Josalyn E. Waters, How Antidepressants Alter Your Brain

Abstract

Antidepressants are commonly used in people dealing with mental health issues. The rise in attention to mental health caused by social media has caused many people to be prescribed antidepressants. SSRIs are the most common type of antidepressant taken. Due to limited research, the effects of this drug have not really been looked at. This paper using various scientific articles and websites looks at how SSRIs affect individuals at different levels and stages of their lives. Background Information

Antidepressants or specifically selective serotonin reuptake inhibitors are used for various mental issues including depression, anxiety, PMS, PTSD, among other psychiatric problems. It can also be used to treat nicotine withdrawal, alcoholism, and irritable bowls syndrome. Some advantages include that it doesn’t cause problems with the cardiovascular system, people are unlikely to overdose on it because even at high dosages they pose little risk, and are less likely to cause weight gain. SSRI’s are designed to increase serotonin levels in the brain. To do this by blocking the serotonin

reabsorption sites on the surface of nerve cells (Alic and Davidson, 2020). Figure 1 shows just exactly how this works (How SSRIs Work, 2018).

Depression in adolescents is also a major problem that scientists are currently trying to solve. Although depression has been around for years, the current age of social media has placed a prominent point on mental health issues. This has led to more scientists trying to find an approach on how to tackle this issue. The adolescent years are the most formative years of one’s life. Suicide has become the second leading cause of death in people aged 10-24. For pediatric patients, it is harder for a doctor to prescribe medication. There is limited evidence of how early use of antidepressants affects developmental issues and how tolerable younger bodies are to it.

Also, the risk of emergent suicide more commonly known as a “black-box” warning, has also led doctors to be wary of this treatment.

With the limited research that has been done, there has been strong evidence to show that SSRIs have been effective in treating anxiety disorders such as OCD and social anxiety in juveniles. This medication combined with cognitive-behavioral therapy had the highest level of improving symptoms.

One reason that there has been such skepticism in prescribing medication has been the difference in effect sizes between industry-sponsored trials and trials ran by the National Institute of Mental Health. In the NIMH-sponsored major trial, SSRIs were shown to be very affective. It also shows that approximately 80% improved over a 9 month period. Industry-sponsored trials had approximately 60% placebo response rates. These inconclusive results have led many to place doubt on all trials.

The limited amount of research that has been done on the effectiveness of antidepressants in juveniles has led many to question whether they are actually effective or not (Dwyer and Bloch, 2019).

Another reason doctors are hesitant to prescribe antidepressants is how has it is to discontinue them. For a multitude of reasons, someone may want to end their antidepressant use. Most Clinicians would recommend discontinuation of medicine for patients who present no or few risk factors for relapse. They would also recommend this upon a patient’s request. Guidelines given by the U.S. Food and Drug Administration recommend gradually tapering to prevent severe symptoms. Severe symptoms include severe depression, increased suicidal thoughts, and even suicide. Figure 2 describes the consequences of discontinuing specifically SSRIs and what possible mitigation strategies can be used.

Discontinuation symptoms are difficult to fathom due to them not being systematically reported in clinical practice. This also doesn’t include patients who willingly drop out of care. In a recent trial, scientists found that up to 40% of pa-

tients reported a new set of symptoms when they abruptly quit SSRIs. In the case of SSRI fluoxetine, it was generally well-tolerated, but some case reports included cases of delirium developing. Paroxetine was shown to have the highest amount of discontinuation symptoms.

Some doctors recommend using the mnemonic device “FINISH” to remember the symptoms of discontinuation. FINISH stands for flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, and lastly, hyperarousal. These symptoms only affect about 40% of patients. The other 60% reported no significant symptoms. In more severe cases, discontinuation could affect multiple organ symptoms. Patients become at risk of developing issues when antidepressants have been taken for at least 4 to 6 weeks. Other factors include patients with panic disorders, early development of depression, and those with a history of discontinuation symptoms (Jha et al., 2018). Journal Article Summary The point of the experiment was to test if older adults with depression had a link between their use of antidepressants and incident mild cognitive impairment. While there have already been experiments to confirm this, the scientist in this experiment argues that there were a lot of inconsistencies in previous experiments. What they are doing differently is that they are using a time-dependent Cox proportional hazard model. In one group they had people who had used antidepressants and a group that is on a baseline level. The result of this is that with the baseline group there was no difference but with the antidepressants group there was a significant association with them and a lower risk of MCI. With this in mind, in the end, they determined that in future studies there needs to be diverse settings to confirm their findings (Han et al., 2020) Careers, Education & Salary Ranges

In order to obtain a doctor of pharmacy degree, a Pharmacist typically needs to attend a four-year program. In saying, this most PharmD programs require students to have prerequisite coursework completed such as biology, physics, statistics, and chemistry. Most pharmacology schools are also looking for two to three years of completed undergraduate coursework. They are also required to take the PCAT (Guide, n.d.).

Working as a Pharmacist at Brookshire Grocery starts at a base salary of 132,300 a year with little experience (Brookshire Grocery Pharmacist Salaries, 2022). Experienced-level personnel earns about $145,444 a year. Also working with the Brookshires company also includes benefits such as employee discounts, vision/ health/dental insurance, and a retirement plan (Brookshire Grocery Company Pharmacist Salaries in the United States, n.d.).

The commonly accepted educational level required to work in mental health

care in a Bachelor’s degree in Psychology, Criminal Justice, and Social Work. About 37% of the people working in this field have majored in Psychology (Mental Health Worker Educations Requirements, n.d.).

The starting salary of someone working at the Shreveport Behavioral Health Therapist is about $56,903 a year as of March 2022. The salary for someone with higher experience is about $70,492 (Behavioral Health Therapist Salary in Shreveport, Louisiana, n.d.).

*Works Cited page and Figures available upon request.