khoodoruth, Yahia Albobali, Peter M. Haddad
The terms ‘Discontinuation’ and ‘Withdrawal’ have been used historically to describe the symptoms experienced by patients when antidepressant medication are stopped abruptly but both have invited criticism. Rather than getting bogged down in semantics, we would argue that irrespective of the term used, it is important to inform patients, whether adults or young people, about the nature of these symptoms before they start antidepressant treatment. This includes informing patients that antidepressant withdrawal symptoms occur on a spectrum of severity. At the severe end of the spectrum, symptoms can cause functional impairment and make it very difficult or impossible for a person to stop taking antidepressants, even when they are tapered slowly. At the other end of the spectrum are patients who can stop antidepressants abruptly and experience none or only mild and short-lived symptoms. There is a lack of research on the prevalence of withdrawal symptoms of different severities. It is equally important to explain to patients that antidepressants are not usually regarded as ‘addictive’ as despite causing withdrawal effects, they do not usually cause craving, tolerance, and loss of control over use which are features seen with most drugs traditionally regarded as addictive, e.g. alcohol, nicotine, and opiates.
Therapeutic potential of plant iridoids in depression: a review
Published in Pharmaceutical Biology, 2022
Yaoyao Kou, Zhihao Li, Tong Yang, Xue Shen, Xin Wang, Haopeng Li, Kun Zhou, Luyao Li, Zhaodi Xia, Xiaohui Zheng, Ye Zhao
Medications are the major treatment for depression. There are five main classes of antidepressants commonly used today: selective serotonin reuptake inhibitors (SSRIs), selective serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and atypical antidepressants (Skånland and Cieślar-Pobuda 2019). Outpatient-related reports state that only 25% of patients are in remission within 6 months and over 50% of patients are still depressed after 2 years. The chance of relapse is high, with approximately 80% of patients relapsing at least once in their lifetime (Wells et al. 1992; Penninx et al. 2011). In addition, these medications have a variety of negative effects, such as nausea, dizziness, headaches, and gastrointestinal discomfort, which can also lead to weight gain, sexual dysfunction, and sleep disorders (Cassano and Fava 2004; Cipriani et al. 2018). As a result, pharmaceutical practitioners pay attention to the screening and discovery of beneficial ingredients from natural products for the treatment of depression with few side effects.
Perspectives on the success rate of current antidepressant pharmacotherapy
Published in Expert Opinion on Pharmacotherapy, 2022
While newer-generation antidepressant tend to incur fewer and less hazardous adverse effects than seen with older-generation agents such as tricyclics or monoamine oxidase inhibitors, bothersome side effects remain prevalent. Common adverse effects of newer-generation antidepressants include weight gain, sexual dysfunction, insomnia, drowsiness, and gastrointestinal upset. In SSRI clinical trials for MDD, more than half of patients report the occurrence of at least one bothersome adverse effect [60], which in turn often contributes to subtherapeutic dosing intended to minimize adverse effects, low patient satisfaction with treatment results, or outright drug discontinuation. Some authors have also described an amotiovational/apathy syndrome that may arise in the course of SSRI pharmacotherapy for depression that is distinguishable from simply a residual depressive symptom [61], and potentially arising from SSRI-induced downregulation of prefrontal dopamine tone [62]. While antidote strategies have been described to manage antidepressant adverse effects such as weight gain or sexual dysfunction, the sheer presence and frequent persistence of adverse effects tends to diminish patient satisfaction and perseverance with maintenance therapy to prevent relapses.