antidepressants Flashcards
what are antidepressants?
- A type of medicine used to treat clinical depression
- Most common intervention for depression
- Have been developed over time to target specific neurotransmitters
- Prescribed to quickly treat the symptoms of depression and to prevent relapse
how do antidepressants work?
- Increase serotonin and noradrenaline in the brain
- Often used in conjunction with other therapies
- They are agonists and increase noradrenaline and serotonin by either blocking reuptake of the chemical or preventing the enzyme that breaks down the chemical in the synapse - both cause the neurotransmitter to be in the synapse for longer, thereby increasing the activity on the affected neural pathways
- Other medications can be added to an antidepressant to enhance their effects e.g. two ads together or a mood stabiliser or antipsychotic
monoamine oxidase inhibitors (MAOI’s)
- First generation
- Prescribed as a last resort if other drugs have failed as they have serious side effects
- stop the enzymes that break down the monoamine neurotransmitters in the synapse, thus making them available for longer
- Requires a strict diet because of dangerous/deadly interactions with foods that contain tyramine (certain cheeses, pickles and wines)
- Musn’t be taken with other common drugs or SSRIs
selective serotonin reuptake inhibitors (SSRIs)
- Work by blocking the reuptake of serotonin by blocking the transporter cells, this means serotonin is left in the synapse for longer, therefore has a greater effect
- Doctors often prescribe these first
- These are safer and generally cause fewer negative side effects than other types of antidepressants, less likely to lead to serious side effects if overdosed
- Side effects include headaches, weight gain, lethargy, nausea and sexual problems
tricyclic antidepressants imipramine
- second generation of antipsychotics
- blocks the reuptake of serotonin and noradrenaline so they remain in the synapse for longer and have a greater effect
- older medication, tend to cause more severe side effects (constipation, blurred vision, memory loss) and more serious consequences if overdosed compared to newer drugs (SSRIs and SNRIs) - psychosis and coma
- not usually prescribed as first choice but only when SSRIs are ineffective
serotonin and norepinephrine reuptake inhibitors (SNRIs)
- block reputake of serotonin and noradrenaline so they remain in the synapse for longer and have a greater effect
- no evidence that these are more effective than SSRIs
drug therapy (antidepressants) - supporting evidence ao3
P - Supporting evidence
Versiani (1999) used a double-blind trial of NRIs and a placebo drug and found significant mood improvement in depression patients given the NRI compared to placebo.
T - effective - valid treatment
drug therapy (antidepressants) - contradicting evidence ao3
p - Contradicting evidence
Trivedi (2006) found only one third of people using the SSRI Citalopram were in complete remission (decrease in symptoms)
↓ effectiveness = ↓ validity and applies only to certain subpopulations
drug therapy (antidepressants) - supporting evidence is scientific ao3
P - Supporting evidence is scientific
Royal College of Psychiatrists
50-60% of people treated with antidepressants showed improvement compared to 25-30% of people treated with a placebo.
therefore as it uses a placebo it increases internal validity
drug therapy (antidepressants) - ethical issues ao3
P - ethical issues
Nausea, insomnia, blurred vision, dizziness and sexual dysfunction. Possible to overdose on MAOIs and Tricyclics, SSRIs have been linked to suicidal ideation in young people.
therefore it can cause people physical harm
drug therapy (antidepressants) - application to society ao3
P - Application
Work quickly for most people (2 weeks) treat the debilitating symptoms (worthlessness, fatigue)
therefore can improve quality of life (maintain jobs and relationships)
drug therapy (antidepressants) - form of social control ao3
P - Social control
antidepressants are used to make patients more manageable and is less empowering than CBT because patients have less control and dependence on a chemical ‘cure’.
therefore it has ethical issues and is only a short term fix
drug therapy (antidepressants) - enable people to access other therapies such as CBT ao3
P - enable people to access other therapies such as CBT ao3
Stabilise mood and help with cognitive functioning, allowing access to CBT. Chan (2006) found a combination of CBT and medication was more effective than just using CBT
therefore drug therapy is effective in combination
drug therapy (antidepressants) - reductionist ao3
P - reductionist
reduce treatment down to focusing on reducing symptoms, drugs don’t take into account a patient’s environmental or cognitive problems which might contribute to relapses
T - therefore it lowers the validity of the treatment as it may miss important factors
drug therapy (antidepressants) - conclusion ao3
in conclusion, drugs are effective for most people with depression, however they do not factor all subpopulations. NICE recognise offering psychological treatments as alternatives and using drugs as a last resort. The most effective treatment would be to use a combination of drugs and psychological treatment
