Depression is a potentially life-threatening illness that affects millions of people, all ages, and both sexes. It is more common in the primary care practice than hypertension, and thus, a massive burden to both the society and individual, costing more than $9 million in 2000 alone: WHO cited it as the leading disability cause globally in 2004, and anticipated it to be the leading cause by 2030. However, due to pharmacological interventions, antidepressant discovery has revolutionized the management of depression. In this context, pharmacological intervention refers to therapy which relies on drugs as medication. Therefore, this paper focuses on discussing pharmacological intervention on depression. The discussion will cover the definition of depression, pharmacological agents used to treat it, their side effects, and the agents which are most prescribed for depression. Also, the paper will address how the treatment can affect all the aspects of a patient, monitoring guidelines for particular treatment regime, and controversies related to a specific pharmacological agent. Then finally, a concluding paragraph.
Pharmacological Intervention for Depression
World Health Organization (WHO, 2013) define depression as a mental illness condition which is characterized by incidents of depressed mood. Each event is marked by energy reduction, activity decrease, and lowering of mood. Interest, enjoyment capacity, and concentration are decreased, and marked tiredness is common. Also, appetite is diminished, and sleep is disturbed, and reduced level of self-confidence and self-esteem (WHO, 2013).
Delegate your assignment to our experts and they will do the rest.
Depression can be treated through pharmacological intervention by use of antidepressants. These antidepressants are classified into classes including: tricyclic (amitriptyline, dosulepine, clomipramine, desipramine, lofepramine, mianserine, nortriptyline, dothiepin trimipramine, and trazodone); monoamine oxidase; (phenelzine, isocarboxazid, tranylcypromine, moclobemide) selective serotonin reuptake inhibitors (paroxetine, citalopram, fluoxetine, fluvoxamine, sertraline, escitalopram); other antidepressants (mirtazapine, reboxetine, duloxetine, venlafaxine). The general rule for administering these medicines is that two antidepressants should not be prescribed simultaneously. The patient should start will doses and increase the doses gradually over a period of 7 to 14 days. Also, switching or discontinuation of the prescriptions should be gradual and done with caution (WHO, 2013).
The types of actions, side effects, indications, and contraindications
For patients with functional impairment, long illness duration, or have moderate to severe symptoms; healthcare providers should consider prescribing an oral antidepressant. Additionally, assess for the effectiveness of treatment should be done after 6-8 weeks, and if no improvement is observed then, doctors should discuss with the patients whether to increase the dose or switch to another antidepressant. The side effects associated with these antidepressants include sedation, cardiovascular effects, weight gain, prostatism, sexual dysfunction, nausea, diarrhea, agitation, dizziness, hyponatremia among others. Hyponatremia is a rare but a serious side effect. For patients taking venlafaxine, blood pressure should be checked regularly (WHO, 2013).
The pharmacological agents that are mostly prescribed include fluoxetine and amitriptyline because of their safety and effectiveness. Amitriptyline starting dose is 50-75 mg/day orally in divided doses or as a single dose at night, and therapeutic dose: 150-200 mg/day orally. Fluoxetine starting dose is 10 mg/day orally, and the dose should be increased to 20 mg/day after a week while Therapeutic dose: 20-40 mg/day orally and can further increase to 60 mg daily if no improvement is observed after many weeks (WHO, 2013). These medicines can work well with non-pharmacological intervention such as cognitive behavioral therapy (CBT). This is a short-term psychological therapy where both patient and therapist work together on identifying and changing behaviors and thoughts that may be sustaining symptoms. It is viewed as a self-help method, and evidence has confirmed its effectiveness. Some of the antidepressants can cause memory problems, muscle cramps, and difficulty in concentrating (Appiah, 2013).
If a particular class of antidepressants is prescribed to a patient with acute depression, after the critical incident has resolved, the patient is suggested to continue with the same treatment for 6-8 months to avoid relapse. Patients at high relapse risk should be offered to continue with pharmacotherapy for not less than two years, and the same dose for acute treatment should be prescribed. As such, follow-up visits should be arranged every 3 to 6 months. If symptoms of depression returns, then the doctor may consider adjusting the dose and monitor with the treatment adherence of the patient. If symptoms worsen, then doctors should consider changing the medication (WHO, 2013).
Controversies about the real efficacy of a given pharmacological agent of depression
SSRI “(serotonin selective reuptake inhibitors)” are one of the most extensively used agents of anti-depressant, mainly because they have a relatively low profile of side effects, their administration ease, and the fact that their initial dose is near to the therapeutic dose. Conversely, all the SSRIs have the prospective of side effects which can remain stable (such as sexual dysfunction, sedation) or fade over time (like activation, nausea). Moreover, the SSRIs ambivalent effects on parameters like mood make some patient cynical about their real impact, and this is further fed by their capacity to change other medication metabolisms through the P450 system, a cluster of hepatic enzymes which metabolize toxins, food, and medications (Popa-Velea, Gheorghe, Truţescu, & Purcărea, 2015).
However, comparing the benefits to risks of SSRIs, the benefits outweigh the risks. First, SSRIs help reduce suicidal ideation frequency, have fewer interactions with drugs than older antidepressants, and even the hepatic cytochrome P450 enzymes inhibition by SSRIs has proven very rarely to be of clinical importance. Additionally, SSRIs, specifically fluoxetine are more appropriate for use as maintenance therapy for long-term in chronic relapsing diseases. Also, fluoxetine has a superior therapeutic profile due to its high rate of efficacy, increased overdose safety, reduced adverse effects incidence, and ease of maintaining patients in plans of adequate treatment (Mourilhe & Stokes, 2018).
Conclusion
Depression is considered a common life-disrupting and deadly illness, with a higher disease burden. Even though antidepressant medication should be considered the first line treatment for both severe and moderate depression, health care providers should consider combining it with non-pharmacological interventions such as CBT and physical exercise programmes. This is because antidepressants have many serious/adverse side effects and combining the two has been proven by research evidence to be effective. Therefore, both of the two interventions are considered essential in the treatment of depression.
References
Appiah, E. (2013). THE USE OF NON-PHARMACOLOGICAL INTERVENTION IN THE TREATMENT OF DEPRESSION: A Literature Review.
Mourilhe, P., & Stokes, P. E. (2018). Risks and benefits of selective serotonin reuptake inhibitors in the treatment of depression. Drug Safety , 18 (1), 57-82.
Popa-Velea, O., Gheorghe, I. R., Truţescu, C. I., & Purcărea, V. L. (2015). Current challenges and pitfalls in the pharmacological treatment of depression. Journal of medicine and life , 8 (2), 181.
World Health Organization. (2013). Pharmacological treatment of mental disorders in primary health care . World Health Organization.
