Prozac And Other SSRIs - Essay Example

Prozac and other SSRIs Name: Institution: Question 1 Selective serotonin re-uptake inhibitors have become common prescription drugs in the treatment of most mental disorders. Before the introduction of this category of antidepressants in the 1980s, doctors and psychiatrists relied on tricyclic antidepressants and monoamine oxidase inhibitors. The initial treatments did not gain as much popularity as Prozac and other SSRIs due to the nature of their action and efficacy. The approval of the drug by the American food and drug administration in 1987 is one of the pointers of its popularity in the control of mental disorders. This approval was motivated by the drug metabolism among other factors. Fluoxetine which is the chemical component of the drug was found to be almost completely absorbed by the body upon oral administration or uptake. Research showed that fluoxetine is highly CNS penetrant to the brain plasma rations in humans at 2.6:1 (Wenthur, Bennett & Lindsley, 2013). A comparison of the adverse effects of the tricyclic antidepressants and those produced by the SSRIs show that the drugs products far less negative side effects. Tricyclic antidepressants have a broad spectrum of action that makes them have an equally large amount of side effects. Scientists discovered that the use of the drugs inhibited the reuptake of norepinephrine and serotonin. Partial inhibition of the reuptake of dopamine was also noted. Due to this reason, the antidepressant took about a period of 2 weeks to produce results in patients. Most patients showed symptoms of drowsiness in the initial week of treatment as a side effect of the administration of the drug. An abrupt withdrawal from the drug also produced major withdrawal symptoms. The oldest class of antidepressants known as monoamine oxidase inhibitors had its equal share of problems that led to their lack of popularity. The most common problem experienced with this class of drugs was the production of tyramine that resulted in abnormal high blood pressures in patients. Research showed that a combination of this drug and some classes of foods and drinks released tyramine in the patients. For this reason, the drug was linked to the dangerously high blood pressure that resulted in stroke and heart attack in most patients. The reaction with foods such as cheese and beverages such as wine led to the recommendation that they should not be utilized as the first line treatment for depression. Most of the patients that consumed the drug experienced postural hypertension which is a major indication of the decreased blood flow to the brain while standing. Fainting was common among the patients and an abnormal heart rhythm was also constantly recorded. According to Mourilhe & Stokes (1998), patients with depression are likely to be suicidal. It states that up to 15% of such patients with recurrent need for hospitalizations have suicide as a major cause of death. The study reveals that current data support the use of SSRIs in the reduction of the prevalence of suicide in such patients. The study also suggests that even in the presence of comorbidities, the use of SSRIs still produced better results. The study further reviews the drug interactions of SSRIs. It notes that as compared to older antidepressants, the inhibition of hepatic cytochrome P450 is infrequent and less medically significant in patients. Antidepressant medications takes clarification based on their specificity in regards to brain neurotransmitters. SSRIs are a class of medication that comprise citalopram, paroxetine, sertraline, fluoxetine, and fluvoxamine. SSRIs are characterized by serotonin transporters, blocking reuptake which in turn results to the increased concentration of the neurotransmitter serotonin within the synapse. Evidence from several studies especially the randomized double-blinded placebo-controlled trials point to the fact that SSRIs can be effectively used to treat adolescent depression. A study by Bridge, Iyengar, &Salary(2007), shows a significant level of importance of Prozac in treatment of depression. According to the study, children under the age of 12 year mainly benefited from fluoxetine for treating pediatric depression. In regards to adolescents, two undertaken randomized controlled trials indicates the efficacy of citalopram for treatment of depression (Bridge, Iyengar, &Salary, 2007). While older methods of treatments did take a longer period to provide therapeutic effects, SSRIs give a rapid response to depression. As compared to tricyclic antidepressants which take up to 2 weeks to begging showing proper therapeutic effects, modern SSRIs can have effects within 24 hours of administration. This makes fluoxetine a drug that patients can start to take at any stage even closer to their full therapeutic dosage. Additionally this characteristic makes the SSRIs safer even in high dosage to patients and point to their high efficiency in the control of depression. Question 2 Despite being touted as better treatment to depression that the older drugs such as TCAs and MAOIs, there are concerns about the use of SSRIs that have been raised by critics. These concerns are related to the negative impacts to the environment and the side effects that are produced by the drugs on the consumers. Fractions of non-metabolized fluoxetine have been discharged into the environment with some unknown consequences to the ecosystem (Mendez-Arriaga et al. 2011). Many side effects of the use of SSRIs are short lived. This makes patients particularly unable to detect them as they can resemble residual symptoms of depression (Moret and Isaac, 2007). Failure to identify the side effects can then lead to continued use of the drugs to more adverse side effects that can affect the quality of life for the patients. It can also lead to the overdependence on the drugs which eventually lower the outcome for the patient. Poor locomotion has also been given as the major side effect of the use of SSRIs (Mendez-Arriaga et al. 2011). Kohlert et al. (2012), examines the effects of fluoxetine on the locomotors behavior in betta splendens. In this study, the lack of treatment of sewage to remove toxic pharmaceuticals is a major concern. It notes that the failure to remove the sub lethal doses of pharmaceuticals such as fluoxetine in sewage and their subsequent discharge in the surface waters is worthy of investigation. In the research, fish that were treated with 705 mgl/l of fluoxetine showed a general reduction on locomotion or movement. Their aggression in attacks was also significantly reduced as compared to the fish that were subjected to 0 mgl/l fluoxetine. A reduction in the treatment of fluoxetine showed a consistent improvement in aggression towards the perceived intrusion in the treated group. There was no difference in locomotion and aggression towards intruders in both group following three weeks of the removal of the fluoxetine treatment. This study (Kohlert et al., 2012) showed that the administration of fluoxetine can considerably affect an animal’s locomotion characteristics. A similar research was conducted by Fong et al. (2015). It compared the effect of either venlafaxine or fluoxetine on the locomotion of water snails towards the water air interface. The snails were subjected to equal amounts of the antidepressants and observed as they moved towards the water/air interface. The study noted that venlafaxine is another antidepressant that is commonly administered to treat psychological conditions just as fluoxetine or Prozac. Results showed that the snails that were subjected to venlafaxine moved faster towards the water-air interface than snails that were treated with fluoxetine. Crawling speed was significantly increased upon the reduction of the dosage of the antidepressants. This results led to the conclusion that fluoxetine has a more adverse effect on the locomotion of animals and a higher chance of foot detachment than other antidepressants. Other studies that have been conducted are related to the environmental impact of fluoxetine. Some studies opine that as compared to other antidepressants, fluoxetine and its metabolites have a higher half-life than other antidepressants. Mendez-Arriaga et al. (2011), examines the oxidative disposal of fluoxetine which is the basic chemical component of the Prozac drug. The experimentation involves several oxidative processes in the presence of ultra violet light and without it. It also factors in hybrid oxidative processes like the oxidation involving TiO2 and O3 or both TiO2 and O3 plus H2O in a laboratory setting. The experiments produced a strong link between the absorption of fluoxetine on TiO2 and PH in the degradation process. Under alkaline conditions, there was a high degree of photolysis of fluoxetine. This process was further aided by the presence of water that mineralized the remaining metabolites further. UV light had the highest elimination of the compound. This research then concludes that a hybrid method consisting of photolysis and TiO2/O3 would be the best method in treating water that is contaminated with pharmaceuticals such as fluoxetine (Mendez-Arriaga et al., 2011). The findings here can be used to justify the fact that in non-alkaline waters and environments, elimination of fluoxetine and its metabolites would be difficult. Question 3 SSRIs are the best antidepressants that should be used to manage mental disorders such as depression and obsessive compulsive disorder. Their suitability stems from the fact that the SSRIs have low negative effects as compared to the TCAs and MAOIs. The adverse side effects of the drugs do not last as long as those of the previous antidepressants. Typical side effects include insomnia, nausea, dizziness, sweating among others. These symptoms last usually between one to two days maximum and disappear completely (Ferguson, 2001). The side effects of MAOIs have been associated with stroke and hypertension which are severe health complications. Depression is one of the major causes of suicide. Many patients who suffer from this condition and fail to take any medication or intervention are more likely to be victims of suicide than patients who take SSRIs as an intervention. A review of some of the benefits of the use of SSRIs show that apart from the improved outcome to patients, the drugs are likely to reduce chances of suicide (Mourilhe & Stokes, 1998). The fact that SSRIs can be used to target a specific group and that gives it an added advantage over some antidepressants. For instance, according to Cheung, Emslie & Mayes (2005), are generally tolerated and preferred by adolescents and children. The SSRIs have a short-term side effects such as insomnia, sleep disturbances, and appetite changes. However, these side effects are nothing compared to other antidepressants and they are dose-dependent hence decrease over time. Efficiency is another factor that would lead to the SSRIs being preferred for treatment of depression. It has been noted that TCAs have a low therapeutic index (Ferguson, 2001). The administration of these drugs at high doses may also result in patients experiencing seizures as a complication. Apart from the seizures, the high dose can lead to death from the slowing of intraventricular conduction and complete blocking of the heart (Ferguson, 2001). Some researchers opine that the use of these drugs is safe since an overdose can have mild side effects depending on the quantity taken. This is another strength of the SSRIs that makes them good for use in controlling depression. Kulin (1998) takes a different perspective in examining the safety of the SSRIs. In this study, the central focus is the effect of the SSRIs on the human fetus. It examines the safety of human fetus through studying parents that are under fluvoxamine, sertraline and paroxetine. It uses a controlled cohort study to review the differences and make its observations. The results show that exposure to these new SSRIs did not have any relation with the fetal development. The main measure of the study was the rate of congenital malformations. It concludes that while the teratogenic risk is not increased if the new SSRIs are used within the physician recommended doses. In my opinion, this is just another reason why SSRIs should be used. Despite the high approval and popularity, the SSRIs have some disadvantages that they pose to patients. The efficiency and acceptability of these drugs have been examined and found to be low due to costs (Song et al., 1993). In this research, the main intention was to conduct a meta-analysis of the outcome for patients using tricyclic antidepressants and those consuming SSRIs. There was no significant difference between the outcome for patients taking SSRIs and those taking tricyclic antidepressants. On costs, the study found that there was a significant increase in the amounts spent by patients taking SSRIs. This led to the conclusion that the routine uptake of the SSRIs would lead to greater costs with benefits that are questionable. This study does not factor in the drug action and the adverse effects that the tricyclic antidepressants bring to patients. In this case, it would be important to weigh the cost of the negative adverse effects against costs. The most probable result is that the benefits of the SSRIs would then outweigh the price tag that is given to them in this study. Despite these many benefits of the SSRIs, I believe there should be limits on the usage of these drugs. Moret and Isaac (2007), explains that the negative impacts of the SSRIs can be easily confused with the symptoms of depression. Patients can therefore continue to take these drugs without knowing whether they are treating depression or the drugs adverse effects. This would then lead further complications that are hazardous and affecting the quality of life. References Bridge J.A, Iyengar S, and Salary C.B., (2007). Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: A meta-analysis of randomized controlled trials, 1683-96. Cheung A.H., Emslie G.J, and Mayes T.L. (2005). Review of the efficacy and safety of antidepressants in youth depression. J Child Psychol Psychiatry, 735-54. Ferguson, J. M. (2001). SSRI antidepressant medications: adverse effects and tolerability. Primary care companion to the Journal of clinical psychiatry, 3(1), 22. Fong, P. P., Bury, T. B., Dworkin-Brodsky, A. D., Jasion, C. M., & Kell, R. C. (2015). The antidepressants venlafaxine (“Effexor”) and fluoxetine (“Prozac”) produce different effects on locomotion in two species of marine snail, the oyster drill (Urosalpinx cinerea) and the starsnail (Lithopoma americanum). Marine environmental research, 103, 89-94. Kohlert, J. G., Mangan, B. P., Kodra, C., Drako, L., Long, E., & Simpson, H. (2012). DECREASED AGGRESSIVE AND LOCOMOTOR BEHAVIORS IN BETTA SPLENDENS AFTER EXPOSURE TO FLUOXETINE 1. Psychological reports, 110(1), 51-62. Kulin, N. A., Pastuszak, A., Sage, S. R., Schick-Boschetto, B., Spivey, G., Feldkamp, M., ... & Brochu, J. (1998). Pregnancy outcome following maternal use of the new selective serotonin reuptake inhibitors: a prospective controlled multicenter study. Jama, 279(8), 609-610. Mendez-Arriaga, F., Otsu, T., Oyama, T., Gimenez, J., Esplugas, S., Hidaka, H., & Serpone, N. (2011). Photooxidation of the antidepressant drug fluoxetine (Prozac®) in aqueous media by hybrid catalytic/ozonation processes. Water research, 45(9), 2782-2794. Moret, C. and Isaac, M. (2007). Problems associated with long-term treatment with selective serotonin reuptake inhibitors. NeuroBiz Mourilhe, P., & Stokes, P. E. (1998). Risks and benefits of selective serotonin reuptake inhibitors in the treatment of depression. Drug Safety, 18(1), 57-82. Song, F., Freemantle, N., Sheldon, T. A., House, A., Watson, P., Long, A., & Mason, J. (1993). Selective serotonin reuptake inhibitors: meta-analysis of efficacy and acceptability. Bmj, 306(6879), 683-687. Wenthur, C. J., Bennett, M. R., & Lindsley, C. W. (2013). Classics in chemical neuroscience: fluoxetine (Prozac). ACS chemical neuroscience, 5(1), 14-23. Read More

According to Mourilhe & Stokes (1998), patients with depression are likely to be suicidal. It states that up to 15% of such patients with recurrent need for hospitalizations have suicide as a major cause of death. The study reveals that current data support the use of SSRIs in the reduction of the prevalence of suicide in such patients. The study also suggests that even in the presence of comorbidities, the use of SSRIs still produced better results. The study further reviews the drug interactions of SSRIs.

It notes that as compared to older antidepressants, the inhibition of hepatic cytochrome P450 is infrequent and less medically significant in patients. Antidepressant medications takes clarification based on their specificity in regards to brain neurotransmitters. SSRIs are a class of medication that comprise citalopram, paroxetine, sertraline, fluoxetine, and fluvoxamine. SSRIs are characterized by serotonin transporters, blocking reuptake which in turn results to the increased concentration of the neurotransmitter serotonin within the synapse.

Evidence from several studies especially the randomized double-blinded placebo-controlled trials point to the fact that SSRIs can be effectively used to treat adolescent depression. A study by Bridge, Iyengar, &Salary(2007), shows a significant level of importance of Prozac in treatment of depression. According to the study, children under the age of 12 year mainly benefited from fluoxetine for treating pediatric depression. In regards to adolescents, two undertaken randomized controlled trials indicates the efficacy of citalopram for treatment of depression (Bridge, Iyengar, &Salary, 2007).

While older methods of treatments did take a longer period to provide therapeutic effects, SSRIs give a rapid response to depression. As compared to tricyclic antidepressants which take up to 2 weeks to begging showing proper therapeutic effects, modern SSRIs can have effects within 24 hours of administration. This makes fluoxetine a drug that patients can start to take at any stage even closer to their full therapeutic dosage. Additionally this characteristic makes the SSRIs safer even in high dosage to patients and point to their high efficiency in the control of depression.

Question 2 Despite being touted as better treatment to depression that the older drugs such as TCAs and MAOIs, there are concerns about the use of SSRIs that have been raised by critics. These concerns are related to the negative impacts to the environment and the side effects that are produced by the drugs on the consumers. Fractions of non-metabolized fluoxetine have been discharged into the environment with some unknown consequences to the ecosystem (Mendez-Arriaga et al. 2011). Many side effects of the use of SSRIs are short lived.

This makes patients particularly unable to detect them as they can resemble residual symptoms of depression (Moret and Isaac, 2007). Failure to identify the side effects can then lead to continued use of the drugs to more adverse side effects that can affect the quality of life for the patients. It can also lead to the overdependence on the drugs which eventually lower the outcome for the patient. Poor locomotion has also been given as the major side effect of the use of SSRIs (Mendez-Arriaga et al. 2011). Kohlert et al. (2012), examines the effects of fluoxetine on the locomotors behavior in betta splendens.

In this study, the lack of treatment of sewage to remove toxic pharmaceuticals is a major concern. It notes that the failure to remove the sub lethal doses of pharmaceuticals such as fluoxetine in sewage and their subsequent discharge in the surface waters is worthy of investigation. In the research, fish that were treated with 705 mgl/l of fluoxetine showed a general reduction on locomotion or movement. Their aggression in attacks was also significantly reduced as compared to the fish that were subjected to 0 mgl/l fluoxetine.

A reduction in the treatment of fluoxetine showed a consistent improvement in aggression towards the perceived intrusion in the treated group.

Read More