Anti-depressants

Chemical involved in anti-antidepressants

Antidepressants primarily work by increasing the activity of neurotransmitters in the brain, such as serotonin, norepinephrine, and dopamine, which help regulate mood.

Side effects of AD

Feeling agitated, shaky, anxious, sickly, indigestion, stomach/headache, diarrhoea, constipation, loss of appetite, dizziness, insomnia, reduced sex drive, erectile dysfunction, difficulties achieving orgasm during sex/ masturbation.

-Feeling agitated

-Dizziness

-reduced sex drive

-loss of appetite

-insomnia

Conditions with similar symptoms to depression

-Is important to know past medical history before prescribing because there conditions that have similar symptoms to depression like: thyroid problems, menopause, hormone issues, vitamin deficiency, low libido.

-Its also important to know that antidepressants simply won’t work if prescribed inappropriately.

Selective serotonin reuptake inhibitors (SSRIs)

It is the most commonly prescribed antidepressant. They work by increasing the concentration (amount) of serotonin in the brain. Serotonin helps to regulate mood, memory, pleasure, sleeping, eating, learning and cell communication. It is also licenced for anxiety and OCD.

Examples of SSRIs

-Setraline

-Citalopram

-Fluoextine 

-Paroxetine

-Escitalapram

Selective serotonin and noradrenaline reuptake inhibitors (SNRIs)

they are a class of antidepressants that increase the levels of serotonin and norepinephrine in the brain by blocking the reabsorption of neurotransmitters.

Examples of SNRIs

-Venlafaxine

-Duloxetine

-Milnacipran

SSRIs vs SNRIs

-SNRIs is newer and stronger than SSRIs

-SNRIs side-effects can be stronger and overdose can be more dangerous

-SSRIs block the reuptake of only serotonin, while SNRIs block the reuptake of both serotonin and noradrenaline (also called norepinephrine

-Venlafaxine tends to be used when SSRIs haven’t worked

-Serotonin, Reuptake (think about recycling), Inhibitors (think about stopping)

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Tricyclics 

They work by blocking the reuptake of the neurotransmitters serotonin and norepinephrine. The increase of these chemicals helps regulate mood, attention, and pain.

Tricyclics are rarely prescribed as front line treatment as they are very lethal in overdose, and have quite unpleasant side-effects.

Tend to see them in older people who have been on them for many years.

They are also used to treat nerve pain, so always check what condition the patient was prescribed the drug for.

Types of tricyclics

-Amitriptyline (can be used for neuro pain)

-Trazodone 

-Doxepin

Monoamine Oxidase inhibitors (MAOIs)

They work by blocking the enzyme monoamine oxidase, which increases the levels of neurotransmitters like serotonin, dopamine, and norepinephrine in the brain. (They are rarely ever prescribed)

Noradrenaline and specific serotonergic antidepressants (NASSAs)

Another type of antidepressant that works by blocking certain alpha-2 adrenergic receptors and specific serotonin receptor.

Example of noradrenaline and specific serotonergic antidepressants

Mirtazapine (in small doses can help with insomnia )

When should anti-depressants be prescribed?

Should avoid medication unless someone is quite impaired by their depression. Depression is now split into ‘less severe’ and ‘more severe’. Screening tools include PHQ-9 and the GAD -7

First-line treatments for less severe depression

First-line treatments for more severe depression

Physical health promoting

They can impact cardiac health, that is why base lines are important to look out for

•Many antidepressants prolong the QTc

•Prolonged QTc can result in fainting

•Ventricular fibrillation (VF)

•Death

•The longer you have prolonged QTc the bigger the risk of serious complications.

Escalation of ECG

Men QTc over 430- escalate

Women QTC over 450- escalate

Hyponatreamia

A low concentration of sodium in the blood. Defined as sodium levels below 135 mmol/L.

Some SSRIs can also cause hyponatremia.

Symptoms of hyponatremia

Nausea, vomiting, headache, coma, seizures, confusion, restlessness, muscle weakness, loss of energy, fatigue etc.

Serotonergic agents

Are drugs which affect/increase the neurotransmitter serotonin (E.g. antidepressants). Including drugs that act on serotonin receptors, increase serotonin release, or block its reuptake. They work by altering the levels of serotonin, a neurotransmitter, in the brain to affect mood and emotions

Examples of serotonergic agents

-Opiates/ Opioids- powerful drugs that work on the CNS.Drugs that tend to be misused / abused tend to be serotonergic.

-Some cough medicines dextromethorphan

-migraine medication-any triptans

-HIV/AIDS medication- Ritonavir

-Some antibiotics

-Some anti-nausea medication

Serotonin syndrome

-Potentially life-threatening drug reaction caused by having too much serotonin in the body's central nervous system. Can be difficult to spot and can progress rapidly.

-Can be caused by antidepressants, opioids, illicit drugs etc.

Serotonin syndrome symptoms

-Common symptoms: restlessness, confusion, insomnia, hypertension, dilated pupils etc.

-Severe symptoms: High fever, tremor, seizures, unconsciousness, irregular heartbeat

Call 999 and a&e if experiencing sever symptoms.