Abstract
This paper explores the pharmacological effects of anti-depressants in their treatment of depressive and related disorders, including ADHD, OCD, anti-social disorders, eating/sleeping disorders, and clinical depression. The constructivism of this work is in its substantial literature review, discussion section, and nursing implication sections where the author reveals both effectiveness and side effects of psychic drugs to cure depression. Nurse practical advice is given for those who work in clinics to reduce side effects and prevent worsening of the situation with patients.
Depression and related disorders have been treated by many generations of medications that are reported to have more or fewer effects on treatment. Specifically, they are all related to activating neural centers in the human brain and helping to transport serotonin and dopamine chemical structures between different brain centers. For this task, it is good to apply anti-depressants as stimulators of the brain activity in relation to their use irrespective of some side effects that may be significant for the brain structures.
Chemically, anti-depressants may differ by the structure of the compound in their atomic nature. For example, there are tricyclic anti-depressants with three atoms in the structure and there are tetracyclic compounds with the four-based compound structure. By effectiveness, selective and serotonin-norepinephrine reuptake inhibitors can be used apart from the major side effects, when regulated by other medications, and in the careful use with other psychic drugs. Noradrenergic and monoamine oxidase inhibitors belong to the new generation of psychic drugs that are used in depressive disorders treatment.
The aim of this paper is to provide an overview of medications of the anti-depressant type and discuss the benefits and side effects of each type of drugs. The Nursing Implication part will highlight consequences, which a nurse should take into account when treating a patient experiencing ADHD, OCD, clinical depression, eating/sleeping disorders, chronic pain, anxiety disorder, antisocial disorder, etc. In this relation, it would be useful to compare and contrast different types of medications in relevance to the nursing implications when they are all related to both benefits and side effects. Nurses should take into account all complexities and hard situations when treating patients with depressive disorders and, by the way, they should be all enlisted in the highly accessible database of clinical reviews and trials like this have been made in some attempts in the Cochrane Library by a number of research experts.
Discussion
Tricyclic Antidepressant Amitriptyline
Tricyclic antidepressant amitriptyline has been tested experimentally and clinically since the 1950s. This medication has shown positive results in the treatment of clinical depressive disorders, ADHD, suicide attempts, schizophrenic disorders, and eating disorders. This medication belongs to tricyclic compounds due to its specific chemical structure as its compounds have been united into triplets.
The superiority to the placebo effect of amitriptyline has been observed by researchers of the Cochrane Collaboration that have recently performed a background systematic review of substantial clinical trials of the tricyclic antidepressants. The effectiveness of this publication can be assessed by the amount of clinical trials data that go well along with the side effects of tricyclic antidepressants. The researchers have pointed out that their side effects are significant, as well as their impact on the organism. For instance, it has been revealed that amitriptyline may cause heart failure, hypertension, sexual dysfunction, vomiting, etc., specifically if the overdose has been applied to a patient. Overdose may even cause a lethal effect.
Selective Serotonin Reuptake Inhibitors
The medical use of selective serotonin reuptake inhibitors is the following: the chemical formula allows reactivating specific dopamine transporters in the organism. In this way, serotonin is easier transported in a patient and helps in the treatment of clinical depression, obsessive-compulsive disorders, eating and sleeping disorders, etc. The medication has been activated when it is bound up with postsynaptic receptors with the available level of serotonin within the synaptic cleft. However, the efficacy of the SSRIs in the clinical depression treatment may be doubtful for during some researches practitioners provide examples when this type of medication appears to be ineffective. On the contrary, Fournier et al. (2010) have provided a meta-analysis and clinical review research that has helped to generate major objectives of the depression treatment in cases of interest when there are observed outside sources reviewed along with practical results of the clinical medication treatment. The discussion of applying the SSRIs as dopamine transporting catalyzers has been on the rise nowadays due to the appearance of the next generation of antidepressants that are designed to get relief for the patients with a low dose of serotonin in the blood.
Serotonin-norepinephrine Reuptake Inhibitors (SNRIs)
Serotonin-norepinephrine reuptake inhibitors (SNRIs) are medications that are relevantly used to treat OCD, depression, attention deficit disorders, chronic pain, and other mood disorders, including ADHD and menopausal syndromes that belong to the group of dopamine and serotonin transmissions disorders. This type of medication belongs to potentially active and useful inhibitors of serotonin and norepinephrine reactions. They catalyze and stimulate other related medications, which is why they should be used carefully in correlation with other ways to treat depression, including natural herbal medications. In any case, improved tolerability and updates in safety profile should be used as applicable to patients who belong to the group of risk as indicated with respect to the correct dosage and in relation to the need to control for the allergic reaction of the organism to the SNRIs and deliverables. As for the forthcoming chemical reaction, it would be useful to provide the correct testing in relation to all types of such medications when they are prescribed and used with a view to ensuring corrections in dosages. The SNRIs ensuring “balanced dual inhibition of monoamine reuptake” can offer an easy way to use this type of medications for curing a wide range of symptoms, as related to clinical depression in all of its aspects, including OCD, ADHD, eating/sleeping disorders, and other clinical extrapolations of medication-required reactions. In some cases, patients are agreed to be cured by this type of antidepressants, but in other cases there is a need for extra care in relation to risky situations of suicidal reactions that may be either side effects of the SNRIs use or just may belong to the extra use of other medications that are left beyond the controllable measures.
The types of SNRIs are different as per dosage that during the initial stages of treatment starts with 300 mg/day is not recommended unless there are no significant reactions to the medication observed. The medications used at the initial stage of treatment are commonly from the following list: Venlafaxine (Effexor), Desvenlafaxine (Pristiq), Duloxetine (Yentreve, Cymbalta), Milnacipran (Ixel, Savills, Dalcipran), Levomilnacipran (Fetzima), etc. In relevance to different generations of medications, there is a variety of them being approved by the FDA as applicable in treatment of depressive disorders. In 1993, Venlafaxine was approved by the FDA, and in the progressive schedule in 1998 the FDA approved Sibutramine, in 2005 – Duloxetine, and in 2008 – Desvenlafaxine. Finally, as per medication of the new forthcoming generations, the Milnacipran was approved by the FDA in 2009 and has been actively tested clinically and used for the treatment of depressive disorders since then. A comparative analysis with other medications has been provided by the Cochrane society and it has been revealed that different SNRIs applied as medications of high-end generations can be effective in treatment of the clinical depression and related disorders if prescribed in the right dosages that are calculated depending on the severity of the disorder, possible allergic reactions, BMI (body mass index), and other health parameters. Apart from the side effects of the SNRIs, they are reported to be effective as per overall relief parameters when applied both in-home treatment and for forecasting of the forthcoming therapeutic effect in the clinical depressive syndromes treatment.
Psychoactive properties of the serotonin transmission catalyzers have been first discovered and tested on tuberculosis patients as the prehistory of treatment depression relating to the state of exhaust in the overall health rates of patients. Serotonin is an active substance that should be actively transmitted between activated centers so that the health parameters of patients can be tested as normal or positive in reactions with other fluids in the organism. Relevantly, the activity of dopamine and serotonin transmissions can be actively related to the progressive disorders since they are formulated in the number of researches from the Cochrane Library. For instance, Benedict, Arellano, De Cock, and Baird (2010) have provided substantial research on the effect of the economic evaluation in the form of a comparative analysis of duloxetine and serotonin selective reuptake inhibitors in treating MDD in relevance to Scotland. The economic evaluation of serotonin transmissions between neural centers appears to be effective as a part of the research.
Monoamine Oxidase Inhibitors (MAOIs)
Monoamine oxidase inhibitors (MAOIs) are chemical medications that have been widely in use for the treatment of atypical depressive disorders. This type of medication has been reported to be effective in the treatment of Parkinson’s disease and other orthopedic and neural disorders. MAOI is the type of antidepressant drugs that are in use only when other types of medications have failed, including tricyclic antidepressants and SSRIs. Accordingly, treatment of major dietary reactions is also under the treatment of MAOIs.
The mechanism of the effect of MAOIs is simple: monoamine oxidase bounds are catalyzed by enzymes clouds until the new enzyme activity is blocked by the previously generated enzymes that are environmental friendly in the monoamine inhibiting transmission. The regressive effect, however, can be traced in case of severe depressive disorders with respect to the stimulated reactions.
Reversible Inhibitor of Monoamine Oxidase A
Reversible inhibitor of monoamine oxidase A belongs to medications that reversibly inhibit the enzyme monoamine oxidase A (MAO-A). Clinically, this medication is widely used in the treatment of depression and dysthymia; however, the use of the medication has a much more pronounced effect on serotonin transporters. The transmission of this chemical can be widely transgressed among neural centers in the organism and this can be related to major relief in stress and depression. However, this medication can be very dangerous in relation to other drugs of a specific kind. The use of reversible inhibitors in depression treatment is explained by the presence of tyramine that has been adversely metabolized by neural receptors in the organism. The use of RIMAs is the following: they are much safer than older MAOIs due to a higher level of oxygen consistency in the dosage that is acceptable for the human organism.
Tetracyclic Antidepressants
Tetracyclic antidepressants have been actively used in the treatment of clinical depressive disorders for they are included in active serotonin and dopamine transmitters between the harmonized neural centrals. In comparison to tricyclic compounds, tetracyclic antidepressants have four atomic rings instead of three. It can be very useful for activating major receptors in the neural system that should be highlighted by them in an active manner. The rings of tetracyclic antidepressants have been described by the Cochrane researchers and by Brunton, Chabner, and Knollmann (2011) in their medical study of the therapeutic effect of antidepressants of such a type.
Noradrenergic and Specific Serotonergic Antidepressants
Noradrenergic and specific serotonergic antidepressants are highly effective psychiatric drugs that can be actively used as treatment medication of depression and related disorders. NaSSAs can help to regulate mood disorders due to enhancing adrenergic stimulators in the brain. It creates specific settings for avoiding the serotonin transmission between not facilitated unwanted areas, preventing incidents of many side effects (Millan et al. 2012). This medication is often associated with the SSRI antidepressants in relevance to specific serotonergic labels.
St. John’s Wort (Hypericum Perforatum)
In the treatment of depression and related disorders, St. John’s wort (Hypericum perforatum) can be effectively used irrespective of the side effects. This herbal medication is typical in the forests of Europe and Asia and it can be associated with the feast of St. John on the 24th of June when people traditionally apply this herb to religious icons to protect living beings from evil forces.
Medications Comparison
Anti-depressants may differ by the chemical structure, while their expected effects seem to remain almost the same: they relieve chronical negative mood disorders. They may include obsessive-compulsive disorders, deviance from the standard behavior in relevance to hormonal disorders, suicidal thinking, and inclines to excessive/insufficient eating/drinking/sleeping habits. All these symptoms may be regulated by psychic drugs and there are different types of them, including various “generations” of medications that are recognized as efficient by international psychological health organizations.
Historically, tricyclic and tetracyclic psychic drugs, including Amitriptyline, have been traditionally used since the 1950s. This medication, however, has a significant impact on the liver, creating the risks of extrapyramidal symptoms. The psychic health in such cases may suffer from the lack of the correct dosage prescribed by a doctor. The overdosage may have a possible lethal reaction.
In contrast, the chemical structure of antidepressants has been improved due to the overwhelming use of the reversible inhibitor of monoamine oxidase A that thanks to its metabolic structure can be used to ensure the better effect of medical compounds in the enzyme structure. New enzymes created in the organism with the help of this medication may be of much use due to the consistency of the chemical structure that can produce the treatment effect sooner and with fewer costs for the liver. Overall, the health rate is of the positive nature when this medication of the 2010 generation is in use in comparison with the traditional Amitriptyline.
Concerning the serotonin selective reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), these medications differ by the type of chemical structure in their compounds and their use relating to the creation of the centers of the brain exaltation in different nerve centers of the brain. The structure of chemicals is useful in these medications when they activate specific transportation means of serotonin and norepinephrine between different centers. Serotonin, in turn, activates centers in the human brain that are responsible for generating the effect of “happiness”, “satisfaction”, and “exaltation”. The effect of surprise, pleasant eating, thinking, dreaming, and other similar activities can be regarded as good for human brain health. In contrast, depressive disorders and related mood disorders may cause the reversible effect that may stimulate other patterns of thinking, decreasing the value of human life and even resulting in the suicidal way of thinking. In order to suppress such a way of thinking, it is possible to take advantages of life when using anti-depressants of many types. It would be useful to start with the simple ones in terms of the chemical structure, as well as trying different types up to the appropriate solution is found by means of using other generations of anti-depressant medications, including MAOIs that can be viewed as the newest generation of medications used to treat clinical depression and other mood-related disorders.
Nursing Implications
Nurses have to be taught to assess possible consequences and side effects that may arise from overdoses, misuse, and use of anti-depressants. In such cases, effective training may help to resolve problematic situations.
For instance, if the correct dosage for most anti-depressants may be 300 mg may already cause some side effects. In most cases, side effects from anti-depressants may cause reverse reactions of treatment in the human organism. In such cases, the liver reactions may be of the negative effect and cause some stomach pain. In other cases, pain may be of the neurotic type. This type of pain is dangerous in terms of its consequences and it can be prevented by lowering the dose of anti-depressants.
In many cases, treatment with anti-depressants is related to strengthening the chronic effects of pain, specifically in relevance to hypertension and hypotension medication. In some cases, an overdose of anti-depressants may stimulate vomiting, vegetative distension, menstrual disorders, sexual dysfunction, etc. These side effects are all related to the instability in the hormonal balance in the organism and can be prevented by recharge in using anti-depressants or choosing another type of this medication.
For better or worse, some anti-depressants keep patients calm, while others stimulate serotonin and dopamine reactions in the brain. Of course, the contrasts in effects are different not only by structure but also by the variety of effects on different people by age, gender, as well as social and psychical/psychical activity. Therefore, each case of depression should be deemed individual and should be treated individually as well. In many cases, side-effects of anti-depressants can be forecasted, but it may happen very often that it can be relatively hard to embrace all such effects when anti-depressants are used for the testing purposes. For a short or long period of time, anti-depressants can be used in all cases according to the overall rates and the state of health to relieve the tension in different parameters.
Anti-depressants are medications that are used to relieve tension in patients with clinical depression and mood-related disorders. In many cases, the use of such medications is chemically related and tested by a number of researches, including those that are included in the Cochrane Library.
However, because of the side effects of medications, some of them should be avoided or used with the extra care due to frequent consequences in patients with high risks for the heart failure, insomnia, eating/sleeping disorders, heart arrhythmia, stomach neurotic pain, OCD, ADHD, sexual dysfunction, etc.
