Psychosocial Pharmacology for Depression – OT / NBCOT® Study Guide

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Psychosocial Pharmacology for Depression

SSRIs

SSRI’s or selective serotonin reuptake inhibitors are the most commonly prescribed antidepressants. Doctors often start by prescribing SSRIs. They can help with symptoms of moderate to severe depression. Compared to other classes of medications, SSRIs are considered to be safer in general.

 

Pharmacology

 

  • SSRIs increase levels of serotonin in the brain by blocking reuptake into neurons. Serotonin is the key hormone that stabilizes our mood, feelings of well-being, and happiness. 
  • SSRIs may also treat anxiety disorders.

 

Common Medications

  • Prozac
  • Zoloft
  • Paxil
  • Celexa
  • Lexapro

 

Side Effects

  • Nausea, vomiting, diarrhea
  • Headache
  • Drowsiness
  • Dry mouth
  • Insomnia
  • Nervousness
  • Dizziness
  • Sexual dysfunction
  • Weight loss or weight gain

Safety

  • Celexa – arrhythmias in high doses
  • Drug interactions
  • Serotonin syndrome – high levels of serotonin accumulate, often due to another medication. Signs and symptoms include anxiety, agitation, fever, diaphoresis, confusion, tremors, discoordination, changes in blood pressure, and tachycardia.
  • Possible risks for pregnancy and breastfeeding
  • Black box warning – possible increase suicide ideation for those under aged 25.

 

SNRIs

SNRI’s stands for serotonin and norepinephrine reuptake inhibitors. They are a class of antidepressants that also help to relieve depression symptoms. SNRIs have also been used for anxiety and chronic nerve pain.

 

Pharmacology

 

SNRI’s block the reuptake of serotonin and norepinephrine in the brain. The changes in brain chemistry help to regulate mood and relieve symptoms of depression.

 

Common Medications

  • Pristiq
  • Cymbalta
  • Effexor
  • Fetzima

 

Side Effects

  • Nausea
  • Dry mouth
  • Dizziness
  • Headache
  • Diaphoresis
  • Fatigue
  • Constipation
  • Insomnia
  • Sexual dysfunction
  • Loss of appetite

 

Safety

  • May cause hypertension
  • May worsen liver problems
  • Drug interactions when combined with certain medications or herbal products and increase the risk of bleeding
  • Serotonin syndrome
  • Possible risks for pregnancy and breastfeeding
  • Black box warning – possible increase suicide ideation for those under aged 25.

 

Atypical Antidepressants

 

Atypical antidepressants are less common than other classes of antidepressants. They also do not fit into other classes such as SSRIs or SNRIs. Atypical antidepressants also work differently from one another to help manage depression.

 

Pharmacology

 

Just like other classes of antidepressants, atypicals alter levels of neurotransmitters in the brain to help regulate mood and relieve symptoms of depression. Atypical antidepressants may change levels of dopamine, serotonin, or norepinephrine.

 

Common Medications

  • Wellbutrin
  • Remeron
  • Trazadone
  • Serzone
  • Viibryd
  • Trintellix
  • Spravato – nasal spray

 

Side Effects

  • Nausea
  • Dry mouth
  • Dizziness
  • Lightheadedness
  • Drowsiness or insomnia
  • Constipation
  • Diarrhea
  • Changes in appetite
  • Sexual dysfunction

 

Safety

  • Should not be used for those with seizures or an eating disorder
  • May increase cholesterol
  • Weight gain
  • Liver failure
  • Priapism – persistent and painful erection
  • Arrhythmias
  • Increased bleeding
  • Drowsiness – driving
  • Drug interactions when combined with certain medications or herbal products and increase the risk of bleeding
  • Serotonin syndrome
  • Possible risks for pregnancy and breastfeeding
  • Black box warning – possible increase suicide ideation for those under aged 25

 

Tricyclic Antidepressants

 

Tricyclic (chemically for three ring) and tetracyclic (or four ring) antidepressants are called cyclic antidepressants. Although they are effective, they are less commonly used than the ones mentioned earlier. They may be a good option if other options are ineffective.

 

Pharmacology

 

Cyclic antidepressants block the reabsorption of serotonin and norepinephrine to increase their levels in the brain. It has also been used to treat OCD, anxiety, and nerve pain.

 

Common Medications

 

  • Amitriptyline
  • Amoxapine
  • Norpramin
  • Doxepin
  • Tofranil
  • Pamelor
  • Protriptyline
  • Trimipramine

Side Effects

  • Drowsiness
  • Blurred vision
  • Constipation
  • Dry mouth
  • Drop in blood pressure when moving from sitting to standing, which can cause lightheadedness
  • Urine retention
  • Weight loss
  • Increased appetite leading to weight gain
  • Excessive sweating
  • Tremor
  • Sexual problems

Safety

  • Confusion
  • Irregular heart rate
  • Seizures
  • Drug interactions
  • Serotonin syndrome
  • Complications with chronic health conditions
  • Possible risks for pregnancy and breastfeeding
  • Black box warning – possible increase suicide ideation for those under aged 25

 

Monoamine oxidase inhibitors (MAOIs)

 

MAOIs were the first class of antidepressants that were developed, but have more side effects than other classes of antidepressants. Being on MAOIs requires diet restrictions and an awareness of other side effects with other medications due to the potential for very high blood pressure.

 

Pharmacology

 

MAOIs prevent the enzyme monoamine oxidase from removing the neurotransmitters norepinephrine, serotonin, and dopamine from the brain. It may also affect other neurotransmitters and the digestive system as a side effect. MAOIs are generally not prescribed for children. It has been used to treat Parkinson’s disease.

 

Common Medications

 

  • Marplan
  • Nardil
  • Emsam
  • Parnate
  • Selegiline as skin patch

 

Side Effects

 

  • Dry mouth
  • Nausea, diarrhea or constipation
  • Headache
  • Drowsiness
  • Insomnia
  • Dizziness or lightheadedness
  • Skin reaction at the patch site
  • Involuntary muscle jerks
  • Low blood pressure
  • Reduced sexual desire or difficulty reaching orgasm
  • Weight gain
  • Difficulty starting a urine flow
  • Muscle cramps
  • Prickling or tingling sensation in the skin (paresthesia)

Safety and Dietary Restrictions

  • Possible risks for pregnancy and breastfeeding
  • Avoiding tyramine – aged cheeses, sauerkraut, cured meats, draft beer, fermented soy products such as soy sauce and tofu.
  • Possible drug interactions with other antidepressants, pain-relieving drugs, fold and allergy medications, and herbal supplements.
  • Black box warning – possible increase suicide ideation for those under aged 25

 

Other medications

Doctors may combine two antidepressants or combine antidepressants with other medications to enhance antidepressant effects. The same side effects and safety apply and should be considered.