2. Antidepressants are the second-
most-prescribed-medication in the
• 15 million Americans are affected by
depression each year
• 7% of all visits to the primary care doctors
involve the doctor prescribing antidepressant
• $10 billion dollars a year are spent on
3. Antidepressant are use for the
treatment of several different forms of
depression and other psychological
Psychological disorders that may accompany, precede, or cause depression:
Bipolar Disorder, (OCD) obsessive compulsive disorder and (PTSD) Post Traumatic Stress
4. Depression is not uniform. Everyone does not
experience the same the signs and symptoms.
The severity, duration, and triggers of one’s
symptoms depend on the individual person and
his or her illness.
5. What are some common symptoms
• Constant feeling of sadness, anxiety and emptiness
• Feelings of hopelessness
• Lose of interest in activities or hobbies once enjoyed
• Low energy, fatigue lose interest in sex
• Complains of aches and pains
• General feelings of pessimism
• Hard to concentrate, hard to remember details, or make decisions
• Sleep disturbance- sleeps too much or too little
• Change in eating habits- eats too much or may have no appetite
• Suicidal ideations
• Complains more of body aches and pains- headaches, cramps, muscle
6. What causes depression?
Experts say Psychology and Biology is a Two-
Biologic effects may secondarily affect psychological functioning in various ways:
• Alter perception biologic effects can contribute to the pessimistic thinking seen in depressive disorders and
the tendency to anticipate fearful outcomes often seen in anxiety disorders.
• Increased emotional sensitivity and reduced emotional controls. Increased arousal or pain may motivate a
person to become more socially withdrawn and can often lead to a host of negative conclusions regarding
personal competency as in. “What’s wrong with Me? I’m crying like a baby.”
• Decreased energy and arousal, poor concentration, and lowered motivation, which often lead to impaired
performance in school and work.
• Sexual dysfunction, which can translate into interpersonal problems in intimate relationships.
• Bizarre behavior enacted during a manic or a psychotic episode. This behavior can continue to be a source of
tremendous personal embarrassment and shame long after the psychotic episode is resolved.
Handbook of clinical Psychopharmacology for therapists Sixth Edition
(John D Preston, Psy.D ABPP John H. O’Neal, MD Mary C. Talaga, R. PH., Ph. D.)
7. What is the treatment for Depression?
• Some medications and physical ailments can
cause the same symptoms as depression. It is
important a full physical examination,
interview and lab test completed by a general
practitioner to rule out possible medical
illnesses. Once medical conditions or
pharmacological causes are ruled out, a full
psychological evaluation is completed or
referral to a mental health specialist is given.
8. What is the treatment for depression?
• Mental health specialist should carry out a MSE
(Mental Status Exam). The patient would be asked
about Family history of depression or mental illness,
when was the onset, duration, and severity of his or
her symptoms, does he or she use drugs and alcohol,
does he or she have suicidal ideation.
9. What is the treatment for depression?
• The mental health specialist would also take note
of how the patient presents during the interview,
verbal and non verbal cues: how the patient is
dressed, patient’s hygiene, is patient time and
place orientated, does that patient exhibit bizarre
thought patterns or abnormal speech (salad
speech slow, delayed, soft, loud suspicious ) body
movement ( rigid, slow, tense, hyper vigilant).
The patient attitude toward the interviewer
should also be noted.
10. Medications for Depression
• The Aim of an Antidepressant is to stabilize and normalize the
neurotransmitters in our brain. Neurotransmitters such as
serotonin, dopamine and norepinephrine play a role in
regulating our mood.
11. Selective serotonin reuptake inhibitors
(citalopram)- is an antidepressant drug prescribed for the
treatment of major depression associated with mood disorders. Celexa is
also used on occasion in the treatment of body dysmorphic disorder and
(escitalopram)- Lexapro is approved for the treatment of major
depressive disorder and generalized anxiety disorder. Social anxiety
disorder, panic disorder and obsessive-compulsive disorder are also some
of the other indication for Lexapro.
(fluoxetine) – Prozac is prescribed to patients suffering from major
depression (including pediatric depression), obsessive-compulsive
disorder (in both adult and pediatric populations), bulimia nervosa,
anorexia nervosa, panic disorder and premenstrual dysphoric disorder. It
remains to this day one of the best-known antidepressant brands.
(sertraline)- it has been approved for major depression, obsessive-
compulsive disorder (OCD), posttraumatic stress disorder (PTSD),
premenstrual dysphoric disorder (PMDD), panic disorder and social phobia
(social anxiety disorder).
Norepinephrine Reuptake Inhibitors
• Effextor (Venlafaxine)-is primarily used to treat
major depression, generalized anxiety disorder,
social anxiety disorder, and panic disorder in
• Cymbalta (duloxetine)-used to treat depression
and generalized anxiety disorder. Duloxetine is
also used to treat pain and tingling caused by
diabetic neuropathy (damage to the nerves)and
fibromyalgia. Its also used to treat ongoing bone
or muscle pain such as lower back pain or
13. • Bupropion (Aplenzin, Wellbutrin, Wellbutrin SR, Wellbutrin
XL) is used to treat depression. Bupropion (Wellbutrin XL) is
also used to treat seasonal affective disorder (SAD;
episodes of depression that occur in the fall and winter
each year). Bupropion (Zyban) is used to help people stop
14. • MAOIs are older antidepressants. They have more side
effects than SSRIs and SNRIs.
• When SSRIs and SNRIs have an undesirable side affect
MAOIs and tricyclics are used.
• Patients taking MAOIs have to be careful with their diet and
other medications. Potentially serious interaction with
cheeses, wines and pickles and decongestions. These items
are high in tyramine which interact with MAOIs
• Patient may experience significant rise in blood pressure
thus increasing the risk of stroke
• Must receive a comprehensive list of foods, medicines and
substances you should avoid.
15. • Most side effects are mild and short-lived. It is rare for a patient to have long-term
• Most antidepressant side effects subside within the first few days to weeks of
• Sexual dysfunction is a side effect of all serotonin reuptake inhibitors, venlafaxine,
and duloxetine. Bupropion and nefazodone have the lowest risk for sexual side
• The risk of suicide may be increased during the first month or so of antidepressant
therapy; physicians, patients, and family members should be vigilant for signs of
suicidal thoughts and behavior.
• In elderly patients, serotonin reuptake inhibitors seem to be safer and better
tolerated than tricyclic antidepressants. The choice should be made on the basis of
side effect profile and drug interactions.
Side effects of antidepressants An overview: Cleveland Clinic Journal of Medicine,
Volume 73. Number 4 April 2006 Retrieved January 29,2012 from
16. Adverse effect of antidepressants
drugs, based on mechanism of action
• Norepinephrine transporter blockade
• Anxiety Augmentation of pressor effects of
sympathomimetic amines Diaphoresis Tachycardia Tremor
• Serotonin reuptake inhibition
• Anorexia early in the treatment and weight gain later Dose-
dependent increase or decrease in anxiety Ejaculatory
disturbances, anorgasmia, and decreased libido
Extrapyramidal side effects
• Interaction with monoamine oxidase inhibitors and
tryptophan Nausea, vomiting, and diarrhea. Sedation or
insomnia Serotonin syndrome
• Dopamine reuptake inhibition
17. Adverse effects of antidepressant
drugs, based on mechanism, of actions
• Activation and aggravation of psychosis Parkinsonism
• Alpha-1 adrenergic receptor blockade
• Postural hypotension and dizziness Potentiation of the
antihypertensive effect of other medications Reflex
• Dopamine D2 receptor blockade
• Extrapyramidal side effects: akathisia, dystonia, parkinsonism,
• Endocrine effects; prolactin elevation
18. Adverse effects of antidepressant
drugs, based on mechanism, of actions
• Histamine H1 receptor blockade
• Drowsiness Falls in the elderly Orthostatic hypotension
Sedation Weight gain
• Muscarinic acetylcholine receptor blockade
• Blurred vision Central effects: memory and cognitive
impairment, delirium in severe cases Gastrointestinal effects:
decreased salivation, dry mouth,
19. Adverse effects of antidepressant
drugs, based on mechanism, of actions
• decreased peristalsis, constipation Precipitation of
narrow-angle glaucoma Sinus tachycardia Urinary
hesitancy and retention
Side effects of antidepressants An overview: Cleveland Clinic
Journal of Medicine, Volume 73. Number 4 April 2006 Retrieved
January 29,2012 from
20. Take Time To Begin Working
• It may take a few weeks before the patient begins feeling
any positive effect from medication
• Patients may feel tempted to stop taking medication
because it is not doing anything.
• If patient has not received any benefits from medication
within the expected timeframe, patient should talk to
doctor about other options or dosage change
• Each person reacts differently antidepressant medication
• Communicate with your doctor about your symptoms how
you are reacting to your antidepressant medication for the
antidepressant treatment to be successful.
21. • Do not stop taking your antidepressant
without consulting your doctor first.
• The combination of psychotherapy and
antidepressant has been shown to be very
effective in treating depression and lessen the
possibility of relapse
22. When we look at our body for a fix of the mind, then we can
have problems. Let me explain. Do we just grab an
antidepressant pill when we are just sugar coating the problem
and not really investigating why we are feeling the way we are
feeling? Is there a deeper rooted, older feeling that is lingering
around until today that is manifesting in the way that we
respond to the world? When the stock market crashes, do we?
Reinventing the Body, Resurrecting the Soul Part 2 of 9: Flexibility, December 24, 2009
by Dr. Iam Retrieved, January 29,2012, from http://lfp-blog.com/reinventing-the-
23. • Not everyone needs and antidepressant you and
your doctor should determine if antidepressant
medication is right for you.
• Antidepressants are not “magic pills”, they do help
patients with the relief from some depression and
symptoms when used correctly.