Kassie Blaylock

Psychology 1010
Drug Therapy for Depressive Disorders
February 25, 2018
Title

Pharmacologic Therapy for Depressive Disorders

Introduction

Major depressive disorder (MDD) has been characterized as being the fourth leading cause of
disability in the United States. (Sato, 2013) MDD is a psychobiologic disorder that affects a
person’s objective expression of mood which decreases their ability to provide information about
the emotions a person is feeling. MDD affects a person’s ability to perform activities of daily
living and to function socially and professionally. There are many different approaches to
helping people suffering from MDD broadly there are psychological and biological methods,
often these methods are used together. The following information will go over the factors that
define MDD and the methods that are used to treat MDD; focusing on the pharmacologic
management of MDD.

Literature review

DSM-5 Selections defines Major Depressive disorder as follows:

A. Five (or more) of the following symptoms have been present during the same 2-
week period and represent a change from previous functioning; at least one of the
symptoms is either depressed mood or loss of interest or pleasure. Note: Do not
include symptoms that are clearly attributable to another medical condition.
1. Depressed mood most of the day, nearly every day, as indicated by either
subjective report (e.g., feels sad, empty, hopeless) or observation made by
others (e.g., appears tearful). (Note: In children and adolescents, can be
irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most
of the day, nearly every day (as indicated by either subjective account or
observation).
3. Significant weight loss when not dieting or weight gain (e.g., a change of
more than 5% of body weight in a month), or decrease or increase in appetite
Kassie Blaylock
Psychology 1010
Drug Therapy for Depressive Disorders
February 25, 2018
nearly every day. (Note: In children, consider failure to make expected weight
gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others,
not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be
delusional) nearly every day (not merely self-reproach or guilt about being
sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day
(either by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation
without a specific plan, or a suicide attempt or a specific plan for committing
suicide.
B. The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a substance or to
another medical condition.(p.7-8)

Many of these characteristics defined above are caused by biological factors, such as genetics,
brain function, and chemical equilibrium, there are also psychological and sociocultural factors
that come into play. (Durbin, 2014) Types of psychological treatment available include
behavioral, cognitive, and cognitive-behavioral psychotherapies and biological therapy including
pharmacologic therapy and electroconvulsive therapy (ECT). Studies suggest that
psychotherapies are more effective for treating symptoms long-term than biological therapy.
(King, 2013) More often than not there is a multifaceted approach to helping people suffering
from MDD including all or multiple approaches.

Behavioral therapy’s goal is for a person to adopt new healthy strategies to deal with
emotions and other aspects of life and to eliminate the unhealthy behavior. Behavioral therapies
include Classical Conditioning and Operant Conditioning (Durbin, 2014) Cognitive therapy’s
goal is to change a person’s thoughts in order to fix their feelings and behaviors. There are many
Kassie Blaylock
Psychology 1010
Drug Therapy for Depressive Disorders
February 25, 2018
different techniques for cognitive therapy, cognitive restructuring is a broad concept that all
techniques encompass, the idea that cognition patterns are causing maladaptive behaviors.
(Durbin, 2014) Behavioral therapy and cognitive therapy are most often used in conjunction with
each other. (King, 2013) Biological therapy is also used, often in conjunction with psychological
therapies when appropriate. No matter which treatment method a person is on, the goal is to help
them to have a quality lifestyle.

As mentioned before, biological therapy includes pharmacologic treatment and ECT.

Pharmacologic therapies are used to alter the body’s chemical environment. MDD is often
accompanied with additional disorders, called comorbidities, that may have led to the depressive
state or vice versa, these include; anxiety disorders, psychotic disorders, substance use disorders,
eating disorders, and personality disorders. Many of these comorbidities have a tendency towards
suicidal ideation and so does MDD. To prevent suicidal ideation, western medicine uses
medication to manage these feelings and to help these people regain their mental health. The
medications that are used to manage these disorders include tricyclic antidepressants, selective
serotonin reuptake inhibitors (SSRI), Monoamine oxidase inhibitors (MAOI), and atypical
antidepressants. (ATI, 2016) The use and management of these medications can be complicated
because of the adverse effects they may have or because of other comorbidities a person may
have. These medications are often used in conjunction with psychological therapy in order to
treat the disorder effectively. Medication management is key to helping people who suffer from
MDD live a normal life.

The following is a summary of medication information from ATI Nursing Education

(2016):

A common tricyclic antidepressant medication is Amitriptyline. This drug’s purpose is to

block norepinephrine and serotonin from reuptake in the synaptic space, which results in a more
intense effect of these neurotransmitters. A person with MDD may be suffering from an
imbalance of too much or too little dopamine, norepinephrine, and/or epinephrine, all important
neurotransmitters that affect many physiologic systems in the body. Tricyclic antidepressants are
used as a stimulant to increase the potency of the neurotransmitters a person has. Some issues
that can come up while using this medication include orthostatic hypotension, anticholinergic
Kassie Blaylock
Psychology 1010
Drug Therapy for Depressive Disorders
February 25, 2018
effects (dry mouth, blurred vision, constipation, etc.), sedation, and toxicity. Women who are
pregnant should not take this medication, as well as people with a history of seizures. A major
issue with these medications is that they can take time to come into effect, and during that time
the people taking it are at an increased risk for suicide and need to be closely monitored by
medical professionals.

SSRIs block the reuptake of serotonin selectively in the synaptic space by doing this,
serotonin effects are strengthened. Fluoxetine is an example of an SSRI, this is one of the first
medications a doctor may want a patient to try that is suffering from depression because it has
fewer adverse effects than many of the other options for people with MDD. Although they may
be less intense, SSRIs still have many complications some being; sexual dysfunction. Central
nervous system stimulation including insomnia, agitation, and anxiety, weight changes, and
serotonin syndrome. Like many psychiatric medications, women who are pregnant should not
take fluoxetine because of increased risk of birth defects and hypertension in the newborn. SSRIs
may not be taken in conjunction with other antidepressant medications.

MAOIs work by blocking monoamine oxidase in the brain resulting in an increase of

norepinephrine, dopamine, and serotonin readily available for the body’s use, thereby
intensifying nerve responses and relieving depression. Like the other medications for MDD,
there are many complications that people taking these medications should be aware of. Some of
the complications that can arise as a result of MAOI therapy include; anxiety, agitation, mania,
orthostatic hypotension, and hypertension. Women who are pregnant should not take this
medication. MAOIs should not be taken together with other antidepressant medications.

Bupropion is a common example of an atypical antidepressant, this medication works in

the body by stopping reuptake of dopamine. By blocking dopamine reuptake, bupropion
enhances the effects of dopamine, allowing for more nerve stimulation and less depression. This
is often used as an alternative treatment to SSRIs. SSRIs can result in sexual dysfunction for
many people and atypical antidepressants do not have that effect. There are however other
complications that can come up while a person is taking bupropion such as headaches, dry
mouth, gastrointestinal distress, tachycardia, and insomnia, decreased appetite. Women who are
Kassie Blaylock
Psychology 1010
Drug Therapy for Depressive Disorders
February 25, 2018
pregnant should avoid taking this medication. If a person has a history of seizures, has an eating
disorder, or is taking an MAOI they should not take bupropion. (p. 123)

Doctors often have to try out many different combinations of drugs until they find the
right combination for each individual. All antidepressant medication can cause suicidal thoughts,
this is a major safety issue and needs to be taken seriously. People taking antidepressant
medication must be monitored closely. If a person is going to therapy and seeing their doctor
each week or so, they are being monitored fairly closely, but having a strong support system
outside of the medical field is very important for these people as well. (ATI, 2016)

Application

As a nursing student, this information is very helpful for me to know because I will soon
be administering these medications to patients that are my responsibility. Before reading more in
detail about major depressive disorder and the medications that are used to treat it, I had a lot of
misconceptions. Many of these antidepressant medications have interactions with other drugs
and side effects that can be life-threatening. I also learned how important it is to have a
multifaceted approach to mental illness. Having a community rather than one source working
with an individual gives people suffering from MDD a much greater chance to succeed.

Conclusion

In conclusion, MDD is a debilitating disorder that impacts many people throughout the
world. MDD is recognized by the DSM-5 and has specific treatment methods that have been
scientifically proven to help many people. There are many medication options including tricyclic
antidepressants, SSRIs, MAOIs, and atypical antidepressants. All of these medications affect
neurotransmitters in the body, the goal of these therapies is to increase nerve stimulation
resulting in decreased depression. (Sato, 2013)These medications all have adverse effects that
need to be taken into account before someone takes them. MDD is managed pharmacologically
and psychologically, with many different options of treatment within these fields.
Kassie Blaylock
Psychology 1010
Drug Therapy for Depressive Disorders
February 25, 2018
References

American Psychiatric, A. (2016). Depressive Disorders: DSM-5® Selections. Arlington, VA:

American Psychiatric Publishing.

Durbin, E. (2014). Depression 101. New York, NY: Springer Publishing Company.

Sato, S., & Yeh, T. (2013). Challenges in Treating Patients with Major Depressive Disorder:
The Impact of Biological and Social Factors. CNS Drugs, 275-10.

King, L. (2013). Experience psychology (3rd edition). New York, NY: McGraw-Hill.