New Generation Antidepressants
In this new era of everchanging technology and lifestyle, scientists and researchers are always looking to improve the current resources. From the nib of the pen to a space shuttle, we are continuously improving technology to make them more easily accessible and safer for the future use. Even in the field of medicine, new discoveries are taking place everyday which can potentially serve as future clinical drugs and which are much cheaper to prepare. According to the Allied Market Research, antidepressant drug market will reach $15.98 billion by 2023. It is certain that the medicine industry is making a whole lot of business worldwide, but do they really have a positive impact on the patient's life? In this article, we will specifically talk about antidepressants and their effectiveness along with the long list of side effects and potential future antidepressants. In our guest interview, we'll talk to Pulkit Kumar and Dhaniket Patel from the University of Alberta, Canada and their concerns about the current treatments.
There are several types of antidepressants available in the market today including (but not limited to) selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs), tricyclic antidepressants and many more. Let's talk in detail about a few of these
1. SSRIs- SSRI’s are prescribed to treat MDD, especially in the cases of severe and or persistent cases. SSRI works by affecting serotonin levels in the brain. Serotonin is a neurotransmitter, which affects directly on mood, emotions and sleep, which are few of the most relevant symptoms of MDD. Once a neurotransmitter does its function it is reabsorbed by the nerve cells, but what SSRI does is, it blocks the reuptake (reabsorption) so serotonin can now be more readily available to pass the stimulation to the nearby nerve cells.
Serotonin rise doesn’t treat MDD but it reduces the symptoms which makes people more responsive to other treatments, such as CBT. The side effects of these include: Sexual dysfunction, drowsiness, nausea, dry mouth, insomnia, diarrhea, nervousness, agitation, dizziness, reduced sexual desire or difficulty reaching orgasm, headache, blurred vision; discontinuation syndrome (withdrawal symptoms); problems in erection; chances of having suicidal thoughts are doubled some after consuming SSRIs; can develop a condition called serotonin syndrome.
2. SNRIs- SNRI’s also help to relieve the symptoms of depression in MDD such as low mood, feelings of worthlessness, irritability, restlessness, anxiety along with chronic muscle or joint pain, fibromyalgia, low back pain or osteoarthritis pain, panic disorder, social phobia. SNRIs increase levels of serotonin and norepinephrine in the brain by blocking or delaying their reuptake by nerves, similar to the function of SSRIs .Serotonin, as described above is a neurotransmitter and is often referred to as the feel good hormone. It is responsible for carrying messages between brain cells and also contributes to good mood, appetite, social behaviour, as well as regulating the internal clock of the body and the sleep-wake cycle.
When taken at the recommended dosage, SNRI antidepressants are considered safe. However, they have been associated with a few serious, potentially fatal, severe side effects such as:
Serotonin syndrome – this is caused by excessive levels of serotonin in the body and is more likely to occur with higher doses of SNRIs or when SNRIs are administered with other medications that also release serotonin (such as dextromethorphan, tramadol, and St. John's Wort). Symptoms include agitation, confusion, sweating, tremors, and a rapid heart rate
Interaction or overdosage may cause serotonin syndrome (symptoms include mental status changes [such as agitation, hallucinations, coma, delirium), fast heart rate, dizziness, flushing, muscle tremor or rigidity and stomach symptoms (including nausea, vomiting, and diarrhea).
The dosage of some SNRIs may need reducing in people with mild to moderate kidney or liver disease. Avoid in severe kidney and liver disease and may not be suitable for people who are susceptible to glaucoma. Not generally recommended for people under the age of 18. Along with these fatal side effects, some of the common side effects include: Constipation, dizziness, drowsiness, dry mouth, Gastrointestinal upset, headache, hot flushes, insomnia, nausea, sexual dysfunction
3. Tricyclic Antidepressants- The function of Tricyclics is to increase the levels of Serotonin and norepinephrine and also to block the action of acetylcholine, which are all neurotransmitters. In addition they also cause sedation by blocking the functions of Histamine. Tricyclics have many different subclasses but they all have the same chemical and biological effects. The side effects of Tricyclics are blurred vision,dry mouth,constipation,weight gain or loss, low blood pressure on standing,rash, hives, and increased heart rate.
These are all common side effects but the list of side effects also include many fatal side effects such as increase in seizures, worsen urinary retention (difficulty urinating) and narrow angle glaucoma. Abnormal heart rhythms and sexual dysfunction have also been associated with tricyclic antidepressants. Also has withdrawal effects even the medications are taken for a short amount of time and even when few doses are skipped. They also increase the risk of suicidal thinking and suicidal behavior which must be monitored, along with this their behaviour must be monitored as it has the tendency to increase psychiatric disorders in the subject.
Despite having so many options of therapies and drugs that have been established by modern medicinal science, the generation which has solutions on their fingertips (google) have started looking for other options to treat MDD, which has again opened up routes that point towards the path of alternative therapies. Alternative therapy encompasses a variety of disciplines that includes everything from diet and exercise to mental conditioning and lifestyle changes. Examples of integrative therapies include acupuncture, guided imagery, chiropractic treatments, yoga, hypnosis, biofeedback, aromatherapy, relaxation, herbal remedies, massage and many others. Despite the presence of evidence for traditional medicine a lack of systematic research have made them much less likely to be used by the patients with MDD. Here in this paper the researchers are highlighting the level of evidence for treatment of MDD using traditional medicines specifically when looked at Ashwagandha. Some examples of alternate therapy include:
Acupuncture- Acupuncture is an ancient Chinese method of healing that prevents and cures specific diseases and conditions by sticking very fine, solid needles into specific points on the body. Acupuncture stimulates the body's ability to resist or overcome illness by correcting imbalances. It also prompts the body to produce chemicals that decrease or eliminate painful sensations. In a recent clinical study, acupuncture has been shown effective in decreasing depression at three months, compared to usual care.
Reflexology- Reflexologists believe that the body has the capacity to heal itself. The nerves in the hands and feet are related to various parts of the body. Reflexologists believe that the healing process is stimulated by applying pressure to specific points on the hands and feet.
Exercise- Different forms of exercise can lower your stress; reduce depression; and increase your energy level, balance, flexibility, and ability to relax. In general, exercise is a safe and easy way to improve your well-being, but it is recommended to always check with your doctor before starting a new exercise program.
Meditation- Meditation is sometimes described as an altered state of consciousness. It is a form of relaxation that, unlike sleep, is entered into purposely. Meditation is usually practised regularly—for at least 10 minutes each day. While the body is at rest, the mind is cleared by focusing on one thought, which could be a word, phrase, or particular scenery.
Massage- Massage uses touch to promote relaxation while decreasing tension and stress. The release of serotonin and dopamine and the decrease of cortisol during a massage may help improve the symptoms of depression, lessen pain and improve sleep.
Guided Imagery and Relaxation- Guided imagery is a form of focused relaxation that helps create harmony between the mind and body. Guided imagery coaches you in creating calm, peaceful images in your mind—a "mental escape" for therapeutic purposes. It can be a powerful psychological strategy to enhance a person's coping skills. It can help people cope with—and possibly overcome—stress, anger, pain, depression, and insomnia with or without associated physical illness.
Yoga- Yoga “meets you where you are,” even when you are depressed. Practising yoga teaches you breathing techniques that can help to energize you when you are feeling down or to help calm you at the times you may be feeling anxiety.
Herbal remedies- Of the wide variety of available herbal therapies, St. John's wort and Ashwagandha are the most famous and most useful as per the evidence that has been seen by different researchers:
We had a chat with Pulkit Kumar, a student of the University of Alberta, Canada. He is concerned with the adverse side effects of the current antidepressants. He is working on developing and discovering alterative therapies/ treatments along with his co-researcher Dhaniket Patel. While they were shadowing doctors, they saw the adverse side effects that patients have to go through, when they are on antidepressants. The patients have to take their regular antidepressants and further medications for the side effects. This really concerned the duo and they decided to do something about it. The two have introduced the long forgotten antidepressant properties of Withania Somnifera (WS). Although WS is used for its multipurpose medicinal properties in countries like China, India, Sri Lanka, Bangladesh and other parts of Asia, there are a lot of things that remain unknown and require further treatment. These two researchers have found out that the phytochemicals in the plants including Alkaloids and Withanolides have excellent antidepressant properties. They have also mentioned there are no side effects known, even if used for a longer term for 7-10 years.
They mentioned that "even after being used for so long, the mechanism of action and a proper randomized control trial remain unknown." They have taken it upon themselves to conduct a randomized control trial and are encouraging researchers to do more research on medicinal herbs. They also mentioned that 1 kg of WS would only cost about $23, which is much cheaper when compared to the preparation, development and other related costs of the current antidepressant. Their aim is to develop and discover medicines which are cheap to prepare and have little to no side effects when compared to the current treatments. They are really sure that although these medications will be a little slower in showing all their benefits, but once they're activated, they will be much more affective than the current treatments.
They also mentioned that apart from no side effects, WS also increases your testosterone levels, helps patients with impotence and also neutralizes dangerous free radical molecules in the bloodstream, thus preventing and reversing the cellular damage at the root of heart disease and most cancers. All in all their claim is that WS is a great tonic for the human body
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
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