Antidepressants: Composition, Therapeutic use, Treatment. Antidepressants Effects. Reactions with other drugs.

Last modified: Thursday, 25. December 2008 - 5:41 am

 

Official names: Amitriptyline (Elavil), amoxapine (Asendin), bupropion (Wellbutrin), citalopram (Celexa), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), fluoxetine (Prozac), imipramine (Norfranil, Tofranil), isocarboxazid (Marplan), maprotiline (Ludiomil), mirtazapine (Remeron), nefazodone (Serzone), nortriptyline (Aventyl, Pamelor), paroxetine (Paxil), phenelzine (Nardil), protriptyline (Vivactil), sertraline (Zoloft), thioridazine (Mellaril), tranylcypromine (Parnate), trazodone (Desyrel), trimipramine (Surmontil), venlafaxine (Effexor); the herb St. John’s wort (Hyper-icum perforatum) is sold over-the-counter without prescription

Street names: Happy pills

Drug classifications: Not scheduled, psychotherapeutic drugs

 

Key terms

DEPRESSION: A feeling of sadness and helplessness with little drive for communication or socialization with others.

HERB: Any such plant used as a medicine, seasoning, or food. Mint, thyme, basil, St. John’s wort, and sage are herbs.

NEUROTRANSMITTER: A chemical produced by one nerve cell that stimulates another nerve cell in the process of sending messages along the nerves.

POST-TRAUMATIC STRESS DISORDER: A mental disorder that can occur in those who have experienced a life threatening-situation. PTSD is characterized by nightmares and flashbacks, among other symptoms.

PSYCHOTHERAPEUTIC DRUGS: Drugs used to relieve the symptoms of mental illness, such as depression, anxiety, and psychosis.

PSYCHOTHERAPY: The non-drug treatment of psychological disorders. It can be in the form of behavioral therapy (where the person is gradually exposed to their fears) or cognitive therapy (where people learn to control their unrealistic or negative thinking.

REU PTAKE: The process by which a nerve cell reabsorbs the chemical it had used to send a message to another nerve cell.

STRESS: A disturbance in the body’s physiological equibrium, resulting from psychological or physical forces on a person.

 

Overview

Depression is an illness that affects the body, moods, and thoughts. It affects how people eat, sleep, take care of themselves, and how they think of themselves. It is an illness that requires medical assistance. It may originate with a stressful situation, a medication, or another illness.

Scientists were looking for drugs to treat different medical problems when their observations almost accidentally led them to the study of depression and its treatment. Many scientists continued in this new direction to the discovery of the current three classifications of antidepressant drugs used today: monamine oxidase inhibitors (MAOIs), tricyclic drugs (TCAs), and selective serotonin reuptake inhibitors (SSRIs).

One such accident occurred in the 1950s, when scientists searching for a tuberculosis treatment observed that the drug iproniazid caused mood elevation. Since there were few treatments for depression, the findings were exciting.

Reserpine, a drug used for the treatment of high blood pressure, was known to have the side effect of depression. Upon studying this effect, scientists observed that this drug caused a depletion of the amine neurotransmitters serotonin and norepinephrine. Neurotransmitters transmit “information” from one nerve to another across a “synapse.” The neurotransmitters are than reabsorbed by the first nerve in the process called reuptake.

The depletion of the neurotransmitters — as observed with reserpine — came under study as the possible cause of depression and became known as the “amine hypothesis of depression.” The drug iproniazid reversed some of these negative side effects, confirming the usefulness of drugs in the treatment of depression.

When used with psychiatric patients, iproniazid showed mood elevation and heralded the first class of antidepressants — the monoamine oxidase inhibitors (MAOIs) — into psychiatric practice.

Names associated in these discoveries include Roland Kuhn and John Cade. While looking for a treatment for depression, Kuhn worked with thorazine, the newly found drug effective with schizophrenia. He progressed to find the second classification of antidepressants, the tricyclic drug (TCA) imipramine, a close chemical relative of thorazine.

In the 1950s Marsilid (the brand name of iproniazid) and Tofranil (imipramine) were manufactured and sold as antidepressant drugs.

When studying manic patients, who have a form of depression with periods of abnormal excitability and excessive activity, Australian psychiatrist John Cade found that lithium had a controlling effect on the patient’s mania. He used lithium as a solvent when he attempted to inject the urine of manic patients into guinea pigs and found it made the urine less toxic. It was this finding that sparked his interest in lithium. In 1948 he injected lithium into ten patients and observed that lithium controlled their mania.

As a result of these findings, the emphasis in the study of depression from the 1950s to the present has centered on the study of the brain and the chemical actions occurring there. Research emphasis in the 1980s moved to serotonin, a neurotransmitter in the brain. Through the 1990s into the 2000s, the newer and third classification of antidepressants became the serotonin reuptake inhibitors (SSRIs). Prozac is among this group of drugs. They interfere with the reabsorption of serotonin in the brain and have fewer side effects than the earlier classes of antidepressant drugs.

Extensive media coverage in the 1990s made the public aware of Prozac and greatly increased the demand for the drug. Some people got the impression that it had no side effects, helped in weight loss, and was a sort of “happy pill” that everyone should take. But neither this nor the other SSRI drugs improve mood or make healthy people high or happier if they are not clinically (observed symptoms) depressed.

Knowledge of these drugs has increased the public’s demand for them at times of personal or societal tragedies and crises. In 1999, as many as 135 million prescriptions for antidepressants were filled in the United States.

As far back in history as the Greek physicians Hippocrates, Pliny, and Galen, through to present time, the herb St. John’s wort has been used for its antidepressant effect. It is believed to influence the neurotransmitters in the brain. Although some research has shown it to be effective in cases of mild to moderate depression, many questions remain as to its safety and effectiveness.

In Germany, St. John’s wort is approved for use in depression and anxiety. It is the most common antidepressant used and is usually sold by prescription. However, in the United States it is sold only as an herb and without prescription. It is frequently used by people with self-diagnosed depression. Preparations of St. John’s wort will vary in potency according to manufacturer. Although extensive studies have been conducted on the usefulness of St John’s wort, the evidence has not been conclusive. More recent studies raise even more questions about its effectiveness.

By the end of 2002 the National Institutes of Health (NIH) will make their large study of the herb available. This should clear up the confusions concerning its effectiveness.

 

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