Monoamine Oxidase Inhibitors (MAOIs) - Antidepressants for Major Depression

Monoamine oxidase inhibitors (MAOIs) are one of the oldest classes of antidepressants and are typically used when other antidepressants have not been effective. They are used less frequently because they often interact with certain foods and require strict dietary restrictions. MAOIs can also result in severe adverse reactions if taken with many other medicines, including some over-the-counter cough and cold remedies. MAOIs are mostly used for atypical depression.

A newer type of MAOI called moclobemide is slightly different to the older MAOIs. It is considered to be a safer choice than the older MAOIs, as it requires fewer dietary restrictions and has fewer significant interactions with other medicines. Moclobemide is considered a second-line treatment for major depression.

How do MAOIs work?

It is thought that depression may be linked to an imbalance of chemicals within the brain.

Within the brain there are chemical messengers or neurotransmitters, called monoamines. Examples of these are noradrenaline and serotonin.

Neurotransmitters are involved in controlling or regulating bodily functions, and noradrenaline and serotonin are involved in the control and regulation of mood.

When depression occurs, there may be a decrease in the amount of these monoamines released from nerve cells in the brain. Monoamines are broken down by a chemical (enzyme), called monoamine oxidase.

MAOIs prevent monoamine oxidase from breaking down the monoamines. This results in an increased amount of active monoamines in the brain.

By increasing the amount of monoamines in the brain, the imbalance of chemicals, thought to be important in causing depression, is altered. This helps relieve the symptoms of depression.

Moclobemide is a more selective type of MAOI, called a reversible inhibitor of monoamine oxidase type A (RIMA). It works specifically on monoamine oxidase type A, which gives it its slightly different profile.

How long do MAOIs take to work?

MAOIs can take a while to have an effect so you may not feel better immediately when you start treatment with one.

You may experience an effect on your mood within two weeks, however, the full benefits of treatment with MAOIs may not occur for a further two to four weeks. It is important to keep taking the medicine even if you think it is not working at first.

If you feel your depression has got worse, or if you have any distressing thoughts or feelings in these first few weeks, then you should talk to your doctor.

How long will I have to take them for?

MAOIs usually help mood improve over a number of weeks or months. Even when things seem back to normal, you should keep taking them for a further six months to minimise the chances of the depression coming back.

Are they addictive?

No. It is possible for MAOIs to produce unpleasant withdrawal symptoms (sometimes called a discontinuation syndrome) when they are stopped. But this is temporary, does not involve a craving for the medication, and can usually be avoided if the drug is tapered off rather than stopped suddenly. This is not addiction.

Withdrawal symptoms may include nausea, headache, insomnia, giddiness, vivid dreams, agitation and irritability. These can sometimes occur if you miss a dose of the antidepressant, which is why it is important to take them as directed by your doctor.

When stopping treatment withdrawal symptoms can be minimized or avoided if the dose of the MAOI is gradually decreased over a period of a few weeks. Your doctor will help you do this.

Tolerance

Some people develop a tolerance to MAO inhibitors. This could mean that the drug will work for you at first, but you could suddenly become depressed again in the middle of treatment. This sort of reaction is particularly disturbing because it sets off a plummeting depression that may not respond to any other antidepressant. Oddly, if you develop tolerance to an MAOI, the best solution may be to switch to another antidepressant for a few weeks, and then start taking the same MAOI again. This way, the drug may regain its effectiveness.

Overdose

The MAO inhibitors are somewhat more dangerous drugs than other antidepressants when taken in excessive amounts -- far more so than newer drugs such as Prozac, Zoloft or Desyrel. Symptoms of overdose include severe anxiety, confusion, convulsions or seizures, cool clammy skin, severe dizziness, severe drowsiness, fast and irregular pulse, fever, hallucinations, severe headache, high or low blood pressure, muscle stiffness, breathing problems, severe sleeping problems, or unusual irritability.

Side Effects

Unfortunately, monoamine oxidase doesn't just destroy neurotransmitters to increase level of monoamines in the brain; it's also responsible for mopping up another amine called tyramine, a molecule that affects blood pressure. So when monoamine oxidase gets blocked, levels of tyramine begin to rise, too. And that's when the trouble starts.

While a hike in neurotransmitters is beneficial, an increase in tyramine is disastrous. Excess tyramine can cause a sudden, sometimes fatal increase in blood pressure so severe that it can burst blood vessels in the brain.

Every time you eat chicken liver, aged cheese, broad-bean pods, or pickled herring, tyramine floods into your brain. Normally, MAO enzymes take care of this potentially harmful tyramine excess. But if you're taking an MAO inhibitor, the MAO enzyme can't stop tyramine from building up. This is exactly what happened when the drugs were introduced in the 1960s. Because no one knew about the tyramine connection, a wave of deaths from brain hemorrhages swept the country. Other patients taking MAO inhibitors experienced severe headaches caused by the rise in blood pressure. These early side effects were particularly disturbing because nobody knew why they were happening.

The mystery was solved when a British pharmacist noticed that his wife, who was taking MAO inhibitors, got headaches when she ate cheese. But the early MAOIs were considered so dangerous (they also can damage the liver, brain, and cardiovascular systems) that even after the MAO-tyramine connection was finally understood, these drugs were taken off the American market for a time. (A related European antidepressant drug, Deprenyl, is marketed in this country as an anti-Parkinson's medication; it requires less stringent dietary cautions.)

Eventually the MAOIs were reintroduced in this country despite the tyramine risk because some depressed people don't respond to any other medication. Nevertheless, MAO inhibitors are usually the antidepressant of last resort.

"I call it the 'St. Jude' drug," says psychiatrist Andy Myerson. "It's the drug I use when nothing else works and someone is willing to give up anything in the hope that something will help their depression."

Side effects of MAOIs include:

• Drowsiness


• Constipation


• Nausea


• Diarrhea


• Stomach upset


• Fatigue


• Dry mouth


• Dizziness


• Low blood pressure


• Lightheadedness, especially when getting up from a lying or sitting position


• Decreased urine output


• Decreased sexual function


• Sleep disturbances


• Muscle twitching


• Weight gain


• Blurred vision


• Headache


• Increased appetite


• Restlessness


• Shakiness


• Trembling


• Weakness


• Increased sweating

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Safety concerns with MAOIs

MAOIs can cause dangerous interactions with certain foods and beverages. And you can understand why. If you take MAOIs, you'll face dietary restrictions that require you to limit consumption of foods that contain a high level of tyramine, such as many cheeses, pickled foods, chocolates, certain meats, beer, wine, and alcohol-free or reduced-alcohol beer and wine. The interaction of tyramine with MAOIs can cause a dangerously high increase in blood pressure, which can lead to a stroke. Your doctor can give you a complete list of dietary restrictions.

Emsam may offer a way to avoid these dietary restrictions. At its lowest dose of 6 milligrams a day, you don't need to follow those dietary restrictions. At higher doses of Emsam, you do, though. Talk to your doctor or mental health provider to see if this may be an option for you.

MAOIs can also cause serious reactions when you take them while you're also taking certain other medications. Examples of medications to avoid include other antidepressants, certain pain medications such as tramadol (Ultram) and meperidine (Demerol) over-the-counter decongestants and herbal weight-loss products, and St. John's wort. Always check with your doctor or pharmacist before taking any new prescription medication, over-the-counter medication or supplement while taking MAOIs.

Dietary Restrictions

Don't eat or drink any of the following when taking MAOIs unless your doctor advises otherwise:

• aged foods


• alcoholic beverages (especially chianti, sherry, liqueurs, and beer)


• alcohol-free or reduced-alcohol beer or wine


• anchovies


• bologna, pepperoni, salami, summer sausage, or any fermented sausage


• caviar


• cheeses (especially strong or aged varieties), except for cottage and cream cheese


• chicken livers


• fermented foods


• figs (canned)


• fruit: raisins, bananas (or any overripe fruit)


• meat prepared with tenderizers; unfresh meat; meat extracts


• smoked or pickled meat, poultry, or fish


• soy sauce

Foods you can eat in moderation:

• avocados


• beer


• caffeine (including chocolate, coffee, tea, cola)


• chocolate


• raspberries


• sauerkraut


• soup (canned or powdered)


• sour cream


• yogurt

Serotonin syndrome and MAOIs

A rare but potentially life-threatening side effect of MAOIs is serotonin syndrome. This condition, characterized by dangerously high levels of serotonin in the brain, can occur when an MAOI interacts with another type of antidepressant called selective serotonin reuptake inhibitors (SSRIs). Because of this, don't take any MAOIs while you're taking any SSRIs or within two weeks of each other. Serotonin syndrome requires immediate medical treatment.

Signs and symptoms of serotonin syndrome include:

• Confusion


• Restlessness


• Hallucinations


• Extreme agitation


• Fluctuations in blood pressure


• Increased heart rate


• Nausea and vomiting


• Fever


• Seizures


• Coma

Stopping treatment with MAOIs

Discontinuation of MAOIs has been associated with nausea, vomiting and malaise. Rarely, discontinuation has caused an uncommon withdrawal syndrome involving vivid nightmares with agitation, psychosis and convulsions. The syndrome is treated with a low-dose MAOI and more gradual tapering off. Talk to your doctor before stopping treatment with MAOIs.

Suicidal feelings and MAOIs

In some cases, antidepressants may be associated with worsening symptoms of depression or suicidal thoughts or behavior in those ages 18 to 24. It's likely to occur in the first one to two months of treatment or when you change your dosage. Be sure to talk to your doctor about any changes in your symptoms. You may need more careful monitoring when beginning or changing treatment, or you may need to stop the medication if your symptoms worsen. Adults age 65 and older taking antidepressants have a decreased risk of suicidal thoughts.

Several Types of MAO Inhibitors and Their Dosages

-        Isocarboxazid (Marplan)

Usual Starting Dose: 30 mg/day

Maximum Dose: 30 mg/day

-        Phenelzine (Nardil)

Usual Starting Dose: 15 mg/day

Maximum Dose: 60 mg/day

-        Tranylcypromine (Parnate)

Usual Starting Dose: 30 mg/day

Maximum Dose: 60 mg/day

Sources and Additional Information:

http://www.netdoctor.co.uk/diseases/depression/monoamineoxidaseinhibitors_000101.htm

http://www.healthyplace.com/depression/antidepressants/monoamine-oxidase-inhibitors/menu-id-68/

http://www.mayoclinic.com/health/maois/MH00072

http://en.wikipedia.org/wiki/Monoamine_oxidase_inhibitor

Selective Serotonin Reuptake Inhibitors (SSRIs)

What is serotonin and how it is linked to depression



Serotonin acts as a neurotransmitter, a type of chemical that helps relay signals from one area of the brain to another. Although serotonin is manufactured in the brain, where it performs its primary functions, some 90% of our serotonin supply is found in the digestive tract and in blood platelets.



There are many researchers who believe that an imbalance in serotonin levels may influence mood in a way that leads to depression. Possible problems include low brain cell production of serotonin, a lack of receptor sites able to receive the serotonin that is made, inability of serotonin to reach the receptor sites, or a shortage in tryptophan, the chemical from which serotonin is made. If any of these biochemical glitches occur, researchers believe it can lead to depression, as well as obsessive-compulsive disorder, anxiety, panic, and even excess anger.



One theory about how depression develops centers on the regeneration of brain cells -- a process that some believe is mediated by serotonin, and ongoing throughout our lives. According to Princeton neuroscientist Barry Jacobs, PhD, depression may occur when there is a suppression of new brain cells and that stress is the most important precipitator of depression. He believes that common antidepressant medications, such as Celexa, Lexapro, Prozac, and Paxil -- designed to boost serotonin levels -- help kick off the production of new brain cells, which in turn allows the depression to lift.



Although it is widely believed that a serotonin deficiency plays a role in depression, there is no way to measure its levels in the living brain. Therefore, there have not been any studies proving that brain levels of this or any neurotransmitter are in short supply when depression or any mental illness develops. And while blood levels of serotonin are measurable -- and have been shown to be lower in people who suffer from depression -- what doctors still don't know for certain is whether or not the dip in serotonin causes the depression, or the depression causes serotonin levels to drop.

About SSRI



In healthy brain synapses, one neuron communicates with another via neurotransmitters that traverse across a small gap between them known as a synapse. Neurotransmitter molecules activate receptor molecules on the post-synaptic neuron surface, causing the post-synaptic neuron to become active. Once activation has occurred, the post-synaptic neuron releases the neurotransmitter molecules back into the synapse where they are taken back up by the pre-synaptic neuron for reuse in a future message.



The Selective Serotonin Reuptake Inhibitors, or SSRIs for short, are a popular family of antidepressant drugs frequently prescribed today. Selective serotonin reuptake inhibitors are thought to work by slowing down the reuptake of neurotransmitter molecules (in this case specifically serotonin molecules) by pre-synaptic neurons. Because serotonin reuptake is prevented, serotonin molecules end up staying in the synapse longer than they normally would, and get more of a chance to activate the post-synaptic neuron. There are several types of serotonin receptors, and some medications work on specific receptors better than others.



Therapeutic effects of antidepressants may vary in people, due in part to each person's genetic makeup. It's thought that people's sensitivity to antidepressant effects, especially selective serotonin reuptake inhibitor effects, can vary depending on:

• How each person's serotonin reuptake receptor function works.


• His or her alleles — the parts of chromosomes that determine inherited characteristics, such as height and hair color, which combine to make each person unique

Some SSRIs are available in extended-release form or controlled-release form, often designated with the letters XR or CR. These forms provide controlled release of the medication throughout the day or for a week at a time with a single dose.

Available Medications



Fluoxetine (Prozac) is used for the treatment of major depressive disorder, obsessive compulsive disorder (OCD; a person experiences obsessions, or repetitive uncontrollable thoughts, and compulsions, or repetitive uncontrollable behaviors such as repeatedly washing one's hands), bulimia nervosa (an eating disorder characterized by binges and vomiting), and panic disorder (an anxiety disorder accompanied by feelings of terror that strike suddenly and repeatedly with no warning) with or without agoraphobia (anxiety about being in situations from which escape might be difficult or embarrassing). Prozac used for the treatment of premenstrual dysphoric disorder (mood changes associated with the menstrual cycle), is packaged as Sarafem (fluoxetine hydrochloride).



Side effects of Prozac include: chest pain, chills, hemorrhage (bleeding or abnormal flow of blood), hypertension (high blood pressure, palpitation (irregular and/or forceful beating of the heart), increased appetite, nausea, vomiting, weight gain, agitation, amnesia (impaired memory), confusion, emotional lability (rapidly changing mood), sleep problems, and an increased need to urinate.



Prozac should not be used in combination with monoamine oxidase inhibitors (MAOIs), which are another type of antidepressant medication, or thioridazine (a medication used to treat psychotic disorders, severe depression or anxiety, or severe behavior problems in children). In addition, people should be careful about using Prozac in combination with NSAIDs (pain medication such as ibuprofen), aspirin or other drugs that affect blood coagulation since this increases the risk of bleeding. There is also a risk of developing Serotonin Syndrome, a cluster of uncomfortable and potentially dangerous side effects including agitation, hallucinations, coma, chills, headache, fluctuations in blood pressure, rapid heart beat, raised body temperature, nausea, vomiting, diarrhea, profuse sweating, confusion, and restlessness. As a result, people taking Prozac should avoid taking other medications that affect serotonin such as triptans (used for treating migraines), tryptophan (5-HTP, a dietary supplement used for depression), linezolid (an antibiotic used to treat infections), tramadol (used for pain), St. John's Wort (an herb used for depression), or other SSRIs/SNRIs.



Sertaline (Zoloft) is used for treating major depressive disorder, OCD, panic disorder, posttraumatic stress disorder (PTSD), premenstrual dysphoric disorder, and social anxiety disorder (fear of social or performance situations involving exposure to unfamiliar people or possible scrutiny by others). Side effects of Zoloft include: impotence (a consistent inability to sustain or achieve an erection), heart palpitations (irregular and/or forceful beating of the heart), chest pain, hypertonia (increased muscle tightness), increased appetite, back pain, myalgia (muscle pain), yawning, male and female sexual dysfunction, rhinitis (irritation of the nose), and tinnitus (ringing in the ears). As with Prozac, Zoloft should not be used with MAOIs or thioridazine. In addition, people taking Zoloft should not take pimozide (Orap), a medication used for the treatment of Tourette's Disorder (characterized by motor and oral tics). Zoloft may also affect a person's lithium levels (used for the treatment of bipolar disorder), so close monitoring may be necessary. There is also a risk of Serontonin Syndrome when taking Zoloft.



Paroxetine (Paxil) is used for the treatment of major depressive disorder, social anxiety disorder, OCD, panic disorder, generalized anxiety disorder (GAD; an exaggerated or unfounded state of worry and anxiety, often about such everyday matters as health, money, family, or work ), and PTSD. Side effects include: asthenia (lack of energy), sweating, nausea, decreased appetite, sleepiness, dizziness, insomnia, tremor, nervousness, impotence, problems with ejaculation and other male genital disorders, dry mouth, and constipation. The same warnings listed above apply, people taking Paxil should avoid MAOIs, thioridazine, and pimozide. In addition, the same potential for Serotonin Syndrome exists when taking Paxil.



Citalopram (Celexa) is used for the treatment of major depressive disorder. Side effects include: tachychardia (rapid heart rate), postural hypotension (a drop in blood pressure due to a change in body position), hypotension (low blood pressure), paresthesia (abnormal skin sensensations such as numbness, tingling, pricking, or burning), migraine, increased flatulence, weight gain, weight loss, impaired concentration, amnesia (impaired memory), increased depressive symptoms, increased appetite, suicide attempts, confusion, amenorrhea (cessation of a woman's period), coughing, blurry vision, rash, itching, and increased need to urinate. As with the above medications, people taking Celexa should avoid MAOIs, thioridazine, pimozide, NSAIDs, aspirin, or other drugs that affect coagulation; and watch for signs of Serotonin Syndrome.



Escitalopram (Lexapro) is used for the treatment of major depressive disorder and GAD. Side effects include: heart palpations, hypertension (high blood pressure), light-headedness, migraine, heartburn, abdominal cramps, gastroenteritis (inflammation or infection of the stomach or intestines), limb/muscle/joint pain, fever, hot flushes, chest pain, weight gain, increased appetite, lethargy, irritability, impaired concentration, bronchitis (inflammation and swelling of the airways of the lung) nasal/sinus congestion, coughing, sinus headache, rash, blurry vision, tinnitus (ringing in the ears), increased need to urinate, and urinary tract infections. As with the above medications, people taking Lexapro should avoid MAOIs, thioridazine, pimozide, NSAIDs, aspirin, or other drugs that affect coagulation; and watch for signs of Serotonin Syndrome.



Practically speaking, SSRIs are easy to use. They are taken only once a day, which increases the likelihood that people will comply with treatment and take their medications. They are available in pill form and sometimes as liquids. The pill form is most often prescribed. As with any medication, the risk of overdose is always a possibility. Overdose can cause vomiting, seizures, and even death, particularly when people mix SSRI's with other drugs or with alcohol. In general, reports of overdose with SSRIs are rare, and SSRIs are considered fairly safe medications. To reduce the risk for overdose, your physician may write you a prescription for a small quantity of medication at a time, which will require that you refill your prescription frequently.



Increasing a depressed person's amount of serotonin in their brain does not always improve their mood. Some depressed people also need help increasing levels of additional neurotransmitters such as norepinephrine. Often, people who don't respond to SSRI's will receive a trial of newer antidepressants that also target other neurotransmitters that impact mood.



Side effects of SSRIs



All SSRIs have the same general mechanism of action and side effects. However, individual SSRIs have some different pharmacological characteristics. That means you may respond differently to certain SSRIs or have different side effects with different SSRIs. For instance, you may have unpleasant side effects with one SSRI but not another. Also, they're less likely to have adverse interactions with other medications and are less dangerous if taken as an overdose.



Side effects of SSRIs include:

• Nausea.


• Sexual dysfunction, including reduced desire or orgasm difficulties.


• Dry mouth.


• Headache.


• Diarrhea.


• Nervousness.


• Rash.


• Agitation.


• Restlessness.


• Increased sweating.


• Weight gain.


• Drowsiness.


• Insomnia

You may experience less nausea with extended- and controlled-release forms of SSRIs.



Serotonin syndrome and SSRIs



A rare but potentially life-threatening side effect of SSRIs is serotonin syndrome. This condition, characterized by dangerously high levels of serotonin in the brain, can occur when an SSRI interacts with antidepressants called monoamine oxidase inhibitors (MAOIs). Because of this, don't take any SSRIs while you're taking any MAOIs or within two weeks of each other. Serotonin syndrome can also occur when SSRIs are taken with other medications, including:

• Pain relief medication such as tramadol (Ultram).


• Migraine medications such as sumatriptan (Imitrex) and rizatriptan (Maxalt).


• Supplements that affect serotonin levels, such as St. John's wort

Serotonin syndrome requires immediate medical treatment. Signs and symptoms include:

• Confusion.


• Restlessness.


• Hallucinations.


• Extreme agitation.


• Fluctuations in blood pressure.


• Increased heart rate.


• Nausea and vomiting.


• Fever.


• Seizures.


• Coma.

Drug Interactions



Given together, tryptophan and any of the SSRIs may cause headache, nausea, sweating, and dizziness. Taking an SSRI within two weeks of an MAOI (such as Marplan or Parnate) may cause serious side effects; you should wait at least two weeks between stopping MAOIs and starting an SSRI, or at least five weeks after stopping an SSRI and starting an MAOI.



Combining Paxil and warfarin may cause excess bleeding. If you're taking cimetidine, which can cause an increase in the blood levels of Paxil, your dosage of Paxil should be adjusted.



Research suggests that Zoloft, unlike MAOIs or tricyclics, doesn't necessarily appear to cause problems when mixed with alcohol. However, Zoloft's manufacturers don't recommend the combination.



There are no known dangerous reactions between nonprescription drugs and Zoloft, but because it's theoretically possible, be sure to talk to your doctor about any other drugs you take. Combining Zoloft with either digitoxin (Crystodigin) or warfarin (Coumadin) may cause unwanted side effects.



Safety concerns with SSRIs



Studies show that Paxil increases the risk of birth defects in women taking the drug during their first trimester of pregnancy. Women who take Paxil during their first three months of pregnancy are nearly two times as likely to give birth to a child with a birth defect — in particular a heart defect — as are women taking other antidepressants.



The American College of Obstetricians and Gynecologists recommends avoiding Paxil during pregnancy, if possible. If you're taking Paxil and you're considering getting pregnant, talk to your doctor or mental health provider about switching to another antidepressant or stopping treatment. Don't stop taking Paxil without contacting your doctor first, though.



Also, the FDA warns that infants whose mothers took SSRIs while pregnant may be at an increased risk of persistent pulmonary hypertension. This risk is increased in women who take SSRIs at 20 weeks or later in pregnancy. This rare but serious lung problem occurs when a newborn's circulatory system doesn't adapt to breathing outside the womb.



Use of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) or anticoagulants, such as warfarin (Coumadin), while taking SSRIs may increase the risk of gastrointestinal bleeding and should be monitored by your doctor.



Recent studies have shown that Symbyax and other antipsychotics should not be prescribed to older people for treatment of dementia-related psychosis. Symbyax and other antipsychotic drugs raise the risks of heart failure, sudden death and pneumonia in older people with dementia-related psychosis.



Stopping treatment with SSRIs



SSRIs aren't considered addictive. However, stopping treatment abruptly or missing several doses can cause withdrawal-like symptoms, including:

• Nausea.


• Headache.


• Dizziness.


• Lethargy.


• Flu-like symptoms

This is sometimes called discontinuation syndrome. Talk to your doctor before stopping so that you can gradually taper off.



Suicidal feelings and SSRIs



Antidepressants may be associated with worsening symptoms of depression or suicidal thoughts or behavior in those ages 18 to 24. These symptoms or thoughts are most likely to occur during the first one to two months of treatment or when you change your dosage, but they can occur at any time during treatment. Be sure to talk to your doctor about any changes in your symptoms. You may need more careful monitoring when starting treatment or changing dosage, or you may need to stop the medication if your symptoms worsen. Adults age 65 and older taking antidepressants have a decreased risk of suicidal thoughts.



How can you tell if an SSRI will work?



The straight answer to this question is that until an antidepressant is tried it is impossible to know whether it is the right one for any individual, and it takes a number of weeks (two to eight) to know whether it is going to work.



The first medicine to try is often decided on the grounds of its other effects rather than its antidepressant properties (since all antidepressants are equally effective). Some of these considerations are listed below.



• Is it sedative?

• Is it more alerting?

• Will it help anxiety as well? (Anxiety often goes hand-in-hand with depression.)

• Will it help another disorder, eg obsessive compulsive disorder, that coexists with the depression?

• Does it mix well with other medicines that a person is taking?

• Is it okay if the person has other illnesses?

• Has the person taken it before to good effect?



To make the best initial choice, the doctor needs to know exactly how a person is affected by depression. Some of these other effects may be very helpful in one person, but a problematic side effect in another: sedation is useful in someone whose sleep is disrupted, but not for someone who is sleeping too much.



Sources and Additional Information:

http://resources.atcmhmr.com/poc/view_doc.php?type=doc&id=13018&cn=5

http://www.mayoclinic.com/health/ssris/MH00066

http://www.healthyplace.com/depression/antidepressants/selective-serotonin-reuptake-inhibitors-ssris/menu-id-68/

http://www.healthline.com/galecontent/selective-serotonin-reuptake-inhibitors

http://www.netdoctor.co.uk/diseases/depression/selectiveserotoninreputakeinhibitors_000147.htm

http://www.webmd.com/depression/recognizing-depression-symptoms/serotonin

Link Acne Drug with Depression: True, False, Possible…

One of the most wide-known cases, when the medications was directly linked to the potential development of the depressive disorder is Accutane, drug used in treating severe forms of acne, in case other drugs have not been able to treat the condition. It is very effective as an acne-cure. However, the regular use of this drug has been associated with depression amongst the users. A number of suicide cases have been linked to the use of this drug.





The powerful drug manufactured by Roche Pharmaceuticals was first approved in the year 1982 as a medication to treat persistent acne problems, targeting the severe conditions associated with forward in the treatment of acne vulgaris, the most egregious and resistant form of the disease. But Accutane has been linked to serious health risks, including: strokes, suicide, depression, inflammatory bowel disease, Pancreatitis, and Crohn’s disease.

It is very potent and can cause severely birth defects if taken by women who are pregnant or of childbearing potential. Women using this drug must sign consent forms and promise to use at least two contraceptive procedures to prevent pregnancy during the course of using this drug. Accutane’s most common side effects are gastrointestinal. According to the Food and Drug Administration, the gastrointestinal adverse reactions include: "…inflammatory bowel disease, hepatitis, Pancreatitis, bleeding and inflammation of the gums, colitis, ileitis, nausea, other nonspecific gastrointestinal symptoms."

The long list of the possible side effects is provided at http://accutanesideeffects.net/.

People from different social strata have been long up in arms against the free availability of this particular drug. They are convinced that it creates suicidal tendencies among teenagers many of whom go to the extent of actually becoming suicidal.

In February of 1998 the manufacturer of Accutane, Roche Laboratories, issued a letter to physicians in which they added the following to the WARNINGS section of Prescribing Information for Accutane: Psychiatric disorders: Accutane may cause depression, psychosis and, rarely, suicidal ideation, suicide attempts and suicide. Discontinuation of Accutane therapy may be insufficient; further evaluation may be necessary.

A study published in Experimental Biology and Medicine offers a possible explanation for how the acne drug Accutane (isotretinoin) may cause depression. The authors speculate that it decreases the availability of serotonin, a neurotransmitter which is believed to be involved in the regulation of mood.

Using cell cultures, scientists from the University of Bath (UK) and University of Texas at Austin (USA) were able to observe the effect of the drug on serotonin-producing cells. They found that the cells significantly increased production of proteins and cell metabolites that are known to reduce the availability of serotonin. A reduction in serotonin, say the scientists, could be a cause of depression in patients using the drug.

However, there is not enough evidence to prove that Accutane is the reason behind such occurrences. Recently, a study was conducted to establish a link between the drug and teenage suicides. The study confirmed to an extent that there was nothing like accutane depression. The teenagers on the drug did not show any significant mood swing compared to others treated with different drugs.





These findings were far from conclusive. According to a scientist, the sample group was rather small. The sample group should not have been less than 1000 if a relation were to be established comprehensively. A more recent research found that Accutane induces some changes in the frontal lobe region of the brain, which is identified as the centre of our emotions. Therefore, there is the possibility of a causative link between Accutane use and depression.

A different Canadian study has also found no association between the acne medication isotretinoin, which is sold in the U.S. under the brand name Accutane, and depression.

This study, which was conducted in a community dermatology clinic, looked at acne patients who were beginning treatment with isotretinoin. The control group were treated with either oral antibiotics or medication applied to the skin. The Center for Epidemiologic Studies Depression scale and the Zung Depression Status Inventory were used to assess depression both at the beginning of treatment and at the end of two months.

At the end of the two month period, the researchers found that neither depression assessment indicated any association between treatment with isotretinoin and depression.

The authors conclude that denying patients with significant acne treatment with isotretinoin, which is a very effective treatment, may not be warranted at this time as it does not appear to be associated with depression.

Why the Controversy?

While countless case reports suggest a relationship between Accutane use and depression, proving this connection has been difficult. Some studies suggest acne itself is more likely to cause depression in sufferers than Accutane use. Others have found no definitive link between Accutane use and an increased risk of depression.

Many acne sufferers find they are depressed because of their acne, and isotretinoin helps to clear their skin, making them feel less depressed and more confident.

Accutane is a miracle cure for acne treatment, a claim that most users will uphold. However, it is advisable to use the drug with caution, at least until the drug is proven innocuous beyond reasonable doubt.

Sources and Additional Information:

http://www.aboutstressmanagement.com/stressrelief/stress-management/causes-of-stress/does-accutane-cause-depression-and-suicide.htm

http://depression.about.com/od/secondary/f/accutane.htm

http://depression.about.com/b/2007/11/20/possible-mechanism-found-for-depression-accutane-link.htm

http://depression.about.com/b/2007/06/25/study-finds-no-link-between-acne-drug-and-depression.htm

http://acne.about.com/od/acnetreatments/a/sideeffectsaccu.htm