Analysis of Lola’s Clinical Scenario: Antidepressants and Anxiolytics

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Table of Contents

Introduction
Antidepressants
Serotonin/Norepinephrine Uptake Inhibitors (SNRIs)
Tricyclic Antidepressant Drugs
Adverse Effects of Antidepressants
Clinical Implications of Antidepressants
Physical Health Implications of Antidepressants
Nurses Teaching Strategies
Conclusion
References

Introduction

Anxiety is a common neurological disorder affecting a good number of people globally, this condition can be managed by the use of drugs known as anxiolytics. The regimens used for the long-term management of anxiety disorders include serotonin/norepinephrine uptake inhibitors (SNRIs) and selective serotonin reuptake inhibitors (SSRIs) (Beck & Beck, 2018). When acute cases arise then the regimens referred to as benzodiazepines are the most preferred. The clinical manifestation of anxiety differs in each patient and the doctor relies on this to determine the type of drug to be used in its management.

Antidepressants

More than 300 million people are affected by depressive disorders worldwide, this has made depression to be one of the causes of disability globally (Jakobsen et al., 2020). Antidepressants are drugs that are used to manage or treat depressive conditions, they are an effective regimen against impaired sleep, depression, and even anxiety. Antidepressants, however, have some adverse effects which are characterized by withdrawal symptoms thus influencing their longer use. Personnel charged with the responsibility of doing prescriptions for these drugs should therefore be charged with the role of reviewing the long-term use of antidepressants to manage their long-term side effects.

Serotonin/Norepinephrine Uptake Inhibitors (SNRIs)

They include desvenlafaxine, venlafaxine, and duloxetine they are not relatively selective for 5-HT and the uptake of noradrenaline. Venlafaxine for example when the dose has been increased, its mode of action increases as well (Ritter et al., 2020). This has been attributed to its weak action on the inhibition of the reuptake of noradrenaline hence the rapid development of its resistance. Current approaches have been formulated to overcome this resistance, this includes factors such as modification of drugs in existence and characterization and isolation of the antibiotic substances that are of natural origin.

Tricyclic Antidepressant Drugs

They are widely used and they include clomipramine, amitriptyline, nortriptyline, desipramine, and imipramine. Although they are not used routinely due to their numerous side effects and the need for drugs that have high efficacy levels and thus a quicker mode of action (Rang et al., 2016). Many antidepressants have been re-introduced in the market such as 5-HT reuptake inhibitors which have few adverse effects and produce fewer side effects when used to manage depression.

Adverse Effects of Antidepressants

Antidepressants are chemical that changes how the normal brain functions and other body parts in ways that are not clearly understood. This has led to the wrong prescription of these regimens for millions of people globally with an assumption that they can correct the abnormalities caused by specific brain chemicals that are associated with depression (Moncrieff, 2020). Although antidepressants normalize brain functions whenever there is a disorder, it is crystal clear that there are devastating consequences associated with their use in the body.

Drugs used to manage mental health disorders result in adverse effects such as alterations to normal brain functions including tardive dyskinesia which is caused by antipsychotics. Withdrawal effects for example occur as a dire consequence of the use of these antidepressants. The opioid epidemic is still used in some parts of the world such as the United States although its use is associated with chronic pain at the expense of relieving it.

Withdrawal effects do indicate that the normal function of the body has drastically changed as a consequence of the introduction of a drug into the body system. Although withdrawal effects are attributed to long-term use of a drug, they can temporarily arise even a short while after the onset of the medication. Benzodiazepines which are used to induce sleep work so well when the regimen is initiated for around one or two days. In a case where the medicine is halted, the users find it more difficult to fall asleep than they used before they started using the drug.

Anxiety effects are a common phenomenon as long-term consequences of withdrawal syndrome, paraesthesia, and tinnitus are associated with this scenario. Research shows that when opiates have been used to treat acute conditions, they stimulate the effects of improved sensitivity to a painful stimulus that fades away after a few days. Studies suggest that different people experience various instances of withdrawal effects which range in duration and magnitude although the severity differs from a few weeks to months or can even last longer.

The long-term transition associated with the use of drugs that manage mental illnesses is post-selective serotonin reuptake inhibitor (SSRI) – sexual dysfunction. SSRIs are attributed to impaired sexual function when they are ingested into the body, there is the possibility of persistence of this condition even if the drug is withdrawn (Simonsen et al., 2016). It is indisputable that the non-chronic effects of SSRIs are persistent in sexual dysfunction scenarios. It is therefore true to state that post-SSRI-sexual dysfunction is a result of the use of SSRI and not as a result of the re-occurrence of depression as claimed.

Clinical Implications of Antidepressants

Antidepressants are associated with side effects as a result of metabolism such as weight gain due to cellular processes such as lipogenesis (Ageu et al., 2018). Continued use of these regimens poses pediatric lives at risk, this is common in children and adolescents. Inheritance factors play a key role in contributing to the adverse effects caused as a result of ingestion of antidepressants which includes cytochrome P450 (CYP450) polymorphisms.

Depressive abnormalities are having high prevalence and pose a challenge to be managed, their treatment requires adjustment of doses for proper medications. Genetic factors does a key role in the management of depressive disorders or rather psychotropic medication administration. Other than antidepressants, anxiolytics, antipsychotics, and mood-stabilizing regimens can as well be used as strategies for managing disorders caused by depression. Generally, the management of depressive disorders entails frequent changes in drugs, courses of long treatment, high incidences of adverse events, lack of compliance, and varying drug responses by individuals.

Benzodiazepines which are the commonly used anxiolytics are mostly preferred to manage psychological stress, majorly as second-line regimens. They promote the neurotransmitter signaling, gamma-aminobutyric acid (GABA), which is necessitated by GABA receptors. They may as well hasten the signaling of dopamine to minimize the chances of anxiety cases that are attributed to stress. However, benzodiazepines have been shown to have a derailing impact on bone health, this is possibly due to frequent instances of falling risk among their users. There is documented evidence that they lower the rate of differentiation of the osteoblast through benzodiazepine receptors.

Selective serotonin reuptake inhibitors (SSRIs) are used in the management of sufferers with moderate to severe instances of depression conditions, as first-line treatment regimens. They are used for this purpose since they are attributed to minimal side effects, are considered safe generally, and are tolerated well in the body (Kelly et al., 2019). Their mode of action is associated with the inhibition of serotonin reuptake at the presynaptic neuron. This enhances their levels to be high in the synapse and promotes neurotransmission in the postsynaptic region. There are increased serotonin concentrations in the extracellular regions of the periphery and the brain, this is necessitated by the inhibition of the serotonin levels. These drugs have a high concentration in the bone marrow and hence have a significant impact on the metabolism of the bones.

Barbiturates are derivatives of barbituric acid and are a widely known class of depressants of the central nervous system (CNS). They are not GABA receptors antagonist and their mode of action is through blocking of the receptors of the transmembrane for the excitatory neurotransmitter primarily found in the CNS. Inhibiting excitatory neurotransmitters in conjunction with inhibition of signaling of GABA induces sedation effects. They cause addiction and have no reversal effects in instances of overdose, this has made them not to be commonly used across the globe nowadays. However, their prescription still carries the order of the day in the management of migraine headaches, seizures, and anxiety and to induce sleep in the elderly.

Physical Health Implications of Antidepressants

Children and adolescents should be consulted first before being given these medications due to their adverse effects, in cases of pediatrics their caregivers should be informed of the side effects of these regimens. Psychotherapy considerations should therefore be looked into, cognitive behavioral therapy, in particular, should be well taken care of. Lola was not in a position to carry out her normal enjoyments such as playing the piano and this made her more depressed and isolating herself from others.

Severe mental illness (SMI) in adolescents derails their level of engagement in physical activities, this can lead to poor physical health. Pharmacological agents are attributed to varied side effects which is a common phenomenon in the adolescent populations. Physical effects associated with the use of antidepressants include sedation and fatigue, in addition to this, disturbances to sleep which include both hypersomnia and insomnia are as well common implications (Elbe et al, 2018). Additionally, the eagerness and motivation to engage in physical activity diminish, and chronic pain is as well experienced by many users.

Biological factors play a significant role in adolescents who have depressive disorders as they cause instances of trauma which is in line with hypothalamic-pituitary-adrenal (HPA) axis hypersensitivity. Adolescents who develop trauma since childhood is associated with sedentary behavior which is a result of overactivity of the HPA axis (Anthony et al.,2020). Management of SMI which includes a variety of dosing regimens has implications on how one can respond to the physical activities they engage in. Their motive, capacity, and ability to perform some tasks are hindered, and there is a need for proper research to understand the role of physical activity in the management of depressive disorders.

Nurses Teaching Strategies

A good number of adolescents with depressive disorders do not respond well to the available intervention methods, it is, therefore, necessary for nurses to initiate new teaching strategies as a way of correcting this. Physical activity should as well be tried as a complementary strategy to manage neurological disorders such as depression (Oberste et al., 2020). Physical activity should be organized into sessions for its proper effectiveness as a therapeutic strategy when put into use. Research shows that many people accept this remedy as it has no various side effects like the use of depressants to manage these mental disorders, more focus should therefore be employed in this strategy for the effectiveness of its use.

Nurses should adopt a telephone-based care intervention mechanism where they should maintain contact between themselves and their patients. They should make calls to check on the medication progress of their patients and alert the doctors where need be. Besides, they should offer to counsel depressive patients as a therapeutic way to manage these patients. This will boost the patients’ emotional support and be hopeful of getting better soon (Edward & Alderman, 2013). They should as well try to seek the views of the patients about their take on the use of antidepressants. Medication administration does depend so much on the patient’s psychological take, it’s therefore very necessary to collect views from the patients. This will enable the nurses to know their perception of the effectiveness of these antidepressants.

Conclusion

In conclusion, antidepressants and anxiolytics have been found to have various side effects such as withdrawal syndromes, other teaching strategies should therefore be employed by nurses to overcome this. Teaching patients about the benefits of dose completion and the proper use of these regimens are some of the ways of improving the effectiveness of these drugs. They should offer counseling sessions as one of the strategies, this will create a good rapport between them and their clients thus easy follow-up of disease progression.

References

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Anthony, J., Kinnafick, F. E., Papathomas, A., & Breen, K. (2020). Physical Activity for Adolescents with Severe Mental Illness: A Systematic Scoping Review.International Review of Sport and Exercise Psychology. Web.

Beck, D. A., & Beck, C. L. (2018). Anxiolytics. In Clinical Psychopharmacology for Neurologists. Springer, Cham. Web.

Edward, K. L., & Alderman, C. (2013). Psychopharmacology: practice and contexts. Oxford University Press. Web.

Jakobsen, J. C., Gluud, C., & Kirsch, I. (2020). Should Antidepressants be Used for Major Depressive Disorder?. BMJ Evidence-based Medicine, 25(4). Web.

Kelly, R. R., McDonald, L. T., Jensen, N. R., Sidles, S. J., & LaRue, A. C. (2019). Impacts of Psychological Stress on Osteoporosis: Clinical Implications and Treatment Interactions.Frontiers in Psychiatry, 10, 200. Web.

Moncrieff, J. (2020). Persistent Adverse Effects of Antidepressants. Epidemiology and Psychiatric Sciences, 29. Web.

Oberste M, Medele M, Javelle F, Lioba Wunram H, Walter D, Bloch W, Bender S, Fricke O, Joisten N, Walzik D, Großheinrich N and Zimmer P (2020) Physical Activity for the Treatment of Adolescent Depression: A Systematic Review and Meta-Analysis.Front. Physiol. 11:185. Web.

Rang, H. P., Ritter, J. M., Flower. R. J., & Henderson, G. (2016). Rang & Dale’s Pharmacology (8th ed.). Churchill, Livingstone: Elsevier. Web.

Ritter, J. M., Flower, R. J., Henderson, G., Loke, Y. K., MacEwan, D., & Rang, H. P. (2020). Rang Y Dale. Farmacología. Elsevier. Web.

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