Pharmacological Management of major Depression in older adults using Selective Serotonin-Reuptakes Inhibitors" Abstract Serotonin-specific re-uptake inhibitors (SSRI) belong to the category of antidepressant drugs that have revolutionized the treatment of depression and significantly minimized the range of adverse effects enforced by the use of the tricyclics or MAOIs…
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They have minimal effect on noradrenalin and dopamine activity, compared to the tricyclics or MAOIs. Some of the drugs, like fluoxetine, have a mood elevating effect when used in healthy individuals. Fluoxetine drug has the longest half-life amongst all approved SSRIs with drug and side effects persisting up to six weeks after the termination of therapy. Introduction Serotonin is an important neurotransmitter, a local hormone in the gut, a component of the platelet clotting process, and is thought to play a role in migraine headache. Serotonin is also one of the mediators of the signs and symptoms of carcinoid syndrome, an usual manifestation of carcinoid tumor, a neoplasm of enterochromaffin cells. Patients with non-operable tumor, take serotonin antagonist for a useful treatment. The diagnosis of depression still rests primarily on the clinical interview. Major depressive disorder (MDD) is characterized by depressed mood most of the time for at least 2 weeks and/ or loss of interest or pleasure in most activities. Additionally, depression is associated with sleep, as well as diet disturbances and deficits in cognition and energy. Thoughts of guild, worthlessness and suicide are common. Coronary artery disease, diabetes and stroke appear to be more common in depressed patients and depression may considerably worsen the prognosis for patients with a variety of comorbid medical conditions (Katzang, 2009; Rang, 2009; Kaushik, 2011). Reports by Centers for Disease Control and Prevention highlight the fact that antidepressant drugs were the most commonly prescribed medications in the USA. It is observed that American physicians have been increasingly inclined to use antidepressants to treat a host of conditions that patients have been increasingly receptive to their use. Major depression is commonly associated with a variety of medical conditions from chronic pain to coronary artery disease, panic disorder, generalized anxiety disorder (GAD), post traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD) specifically in older individuals or other related old age diseases which enhances the burden of depressive thoughts and also affects the quality or life. All these reasons paved the way for growth in the use of antidepressants ( Katzang, 2009; Rang, 2009). Comparison of SSRIs with Tricyclic Antidepressants (TCAs) - The first line of antidepressant treatment suggested for elderly population involves SSRIs (Selective Serotonin Reuptake Inhibitors). There are weak facts for this suggestion as studies carried out highlight the comparative usefulness, protection, acceptability, as well as success of SSRIs and TCAs suggesting that there are a few optional returns of both these drugs over one another. Moreover, there is always a potential danger of falls which is prevalent in elderly patients, hyponatremia, loss of weight and sexual dysfunction, as well as drug-drug interactions. Therefore, SSRIs and TCAs must be prescribed by physicians for elderly patients considering frequency and severity of depression (Herrmann, 2000). Pathophysiology of Major Depression Observations reveal that there is a tremendous shift that has been witnessed for understanding the pathophysiology of major depression. Initially, the amount of monoamines was considered to be the central to the biology of depression. Evidence suggests that neurotrophic and endocrine factors
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