lecture recording on 13 February 2025 at 12.57.32 PM

Antidepressant Classes

• Selective Serotonin Reuptake Inhibitors (SSRIs)

  • First line of treatment for depression.

  • Block the reuptake of serotonin, increasing its availability in the synapse.

  • Examples: Pristiq, Cymbalta, Effexor (the last two are also SNRIs).

  • Common withdrawal symptoms include brain zaps and emotional disturbances.

• Selective Norepinephrine Reuptake Inhibitors (SNRIs)

  • Similar to SSRIs, but also block norepinephrine reuptake, impacting mood and energy.

  • More likely to produce withdrawal symptoms compared to SSRIs.

• Tricyclic Antidepressants (TCAs)

  • Block reuptake of serotonin and norepinephrine plus other neurotransmitters, including histamine.

  • Example: Tofranil.

  • Used primarily for patients showing resistance to SSRIs.

• Monoamine Oxidase Inhibitors (MAOIs)

  • Prevent breakdown of neurotransmitters, including serotonin, norepinephrine, and dopamine.

  • Can cause hypertension and require dietary restrictions.

  • Typically used as a last resort.

• Wellbutrin

  • Targets dopamine, used for mood regulation, smoking cessation, and in conjunction with low-dose naltrexone for weight loss.

  • Particularly effective for patients with low motivation related to depression.

Understanding Depression

• Prevalence

  • Approximately 16% of adults in the US experience depression in their lifetime.

• Key Symptoms

  • Sadness or emotional numbness.

  • Loss of interest or pleasure in previous enjoyable activities.

  • Additional symptoms: worthlessness, sleep disturbances, concentration issues.

• Chemical Misconception

  • The oversimplified notion that depression is merely due to low serotonin levels is misleading.

  • Antidepressant efficacy can vary; SSRIs may take weeks before improvement is noticeable.

• Neurotransmitter Complexity

  • Depression is not solely linked to serotonin; other neurotransmitters affect mood.

  • Structural brain changes (e.g., amygdala, hippocampus) are observed in some depressed patients.

• Genetic Influences

  • Evidence suggests depression can be familial but is complex in its genetic associations.

  • Environmental factors, particularly childhood trauma, contribute significantly to adult depression.

Cycle of Depression

• Depression can lead to a repetitive cycle involving:

  • Stressors → Negative thoughts → Specific emotions → Behavioral responses (e.g., avoiding social interactions) → Stressors repeat.

• Cognitive Behavioral Therapy (CBT)

  • Focuses on identifying and altering negative thoughts and behaviors impacting emotional well-being.

  • Worksheets and tracking emotions assist clients in recognizing thought patterns.

Treatment Techniques

• Behavioral Activation

  • Encourages engagement in pleasurable activities to offset depressive symptoms.

  • Often requires support from others for accountability.

• Interpersonal Therapy

  • Emphasizes managing interpersonal relationships and coping skills rather than analyzing the root of depression.

• Multimodal Treatment

  • Combining medication with psychological therapies demonstrates higher efficacy in treating depression and bipolar disorder.

  • Treatment can be concurrent (both therapy and medication) or sequential (one after another).

Considerations in Bipolar Disorder

• Medication

  • Lithium and mood stabilizers (like Depakote) are first-line treatments for bipolar disorder.

  • Important for patients to track moods and medication adherence due to the dynamic nature of their condition.

• Challenges

  • Access to mental health care and medication adjustments frequently proves problematic, exacerbating untreated mental illness.

• Childhood Trauma and Mental Health

  • Trauma in childhood increases vulnerability to depression and other mental health disorders later in life.

  • Adverse childhood experiences (ACEs) have been linked to various health issues, including fibromyalgia.

Emotions and Relationships

• Emotional Awareness

  • Identifying emotions and understanding their implications can guide boundary setting and coping mechanisms.

  • Tools like an emotion wheel help clients decode and manage their feelings effectively.

• Mindfulness Practices

  • Techniques like STOP (Step back, Take a moment, Observe, Proceed mindfully) can drastically improve emotional responses to negative situations.

• Final Thoughts

  • Mental health struggles are complex, and understanding the interplay of genetics, environment, and brain chemistry is fundamental in developing therapeutic strategies.