Using Of Non-SSRI Medications To Treat Depression
Mood Regulating Neurotransmitters
There are three important neurotransmitters that regulate the symptom scene and depression.
- Norepinephrine, which is responsible for executive functioning, motivation and social behavior.
- Serotonin, which regulates mood, appetite, libido and cognition.
- Dopamine, which is responsible for motivation, concentration and pleasure.
As you can see, neurotransmitters work both individually and in combination with each other to regulate the body's normal functioning and normal psychological functioning.
This is important to notice the overlap of the neurotransmitter function in order to understand how medications have been designed to target the various symptoms related to depression and other mental disorders. And also how these medications use a combination of the neurotransmitters in targeting these symptoms.
To help us understand better how these medications work, it's important to understand the functioning of the brain cells and the neurons that they target.
The electrical signals traveling down, wonder on into the next. This is the way that electrical signals are being transferred and information is being transferred about the body's functioning.
Neurotransmitters are stored in these vesicles and once the electrical signal, which is the end of one neuron, empties out these neurotransmitters into the synaptic area. This allows for binding of the neurotransmitters into at the receptor sites. It also allows for the continuation of the signal from one neuron to the new neuron.
Once the signal is transmitted, any access neurotransmitters that are left in this synaptic space or then reabsorbed back into the presynaptic nerves.
Any combination of these mechanisms are the target of antidepressants. The reason for that is if there is a reduction of a neurotransmitter decreased levels in the brain that the antidepressant can work to try to keep the levels of these neurotransmitters high in the synapse so that binding can occur from on the postsynaptic neuron.
Various categories of the non-SSRI
Norepinephrine Serotonin Reuptake Inhibitors
The first group of are the norepinephrine serotonin reuptake inhibitors. As the name suggests, these antidepressants block the reuptake of both norepinephrine and serotonin in the presynaptic nerve.
These medications include Effexor, Cymbalta and Pritiq.
Some of the common side effects of the medications are lost appetite, weight and sleep. They can also cause drowsiness, dizziness, fatigue and other symptoms that we need to be very mindful for an older adults especially.
Some of the contraindications for use of these medications are hypertension in Cymbalta. We would not use these medications is frequently people that have a patek failure or glaucoma.
And another thing that I wanted to bring out is that this category of medications is used to treat depression as well as anxiety disorders. For our patients that have increased anxiety with depression, this might be a good first step as well as the SSRIs because of the serotonin.
When patients discontinued or stop these medications are properly they may have been what's called a discontinuation syndrome. It's like a withdrawal of the medication. They could experience physical complaints because of this.
It's very important for patients to alert the doctor they want to stop these medications so that they can be tapered off gradually instead of abruptly stopping and experiencing this discontinuation syndrome.
Noradrenergic and Specific Serotonergic Antidepressants (NaSSA)
The next category of medications are noradrenergic and specific serotonergic antidepressants (NaSSA). These medications actually block the Alpha 2 receptors. This causes an increase of norepinephrine serotonin in the synaptic space.
They use for the treatment of depression as well as insomnia, anorexia and, in some instances, anxiety.
The main medication in this category is Remeron. Some of the common side effects that we see in this medication or sedation is an increased appetite, as we said earlier, but sometimes physicians use this medication because it's helpful for people with depression who have insomnia and who have decreased appetite or weight loss.
Other side effects that should be aware of are dizziness, blurred vision, dried mouth, constipation and joint and muscle pain.
These medications can interact with fluoxetine, which is Prozac and paroxetine which is Paxil. Other antidepressants can cause an increase in the level of remeron if they're used in conjunction with prescribing physician. It's good to be aware if they're used together so that doses can be adjusted in order to avoid side effects. Carbamazepine, which is an anticonvulsive medication used for the treatment of seizures, can decrease the levels of Remeron.
Norepinephrine-Dopamine Reuptake Inhibitors
The next category are norepinephrine-dopamine reuptake inhibitors. As the name suggests, it inhibits the reuptake of dopamine and norepinephrine in to the presynaptic nerve cell.
Wellbutrin is used for treatment of depression, but also for narcolepsy and for nicotine dependency. It was marketed a few years ago to be used for smoking cessation.
Some of the common side effects are dry mouth, nausea, tremor. But in remeron, which is activating in some patients, you can see an increase in tremor, anxiety, blood pressure levels, excessive sweating. It also causes people to have insomnia if they take it too late in the day. Patients need to be educated about these side effects.
This medication is contraindicated in people with seizure disorders because it lowers the seizure threshold.
Tricyclic Antidepressants (TCA)
The last category of antidepressants we're going to talk about today are the tricyclics. This is an older class of antidepressants, not typically used as a first line of treatment, but you may see patients that have been on them for many years or who are on them for other reasons.
These medications block the serotonin and norepinephrine transporters. They're used for the treatment of depression and anxiety, but they're also used for eating disorders, enuresis, personality disorders and. more importantly, for chronic pain.
You may see a lot of patients who have been prescribed these tricyclic antidepressants by other physicians such as neurologist or primary care physicians for the treatment of chronic pain. It's important to understand why the patient is taking these medications.
This group of drugs includes Elavil, Tofranil, Pamelor, Norpramin and Anafranil.
Some of the most common side effects are dry mouth, dry nose, blurred vision, constipation.
They can also cause urinary retention and cognitive impairment. And more importantly, these medications can cause cardiac side effects if they're used in overdose. These side effects can be fatal, which is why a lot of patients aren't prescribed these anymore as a first-line medication.
The newer antidepressants are generally safer in overdose. Patients need to understand that they have to take these medications as prescribed, so they won't have any cardiac side effects. Especially people that already have pre-existing cardiac conditions.