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

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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. The text for this video is too long and exceeds the max allowed character length for Youtube. You can read the rest here http://www.stomponstep1.com/antidepressants-ssri-snri-tricyclic-antidepressants-citalopram-prozac-amitriptyline/ Pictures Used: • “SynapseSchematic” by Thomas Splettstoesser available at https://commons.wikimedia.org/wiki/File:SynapseSchematic_unlabeled.svg via Creative Commons 4.0 Attribution-Share Alike • “Zoloft Bottles” by Ragesoss available at https://commons.wikimedia.org/wiki/File:Zoloft_bottles.jpg via Public Domain
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Текстовые комментарии (26)
Evan Taaved Pert (1 месяц назад)
Candace Winfrey (2 месяца назад)
TrazoBONE lol
julieann522 (5 месяцев назад)
bad medications
Rameez Ullah (8 месяцев назад)
I am a patient of depression and stomach gases. My phsycatrist recommended me Amitriptyline for this. I want to ask does it really work? I have taken 26 doses till now.........
Ephafrus Mathabatha (7 месяцев назад)
Rameez Ullah I'm not understanding what is it that you mean by stomach gases but amytryptiline is known to relieve pain. It is good for things like back pain or muscle pain. It can also help in night for people who tend to wet their beds unintentionally. I hope this provides clarity.
Kas (10 месяцев назад)
you are western medicine brain washed....
Luffy HJ (1 год назад)
very informative video...thx!
Kamil Malshy (1 год назад)
great job sir!
MetusChelah85Rolle (1 год назад)
I love it, to the point.
2301303189 views (1 год назад)
There are a few components to natural treatments for depression. One plan I discovered which successfully combines these is the Martos Magic Method (check it out on google) without a doubt the most incredible guide i've seen. look at the amazing information .
Almir Habibović (1 год назад)
I've been researching reducing depression quickly and found an awesome website at Sebs Shy Remedy (look it up on google)
M.N.E (1 год назад)
Thank you
Jaff Fox (1 год назад)
*You forgot to mention Mirtazapine most potent side effect: It gives most people debilitating night terrors.*
Emanuela Muntean (2 года назад)
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!!!!
varun tej (2 года назад)
paula19762007 (2 года назад)
Really good information thanks
Stomp On Step 1 (2 года назад)
+paula19762007 thanks for the comment Paula :)
Jaime Maussan (2 года назад)
So helpfull!!!! Thanks!!!!
Sorieyn (2 года назад)
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!
Stomp On Step 1 (2 года назад)
+Sorieyn LOL thanks!
reem ibraheem Alaraj (2 года назад)
Stomp On Step 1 (2 года назад)
+reem ibraheem Alaraj :)
smartaleck05 (2 года назад)
Awesome, thanks! Not there yet for step, but it's material in my current block. ^^
Valeri Karavasilev (1 год назад)
There are several factors in treatments for depression. One resource I discovered that successfully combines these is the Martos Magic Method (google it if you're interested) it's the most useful guide that I've seen. Check out all the unbelievable info .
Deepesh Thapa (2 года назад)
I\'m not sure but ,if anyone else is searching for alternative treatments for depression try Vaxicorn Depression Remover Guide (just google it ) ? Ive heard some unbelievable things about it and my mate got amazing results with it.
Stomp On Step 1 (2 года назад)
+smartaleck05 thanks for watching!

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