ANTI-DEPRESSANT USE IN UTAH

Anti-depressant use in Utah: A Community Assessment



Anti-depressant use in Utah: A Community Assessment

Introduction

Antidepressants are among the most often prescribed agents in medicine. They are a highly effective, relatively safe, and non-addictive class of therapeutic agents. Antidepressants do not elevate mood in nondepressed people and have no abuse potential. Their primary use is in the treatment of major depressive disorder, although many antidepressants have other established uses such as in the treatment of anxiety and eating disorders.

Social problems can be measured objectively and subjectively. Objectively measured, concrete indicators such as death, disease, monetary cost, and incapacity to work or attend an educational institution define a social problem. Subjectively measured, defining a social problem is its social construction, that is, how the members of a society—including the general population, the media, lawmakers and law enforcement, social movement activists, and the medical and psychiatric professions—define and react to a given condition or supposed condition. Also referred to as the “social construction” of a social problem, this subjective definition often finds expression through emotions such as fear and dread, which may or may not be related to a condition's objective harm.

Meyers notes that Lilly's salespeople were actively promoting DES to doctors and pharmacists even before it was approved by the FDA. Among the research omitted from later DES promotional brochures was a study, conducted from 1950 to 1952 at the Chicago Lying-In Hospital that found DES not only failed to prevent miscarriages but seemed to cause them. Lilly did not fund its own research on DES effects until after the FDA banned the drug in 1971.

Discussion

Our understanding of antidepressants mechanism of action relates to the monoamine hypothesis of depression. This hypothesis suggests that depression follows a dysfunction of one or more of the monoamine neurotransmitters including nor epinephrine (NE), serotonin (5-HT), and dopamine (DA). It follows, therefore, that antidepressants work by increasing monoamine-mediated neurotransmission in one or more ways. The three most established hypotheses for mechanism of antidepressant action are reuptake inhibition (i.e., block the reuptake of NE, 5-HT, DA, or all three, into nerve terminals thereby increasing the amount of the monoamine in the synapse); interaction with the 5-HT, NE, or DA receptors to mimic the effects of these natural monoamines; and block inhibition (i.e., block the metabolic degradation of NE, 5-HT, or DA at the nerve terminals to increase the amount in the synapse).

Antidepressant Use in Utah Community

Antidepressants are not general mood elevators and selectively alleviate symptoms of depression, including extreme sadness, loss of interest, decreased energy, inability to concentrate, sleep disturbance, and appetite changes. Because all antidepressants essentially target the same underlying substrate (monoamine neurotransmitters), no antidepressant is superior to others in the treatment of major depressive disorder. Selection of an antidepressant, therefore, depends on a patient's unique symptoms and the different medication side effect and drug interaction profiles.

In general, treatment with antidepressant medications requires 3 to 6 weeks of continuous therapy at therapeutic doses before symptoms of depression improve. Moreover, not every patient given an antidepressant will ...