Overview Introduction Classes History Included Drugs Characteristics Applications Controversies Negative Effects Conclusion Drugs that are used to relieve or prevent depression. Facts Major depressive disorder affects up to 10% of youths Depression is associated with functional impairment in school and at work Antidepressants prescribed to adults are used to treat depression in children and adolescents (mostly SSRIs and SNRIs)
Efficacy and safety remain constant considerations Common Classes Selective Serotonin Reuptake Inhibitor (SSRI) Tricyclic Antidepressant (TCA) Serotonin-Norepinephrine Reuptake Inhibitors (SNRI) Monoamine Oxidase Inhibitors (MAOI) History - Discovery Early 1900s: minimally successful attempts to treat depression pharmacologically 1950s: iproniazid discovered -- MAOI class imipramine -- TCA class Safety Concerns
History - Synthesizing 1960s and 1970s: use of MAOIs and TCAs Synthesizing and developing of new drugs 1980s to 1990s: fluoxetine -- SSRI class expansion of antidepressant use 1990s and 2000s: further synthesis -- SNRI class Safer, fewer side effects
How antidepressants work Included Drugs/Generic Names SSRIs Citalopram (Celexa) Escitalopram (Lexapro, Cipralex) Paroxetine (Paxil, Seroxat) Fluoxetine (Prozac) Sertraline (Zoloft, Lustral) Characteristics: SSRIs Time of onset: 2-4 weeks for most/6-8 weeks for some Mechanism of Action: Blocks the reuptake of serotonin Affected neurotransmitter: Serotonin Included Drugs/Generic Names TCAs Amitriptyline (Elavil, Endep) Desipramine (Norpramin) Doxepin (Adapin, Sinequan) Imipramine (Tofranil) Nortriptyline (Pamelor) Protriptyline (Vivactil) Trimipramine (Surmontil) Characteristics: TCAs Time of onset: 4-12 weeks Mechanism of Action: Inhibit reuptake of serotonin and norepinephrine Affected neurotransmitters: serotonin and norepinephrine Included Drugs/Generic Names SNRIs Desvenlafaxine (Pristiq) Duloxetine (Cymbalta) Venlafaxine (Effexor) Characteristics: SNRIs Time of onset: 2-4 weeks, some within 1 week Mechanism of Action: Block the reuptake of serotonin and norepinephrine Affected neurotransmitters: serotonin and norepinephrine Included Drugs/Generic Names MAOIs Isocarboxazid (Marplan) Phenelzine (Nardil) Selegiline (Emsam) Tranylcypromine (Parnate) Characteristics: MAOIs Time of onset: 2-4 weeks Mechanism of Action: Prevent inactivation of norepinephrine, dopamine, and serotonin leading to increasing synaptic levels Affected neurotransmitters: serotonin, norepinephrine, dopamine Applications Common uses: Unipolar and bipolar depression organic mood disorders schizoaffective disorder anxiety disorders including OCD, panic, social phobia PTSD premenstrual dysphoric disorder impulsivity associated with personality disorders. Alternative Applications: Pain Insomnia
Negative Effects Withdrawal Symptoms: dizziness, brain zings, insomnia, tremors, night terrors and vertigo.
Interactions: Alcohol, other antidepressants, antipsychotics, anti-anxiety drugs, some pain killers, St. Johns Wart.
Overdosage: Unlikely when taken as prescribed. Tricyclics are the most fatal drug when taken in excess. Conclusion - Many changes in the last 20 years.
-Target neurotransmission
Take home message for school psychologists: - prozac is most common for children - SSRIs are associated with worsening symptoms and suicide in youth and adolescents.
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APA Media Psychology and Technology Division (Div 46) Policy Statement Expressing Concern Regarding The Plan To Include "Gaming Disorder" in The ICD-11