Identify the major medications, including their effectiveness and disadvantages, used to treat depression

Question

What will be an ideal response?

Answer 1

ANSWER:
Tricyclic antidepressants, such as Tofranil and Elavil, elevate mood and reduce the symptoms of depression by influencing the action of norepinephrine and serotonin in the brain (Stahl, 1998). However, it takes from 4 to 8 weeks on such medication before noticeable relief from depression occurs. Tricyclics are effective in relieving depressive symptoms in 60–85% of people who are depressed (Arroll et al., 2005; Fawcett, 1994; Guze & Gitlin, 1994). As with any drug, tricyclics have a number of side effects, including dry mouth, weight gain, dizziness, blurred vision, constipation, and sexual dysfunction. The tricyclics can also be fatal in overdose amounts, which is why they are seldom prescribed to patients who are suicidal.
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The monoamine oxidase (MAO) inhibitors are a class of antidepressants that elevate mood by increasing the monoamine neurotransmitters in the brain (Stahl, 1998). They are just as effective as the tricyclic antidepressants but are less frequently prescribed because of their more serious side effects (M. Fava & Rosenbaum, 1995). These include lowered blood pressure, liver damage, and weight gain. These drugs also interact with substances high in an amino acid called tyramine. Tyramine is present in common foods such as cheese, smoked meats, and chocolate, liquids such as beer and wine, and even over-the-counter medications. This interaction can produce a sudden rise in blood pressure that is potentially fatal. You may have noticed the caution statements on the back of any over-the-counter cold medication stating that it is not to be used by a person who is taking an MAO inhibitor. Yet MAO inhibitors may be more effective in the treatment of severe depression than the newer antidepressants (Parker et al., 2001).
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Currently, the most frequently prescribed antidepressant medications are the selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Lexapro and Zoloft. SSRIs elevate mood by leaving the neurotransmitter serotonin in the synapse longer. They have several advantages over the other two categories of antidepressants. The side effects of SSRIs are less severe and are not fatal in overdose. These include increased nervousness, headaches, insomnia, nausea, stomach cramps, decreased sexual drive, and sexual dysfunction (Fisher, Kent, & Bryant, 1995; Michelson et al., 2000). Some of these side effects may diminish after a few weeks of treatment. Other antidepressants, such as Zyban and Wellbutrin, are similar to SSRIs but influence the norepinephrine and dopamine systems. These antidepressants do not decrease one’s sexual drive and are therefore sometimes used in combination with SSRI drugs to elevate mood while lessening the sexual side effects (Leuchter et al., 2008; Zisook et al., 2006).
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However, there is considerable debate over the SSRIs effectiveness in treating mild to moderate depression. Some research suggests that they are just as effective as the other classes of antidepressants (Arroll et al., 2005; Garnock-Jones & McCormack, 2010; Gartlehner et al., 2005; Stewart et al., 2012). Other research suggests that they have modest to insignificant effects and are most beneficial in the treatment of severe depression (Fournier et al., 2010; Kirsch et al., 2008).
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Antidepressant medication has been associated with an increased risk of suicidal thoughts and behaviors in children and adolescents, especially in the first few months of treatment (FDA Public Health Advisory, 2004). In 2004, the Food and Drug Administration directed that manufacturers of antidepressants include a “black box” warning—the FDA’s strongest—on all antidepressant medication for children and adolescents.