Antidepressants

Carli, Vicki, and Jayla

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


Texas Algorithm on MDD
Controversies
Controversies
Health Canada warnings (Katz et. al, 2008)
Ethical issues:
off-label prescribing
informed consent
developmentally sensitive assent
Pregnancy concerns
Negative Effects
Adverse side-effects:

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.

References
Cheung, A. H., Emslie, G. J., & Mayes, T. L. (2006). The use of antidepressants to treat depression in children
and adolescents. Canadian Medical Association Journal, 174(2), 193-200.

Garland, E. J. (2004). Facing the evidence: antidepressant treatment in children and adolescents. Canadian
Medical Association Journal, 170(4), 489-491.

Hughes, C. W., et. al (1999). The Texas children's medication algorithm project: Report of the Texas consensus
conference panel on medication treatment of childhood major depressive disorder. Journal of the American
Academy of Child & Adolescent Psychiatry, 38(11), 1442-1454.

Katz, L. Y., Kozyrskyj, A. L., Prior, H. J., Enns, M. W., Cox, B. J., & Sareen, J. (2008). Effect of regulatory
warnings on antidepressant prescription rates, use of health services and outcomes among children,
adolescents and young adults. Canadian Medical Association Journal, 178(8), 1005-1011.


References
Kingston, A. The Controversy Surrounding Antidepressants and Pregnancy. Mcleans Magazine. April 20, 2013.
Retreived from: http://www2.macleans.ca/2013/04/20/theres-a-pill-for-that/

Lieberman III, J.A. (2003). History of the use of antidepressants in primary care. Primary Care Companion
Journal of Clinical Psychiatry, 5(7), 6-10.

Nierenberg, A. A., Farabaugh, A. H., Alpert, J. E., Gordon, J., Worthington, J. J., Rosenbaum, J. F., & Fava, M.
(2000). Timing of onset of antidepressant response with fluoxetine treatment. American Journal of Psychiatry,
157(9), 1423-1428.

Quitkin, F. M., McGrath, P. J., Stewart, J. W., Taylor, B. P., & Klein, D. F. (1996). Can the effects of
antidepressants be observed in the first two weeks of treatment?. Neuropsychopharmacology, 15(4), 390-394.

Shih, D. (2007, September).Medication Overview: Common Psychotropic Medications used in Psychiatric
Disorders of Children and Adolescents. Healthy Minds Healthy Children.

References
Vasa, R, Carlino, AR, & Pine, DS (2006). Pharmacotherapy of depressed children and adolescents: Current
issues and potential directions. Biological Psychiatry 59(11): 1021-1028.

Wenzel, R. G., Tepper, S., Korab, W. E., & Freitag, F. (2008). Serotonin syndrome risks when combining
SSRI/SNRI drugs and triptans: is the FDA's alert warranted?. Annals of Pharmacotherapy, 42(11), 1692-1696.

Whittington, CJ, Kendall, T, & Pilling, S (2005). Are the SSRIs and atypical antidepressants safe and effective for
children and adolescents? Curr Opin Psychiatry 18(1): 21-25.

http://www.bpac.org.nz/resources/other/guides/bpac_antidepressant_interactions.pdf