Antidepressants: SSRI, SNRI & Tricyclic Antidepressatns. Citalopram Prozac Amitriptyline

SKIP AHEAD:
2:20 - Mechanism of Antidepressants
3:16 - General Principles of Antidepressant Use: Suicide, Mania & Serotonin Syndrome
7:51 - Tricyclic Antidepressants
9:10 - TCA Side Effects
10:40 - SSRIs
11:47 - SSRI Side Effects
13:01 - SNRIs
13:33 - Atypicals: Bupropion, Mirtazapine & Trazadone
Antidepressant mechanism - One hypothesis for the pathophysiology of depression is that it is due to low levels of monoamine neurotransmitters (mainly serotonin, norepinephrine and dopamine). That is why antidepressants aim to increase the levels of these neurotransmitters in the synaptic cleft. They do this by slowing the reuptake of the neurotransmitters so that they stay in the cleft longer and interact with post synaptic receptors more often. The first drugs in this group were non-specific and increased all of the monoamines, which lead to lots of side effects and safety issues related to toxicity. Newer antidepressants are more selective and mostly only effect 1 or 2 monoamines.
General principles:
Unfortunately, antidepressants take at least a month to start working. Good patient education about the delayed onset of effect and close monitoring of the patient during this initial period is extremely important. Patients can become hopeless if they expect the drug to start working right away. This may be one reason why antidepressants are associated with suicide, especially in patients 25 years old and younger. Another proposed mechanism is that a depressed person may have the energy to carry out their suicide once the medications start to work. There is now a black box warning for suicide on antidepressants. Some psychiatrists argue that they don’t actually see this association with suicide in clinical practice, and that the thing that really increases the risk for suicide is not treating a depressed person with the proper medications. However, it is still standard practice to have a close follow up with patients you are starting on antidepressants. Usually this will involve a follow up visit about 2 weeks after the medication is started. At this visit the drug will not have started working yet so you can’t evaluate efficacy, but you can monitor for side effects like suicidality. Another serious side effect you have to be on the lookout for soon after initiating treatment is mania. If a bipolar individual is incorrectly diagnosed as having depression, an antidepressant may induce a manic episode.
Another very serious side effect that has to be considered for antidepressants is Serotonin Syndrome. This usually occurs when you combined multiple antidepressants at the same time or combine an antidepressant with another medication that increases serotonin such as dextromethorphan or an opioid. It presents with tremor, diaphoresis, tachycardia, flushing and hypertension. If not corrected it can progress to delirium, AMS and death. Treatment includes medication cessation and the use of Cyproheptadine (a serotonin antagonist). In order to prevent this from happening you should have about a month “Wash Out” period when you are switching between antidepressants. So you taper the 1st medication down and then stop it, give the patient at least a month with no antidepressant and then start adding the new medication slowly.
Most side effects begin immediately after starting the medication, but diminish over the course of a month. This is another reason why patient compliance is poor with these meds. It makes them sick and the drug doesn’t work during the first few weeks. However, if they can stick with it the medications will likely start working and the side effects will diminish over time. A principle that applies to all of the antidepressants is “start low and go slow.” This means that you start with a lower dose and slowly increase it in order to decrease side effects and increase patient compliance. The dose you start the patient on may not even be at a therapeutic level, but every month or so you can increase the dose a bit.
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I love your introduction for each video. Not only are the videos themselves entertaining, but that introduction gets me pumped up to study every time!

[@stomponstep1989]

+Sorieyn LOL thanks!

[@infiema]

I'm a nursing student and this was SO helpful because both my book and teacher are not as specific as I would need them to be! Thank you!!!!

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[@whatwazthat16]

Medication is a great help in some cases in combination with therapy or counselling, thank you

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[@Doctor_Sin_Tabu]

So helpfull!!!! Thanks!!!!

[@friencheetah]

I'm a nursing student and thought I'd get a head start before my pharmacology semester next year; this was extremely helpful. Everything was described in a manner that was easy to understand and comprehend. Thank you very much!

[@mne222]

Thank you

[@abbeyawesome1012]

My doctor and I agreed that ssri after my celxa relaspe was really. Bad for me because with my post trumatric stress disorder causes physcosis but I’m taking medication and seeking treatment has been really helpful

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[@realreal377]

Thank u!

[@paula19762007]

Really good information thanks

[@stomponstep1989]

+paula19762007 thanks for the comment Paula :)

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[@stomponstep1989]

+smartaleck05 thanks for watching!

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[@Bonesph]

They say suicide is not associated because they don't have anything else to prescribe and then can't get $$$$

[@reemibraheemalaraj9774]

thanx

[@stomponstep1989]

+reem ibraheem Alaraj :)

[@dansmith9724]

Ive got to say it but the voice over sounds alot like Chris off 'Family Guy'. 🤣🤣😂😂

[@MultiMcgurk]

What chances of pssd off amitriptyline 10 mg 2 weeks ? Defo affected me or it could be my anxiety

[@huzaif1986]

i have been taking amitriptyline 25 mgs for ibs with milk since 35 days,, i think i made a mistake,,, or is it ok to take with milk for ibs,, does it absorb with milk?? i am confused😕😕😕

[@Peanuts76]

Histrionic nya ada, iya emang ga boleh self diagnose....

[@ellenm9363]

Mirtazapine made me gain so much weight, that made me even more depressed than I was before I started taking it.

[@randomfullywonderful]

Probably should have tried you on Prozac first.

[@allisonbergamorto2336]

7 years off of antidepressant drugs and still suffering from discontinued use. It’s like a brain lobotomy

[@randomfullywonderful]

You can tell that this dude wants us all on *PROZAC.* Not a low dose, either. He wants up popping 80mg every morning! He also only approves of fluoxetine by Eli Lilly. Yes sir!

[@UNKNOWN-le2tu]

i take a tetracyclic antidepressant.

[@dagrun3821]

And did it help?

[@winfreyc2010]

TrazoBONE lol

[@adrianabenson9447]

L

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Something ain't right...

[@bassiebassie3417]

?

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bad medications

[@loveeriksson3590]

The side effects disappear, and so do You!

[@Mike-rh9zs]

If you think half the garbage you just spewed in this video is real you should probably get a different job cause you're going to ruin a lot of peoples lives giving them these medications.