Wednesday, February 21, 2024

Non Antidepressants Used For Depression

Doses And Duration Of Treatment

Lecture 32 SSRI+ and Non SSRI Antidepressant Treatments

Antidepressants are usually taken in tablet form. When they’re prescribed, you’ll start on the lowest possible dose thought necessary to improve your symptoms.

Antidepressants usually need to be taken for around 7 days before the benefit is felt. It’s important not to stop taking them if you get some mild side effects early on, as these effects usually wear off quickly.

If you take an antidepressant for 4 weeks without feeling any benefit, speak to your GP or mental health specialist. They may recommend increasing your dose or trying an alternative medication.

A course of treatment usually lasts for 6 months, although a 2-year course may be recommended for people with a previous history of depression. Some people with recurrent depression may be advised to take them indefinitely.

Read more about antidepressant doses.

Can Antidepressants Give You Suicidal Thoughts

In 2004, the FDA issued a black box label warning for suicidal ideation among 18- to 24-year-olds for common antidepressant drugs. This warning is the FDAs strictest warning for labeling prescription drugs.

The effect of suicidal thoughts is most common with SSRIs, occurring in about 4% of people who take them. However, untreated depression is considered to be much more of a suicide risk than taking antidepressants.

Personal Opinion: When To Use Antidepressants For Anxiety Disorders

It is highly debatable as to whether antidepressants should be considered first-line treatments for anxiety. There are people that are in favor of antidepressants because they believe benzodiazepines are dangerous, while there are other people that believe antidepressants end up creating more problems over the long-term than a benzo. Most professionals will not hesitate to recommend antidepressants as a safe first-line treatment option for anxiety.

I believe that certain medications like Buspar and Clonidine for anxiety are superior to antidepressants in managing pure anxiety if they work. When it comes to treating anxiety, it is always best to start with medications that are specifically created for treating anxiety and not necessarily depression. I have personally used Clonidine for anxiety and found it to be a pretty effective option for generalized anxiety symptoms. Additionally it doesnt seem to impede my focus like a benzodiazepine would nor did it affect my mood like an antidepressant.

Buspar is also relatively safe and is a non-benzodiazepine medication that has been approved specifically for anxiety. If you have just anxiety without depression, you may want to consider taking a medication specifically created for anxiety as opposed to an antidepressant. Why? Because over the long-term, using antidepressants can create a chemical imbalance and may even make you depressed.

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How Effective Are Antidepressants

Most people benefit from taking antidepressants to some degree, but research suggests antidepressants may not be as effective as previously thought in cases of mild depression.

However, they’re the most effective treatment in relieving symptoms quickly, particularly in cases of severe depression.

The Royal College of Psychiatrists estimates that 50-65% of people treated with an antidepressant for depression will see an improvement, compared to 25-30% of those taking inactive “dummy” pills . This means that most people do benefit from antidepressants, even if it’s sometimes a result of the placebo effect.

Add Greenery To Your Home Or Office

Depression

You may also find it helpful to add indoor plants to your home or office environment. Natural settings are associated with improved mental well-being, so it makes sense that “bringing the outdoors in” might help improve your mood.

Studies have shown that adding indoor plants to your home or office can help in a variety of ways, including:

  • Improving the workplace: Research has shown that office spaces enhanced with indoor plants improve worker concentration and workplace satisfaction.
  • Reducing stress levels: Another study found that actively interacting with indoor plans by caring for them can reduce both physiological and psychological stress.
  • : Research has found that students who spent most of their time at home during the COVID-19 pandemic had better mental health if they were exposed to more green plants. While about a third of the participants reported symptoms of moderate depression, those exposed to more greenery had lower levels of depression and anxiety.

Choosing certain plants may provide additional benefits. For example, research suggests that the scent of a lavender plant can help people feel calmer and more relaxed. No matter what type of plants you choose, greenery can be a great way to beautify your surroundings and potentially improve your mood.

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Why Antidepressants Are Preferred Over Benzodiazepines For Anxiety

There are many reasons why a doctor may prefer to prescribe an antidepressant as opposed to a benzodiazepine for anxiety. Although benzodiazepines are highly effective and arguably the most potent anxiolytic drugs on the market, they should be reserved for only the most extreme cases of anxiety. Unlike benzodiazepines, antidepressants have a low potential for addiction, arent associated with neurodegeneration, and are safer in regards to both usage and withdrawal.

Selective Serotonin Reuptake Inhibitors For Anxiety

Selective serotonin reuptake inhibitors approved by the FDA to treat anxiety disorders include:

  • Fluoxetine. Sold under the brand name Prozac®, fluoxetine is approved as a treatment for several anxiety disorders, such as panic disorder and obsessive-compulsive disorder .

  • Paroxetine. Sold under the brand name Paxil®, paroxetine is approved as a treatment for panic disorder, generalized anxiety disorder , obsessive-compulsive disorder , social anxiety disorder and post-traumatic stress disorder .

  • Sertraline. Sold under the brand name Zoloft®, sertraline is approved as a treatment for panic disorder, social anxiety disorder , obsessive-compulsive disorder and post-traumatic stress disorder .

  • Escitalopram. Sold under the brand name Lexapro®, escitalopram is approved as a treatment for generalized anxiety disorder .

  • Fluvoxamine. Sold under the brand name Luvox® CR, fluvoxamine is approved as a treatment for obsessive-compulsive disorder and social anxiety disorder.

Some other SSRIs, such as citalopram , arent approved by the FDA to treat anxiety disorders, but may be prescribed off-label by your healthcare provider to treat anxiety disorders if deemed safe and appropriate.

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If You Feel Better Can You Stop Taking Antidepressants

Once you and your provider have determined it is safe for you to stop taking your medicine altogether, you should continue to be monitored during periodic follow-up appointments to detect any signs of depression returning.

Long-term treatment with antidepressant medicine may be recommended to prevent further episodes of depression in people who have already had two or more episodes of major depression. A history of depression in ones family is another factor that supports long-term treatment.

Last reviewed by a Cleveland Clinic medical professional on 05/24/2019.

References

Pharmacokinetic And Pharmacodynamic Considerations Related To Adherence

TMS: A Non-drug Alternative Therapy for Treatment-Resistant Depression

Table 2

However, adverse effects can also be used therapeutically in certain cases. For instance, subjects with insomnia and weight loss might benefit from antidepressants with strong H1 receptor affinity, a particularly sedating agent. Importantly, beyond tolerability, if a drug is not effective and the subject affected by depressive episodes does not feel any relief/improvement/benefit, then poor adherence is as likely as for medications with several adverse events. This point is relevant because, as can be seen in Table 2, while all antidepressants outperform placebo regarding efficacy, the magnitude of the effect size ranges from an OR for response of 1.37 for reboxetine to 2.13 for amitriptyline.88. Cipriani A, Zhou X, Del Giovane C, Hetrick SE, Qin B, Whittington C, et al. Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis. Lancet. 2016 388:881-90. In this sense, amitriptyline, which is the antidepressants with the second-highest odds of being discontinued for adverse events , emerges as one of the most effective antidepressants and can be a good choice for subjects who did not show any response to other compounds. In other words, a patient might decide to accept adverse effects in exchange for the mood improvement that eventually only a TCA might exert in that specific patient.

Figure 1

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Psychological And Psychosocial Treatments For Postpartum Depression

Many mothers with postpartum depression are hesitant to take antidepressants due to concerns about infant exposure to medication through breast milk or concerns about potential side effects, and therefore often prefer psychological treatments.,, Although relatively few studies have systematically investigated nonpharmacologic treatments for PPD, existing research supports the use of both psychological treatments , as well as psychosocial interventions, such as nondirective counseling. A Cochrane meta-analysis of ten randomized controlled trials of psychosocial and psychological treatments for postpartum depression concluded that both psychosocial and psychological interventions are effective in decreasing depression and are viable treatment options for postpartum depression.

Interpersonal therapy

Cognitive behavioral therapy

Nondirective counseling

Peer and partner support

Comparisons of psychological and psychosocial treatments

A recent meta-analysis compared psychological and psychosocial interventions for PPD, including CBT, IPT, and nondirective counseling, as well as peer support. This study did not find any difference in effect size for any of these treatments, and concluded that different types of psychological interventions seem equally effective for treatment of PPD.

How Antidepressants Can Help To Treat Anxiety

Two types of antidepressants are typically used to treat anxiety disorders selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors .

SSRIs and SNRIs function by changing the levels of certain neurotransmitters in your brain and body. Neurotransmitters are chemical messengers that are used by your body to communicate between nerve cells and regulate your mood, behavior and other bodily functions.

More specifically, SSRIs work by increasing the amount of serotonin thats present in your brain.

Serotonin is sometimes referred to as a happy hormone or happy chemical. This is because it plays a key role in regulating your mood and feelings of well-being. It also assists in reducing feelings of depression and regulating your levels of anxiety.

Research has shown that low levels of serotonin are linked to depression, anxiety disorders and suicidal behavior. If you are feeling any of these consult a healthcare provider immediately.

SNRIs work by increasing the amounts of serotonin and norepinephrine that are present in your brain.

Like serotonin, norepinephrine is a neurotransmitter thats responsible for regulating mood and behavior. More specifically, its responsible for everything from helping you focus, to assisting in the management of your sleep-wake cycle, your response to stress and your memory.

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Best Ssris For Anxiety Include: Paxil Lexapro Zoloft

Below is a list of various SSRIs that have been used specifically for the purpose of treating anxiety. Although Paxil, Lexapro, Zoloft, and Luvox are the only ones FDA approved for various types of anxiety, others have been found effective as well. Additionally it should be mentioned that the SNRI drug Effexor is also approved to treat anxiety.

SNRI: This class of drugs works by inhibiting the reuptake of both serotonin and norepinephrine in the brain. The serotonin reuptake inhibition can create a sense of anxiety, but the norepinephrine reuptake inhibition can actually increase anxiety. For this reason, SNRIs are not as commonly used to treat anxiety disorders. Of all SNRIs, the drug Effexor is the only one that is approved to treat generalized anxiety disorder.

  • Effexor : This is the only SNRI approved to treat generalized anxiety disorder. It is likely effective due to the fact that it acts on serotonin significantly more than other SNRIs. The ratio of serotonin to norepinephrine reuptake inhibition is approximately 30:1. Most other SNRIs have ratios 10:1 or less in favor of serotonin.

Interactions With Other Medications

Understanding Antidepressants

Antidepressants can react unpredictably with other medications, including over-the-counter medications such as ibuprofen. Always read the patient information leaflet that comes with your medication to see if there are any medications you should avoid.

If in doubt, your pharmacist or GP should be able to advise you.

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How Does Your Doctor Select Which Antidepressant To Administer

Your doctor chooses which antidepressant medicine to recommend based on your symptoms, the presence of other medical conditions, what other medicines you are taking, cost of the prescribed treatments, and potential side effects. If you have had depression before, your doctor will usually prescribe the same medicine you responded to in the past. If you have a family history of depression, medicines that have been effective in treating your family member might be one factor to consider in choosing an appropriate medication for you.

Usually you will start taking the medicine at a low dose. The dose will be gradually increased until you start to see an improvement .

How Do Antidepressants Work

Various antidepressant medications are available for prescription use. There is no single best antidepressant, and the best one for you depends on your symptoms and individual needs.

Usually, antidepressants help balance the levels of neurotransmitters, which are chemicals responsible for communications between neurons in the brain. These chemicals include serotonin, dopamine and norepinephrine. Higher levels of these chemicals usually correspond with lower levels of depression.

While antidepressants can be helpful in depression, effectiveness varies from patient to patient. How long the drugs stay in your body also varies. Some drugs stay in your body for about 36 hours, while others last as long as several days.

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Should You Treat Your Depression With Medications

You might be asking your healthcare provider this question if you have been feeling low and your friends and family have mentioned this to you. Your provider might have mentioned medication if your mood interferes with work, family or socializing for more than two weeks. Some people with depression might even have legal troubles linked to outbursts.

Using Antidepressants For Anxiety And Depression

Antidepressant Medications

It should be mentioned that SSRI antidepressants are a great first-line treatment option for people with anxiety and comorbid depression and individuals with depression and comorbid anxiety. Although most doctors will simply throw SSRIs at you if you mention anxiety and depression, they may tweak treatments based on whether you are experiencing more anxiety than depression or vice versa. Below are various scenarios of how a person may be affected by anxiety.

Anxiety with comorbid depression: In this diagnosis, a person is primarily dealing with anxiety. The anxiety may be causing them to feel depressed and/or may be significantly more problematic than the depression. In this case, treating the anxiety may help the depression. In other cases, both the anxiety and depression need to be targeted.

Depression with comorbid anxiety: In this diagnosis, a person primarily is dealing with major depression. The depression could be causing them to feel anxiety and/or may be significantly more problematic than the anxiety. In this case, treating the depression may help the anxiety. In other cases, a doctor may need to target the depression and the anxiety for a person to feel relief.

Pure anxiety: For individuals with pure anxiety, it may be better to pursue anxiolytics prior to using antidepressants. If you get no relief from any drugs that your psychiatrist prescribes, you may get put on a benzodiazepine.

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Ketaminefrom Anesthetic To Depression Miracle Drug

Interestingly, studies from Yale research labs showed that the drug ketamine, which was widely used as anesthesia during surgeries, triggers glutamate production, which, in a complex, cascading series of events, prompts the brain to form new neural connections. This makes the brain more adaptable and able to create new pathways, and gives patients the opportunity to develop more positive thoughts and behaviors. This was an effect that had not been seen before, even with traditional antidepressants.

I think the interesting and exciting part of this discovery is that it came largely out of basic neuroscience research, instead of by chance, says Gerard Sanacora, MD, PhD, a psychiatrist at Yale Medicine who was also involved in many of the ketamine studies. It wasnt just, lets try this drug and see what happens. There was increasing evidence suggesting that there was some abnormality within the glutamatergic system in the brains of people suffering from depression, and this prompted the idea of using a drug that targets this system.

This is why Dr. Sanacora believes that ketamine may be most effective when combined with cognitive behavioral therapy . CBT is a type of psychotherapy that helps patients learn more productive attitudes and behaviors. Ongoing research, including clinical trials, addressing this idea are currently underway here at Yale.

Negative Effects Of Maternal Depression

The adverse impact of maternal depression on infant outcomes has also been studied. Depression has significant negative effects on a mothers ability to interact appropriately with her child. Depressed women have been found to have poorer responsiveness to infant cues and more negative, hostile or disengaged parenting behaviors. These disruptions in maternal-infant interactions have been associated with lower cognitive functioning and adverse emotional development in children, and they appear to be universal across cultural and economic divides., Other parenting behaviors are also affected, including problematic sleep habits, lower preventative health care utilization and undesirable safety practices. Chronic depression in mothers places children at higher risk for behavioral problems and later psychopathology, including anxiety, disruptive, and affective disorders conversely, remission of depression in mothers is associated with reduction or remission in the childrens psychiatric diagnoses. Maternal depression also increases the risk for negative infant feeding outcomes, including lower rates of initiating or maintaining breastfeeding, lower levels of breastfeeding self-efficacy, and more difficulties while breastfeeding. In low-income countries, maternal depression has been associated with both malnutrition and higher rates of diarrheal illness in children.

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Children And Young People

Children and young people with moderate to severe depression should first be offered a course of psychotherapy that lasts for at least 3 months.

In some cases, an SSRI called fluoxetine may be offered in combination with psychotherapy to treat moderate to severe depression in young people aged 12-18.

Learn To Recognize Negative Thinking

Beyond Depression: Other Uses for Tricyclic ...

Sometimes these thoughts can be obvious, such as times when you berate or criticize yourself. Other times, they can be more subtle. You might find yourself engaging in things like catastrophizing or all-or-nothing thinking.

Catastrophizing involves always anticipating negative outcomes. All-or-nothing thinking means that you think of things as either successes or failures with no in-between. Once you get better at recognizing these cognitive patterns, you can start working on some healthier replacements.

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