According to WHO, depression is a clinical mental disorder, and presently, it is a leading cause of disability and suicide worldwide, with more women affected than men, affecting about 5% of adults globally. Antidepressants are used in the management of depression. The symptoms include loss of concentration, self-guilt or low self-esteem, feeling hopeless, anxiety, suicidal thoughts, deprived sleep, loss of appetite, weight loss, and fatigue.
Generally, Antidepressants are used in the management of clinical depression, which include the following;
- Major Depressive Disorder
- Persistent Depressive Disorder (Dysthymia)
- Premenstrual Dysphoric Disorder
- Obsessive-Compulsive Disorder (OCD)
- Social Anxiety Disorder
- Generalized Anxiety Disorder (GAD)
- Post-Traumatic Stress Disorder (PTSD)
Management of Depression –Typical Medications
Typical Antidepressants are divided into 6 classes namely;
1. Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are most widely prescribed class of antidepressants in clinical practice. It works by decreasing serotonin re-uptake in the brain. They’re known to cause lesser side effects. Examples include;
2. Serotonin-Noradrenaline Reuptake Inhibitors (SNRIs)
Comparatively, They are similar in activity with SSRIs. however, the use of SNRIs depend solely on the clinical response of patients. Some patient interventions are better with SNRIs, however, others respond better to SSRIs, and vice-versa. Examples of SNRIs include Duloxetine and Venlafaxine (Effexor).
3. Noradrenaline and Specific Serotonergic Antidepressants (NASSA)
It helps to improve serotonin and norepinephrine levels in the brain. Furthermore, NASSAs are prescribed to individuals who can’t tolerate SSRIs. . Examples include; is Mirtazapine (Zispin).
4. Tricyclic Antidepressants (TCAs)
Although, TCAs are one of the oldest class of antidepressants, they are not considered as first-line treatment, due to their unpleasant side effects. However, they are still prescribed in the management of OCD. Examples of TCAs include Amitriptyline, Clomipramine, Dosulepin, Imipramine, Lofepramine, and Nortriptyline.
5. Serotonin Antagonists and Reuptake Inhibitors (SARIs)
SARIs are not first-line antidepressants, however, they are administered in situations where other classes failed or cause unpleasant side effects to the patients. Examples are Trazodone (Molipaxin).
6. Monoamine Oxidase Inhibitors (MAOIs)
The use of MAOIs is very limited in clinical practice, because of its serious side effects. Examples of MAOIs include Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline (Emsam), and Tranylcypromine.
Other treatments for depression
Other interventions in the management of depression include undergoing therapies like Cognitive Behavioral Therapy (CBT). This approach is used alongside antidepressants, as it helps to address the causes of depression and how to effectively manage the condition. One of the CBT approaches is regular exercise.
Management of Depression – Atypical Medications
Basically, the drugs earlier discussed earlier fall under “Typical Antidepressants”. However, some drugs are also classified as “Atypical Antidepressants. An example is Olanzapine/Fluoxetine (Symbyax), used in the management of major depression conditions.
Lastly, in the management of depression, it is advised that both the healthcare expert initiates the therapy for the management of depression, rather than the individual, Furthermore, the practitioner clinically ascertains the type of depression previously or presently experienced by the individual and the best management approach to achieving effective therapy and improved quality of life of patients.
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