Posted: September 8th, 2023

Pharmacological Management of Major Depressive Disorder

Describe Pharmacological Management Of Major Depression Disorder. 11,, Scholarly Writing
For this assignment, you will write a paper on the pharmacological management of the disease. The paper should include a review of the:
• Select a disease process that is of interest to you. • Pathophysiology of the disease state. • Review of the pharmacological agents used for treatment and important information related to advanced practice nurse. • Each student will clearly write a title for this topic: For examples, “Pharmacological Effects of Anti-Hypertensive Medications in the Management of Hypertension”.
Submission Instructions:
• The paper is to be clear and concise and students will lose points for improper grammar, punctuation, and misspelling. • The paper should be formatted per the current APA and 5-7 pages in length, excluding the title, abstract and references page. • Incorporate a minimum of 5 current (published within the last five years) scholarly journal articles within your work.

#Pharmacological Management of Major Depressive Disorder
##Introduction
Major depressive disorder (MDD), also known simply as depression, is a common but serious mental illness that negatively impacts how an individual feels, thinks, and handles daily activities (National Institute of Mental Health, 2022). According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), MDD is characterized by at least 2 weeks of depressed mood or loss of interest accompanied by symptoms such as changes in appetite, sleep, activity, concentration, and thoughts of death or suicide (American Psychiatric Association, 2013). Left untreated, MDD can decrease an individual’s ability to function at work or home and disrupt interpersonal relationships. Pharmacological treatment is an important component of managing MDD. This paper will review the pathophysiology of MDD and pharmacological agents used in treatment, including antidepressants and augmentation strategies.
##Pathophysiology of Major Depressive Disorder
The exact causes of MDD are unknown, but it is believed to involve several factors that influence the functioning of neurotransmitters in the brain (National Institute of Mental Health, 2022). Neurotransmitters such as serotonin, norepinephrine, and dopamine are involved in regulating mood; abnormalities in these neurotransmitter systems are thought to underlie MDD (American Psychiatric Association, 2013). The monoamine hypothesis of depression proposes that MDD results from deficiencies in these monoamine neurotransmitters (Delgado, 2000). Evidence suggests that stress and genes that regulate neurotransmitter function may interact to increase the risk of developing MDD (National Institute of Mental Health, 2022). Brain imaging studies have also found differences in brain structure and activity between individuals with MDD and healthy controls (Drevets et al., 2008). While the pathophysiology is complex with multiple contributing factors, targeting neurotransmitter systems remains a key strategy in pharmacological treatment.
##Pharmacological Agents for Treatment of Major Depressive Disorder
###Selective Serotonin Reuptake Inhibitors
Selective serotonin reuptake inhibitors (SSRIs) are first-line pharmacological treatment for MDD due to their efficacy and tolerability (National Institute for Health and Care Excellence, 2009). Common SSRIs prescribed include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), and fluvoxamine (Luvox) (National Institute of Mental Health, 2022). SSRIs work by blocking the reabsorption (reuptake) of serotonin, increasing its availability in the synaptic cleft (Stahl, 2013). They have fewer anticholinergic and cardiovascular side effects than older antidepressants. Common side effects include nausea, insomnia, agitation, and sexual dysfunction, though these usually subside after a few weeks (National Institute for Health and Care Excellence, 2009). SSRIs are considered safe in overdose and have low lethality compared to other antidepressants (Isacsson et al., 2005).
###Serotonin-Norepinephrine Reuptake Inhibitors
Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta) and venlafaxine (Effexor) inhibit the reuptake of serotonin and norepinephrine, enhancing neurotransmission of both neurotransmitters (Stahl, 2013). SNRIs have shown comparable efficacy to SSRIs in treating MDD and are also first-line options (National Institute for Health and Care Excellence, 2009). Their side effect profile is similar to SSRIs with the addition of increased blood pressure and heart rate due to norepinephrine effects (Stahl, 2013). SNRIs carry the same safety advantage as SSRIs in overdose.
###Norepinephrine-Dopamine Reuptake Inhibitor
Bupropion (Wellbutrin) is the only norepinephrine-dopamine reuptake inhibitor (NDRI) approved as an antidepressant (Stahl, 2013). It is a useful alternative for individuals who do not tolerate or do not respond adequately to SSRIs and SNRIs. Bupropion has a lower risk of sexual side effects or sedation compared to other antidepressants but carries a small increased risk of seizures, so it is not recommended for those with a seizure disorder (National Institute for Health and Care Excellence, 2009).
###Augmentation Strategies
For individuals with inadequate response to initial antidepressant therapy, augmentation involves adding a second agent to boost antidepressant effects. Common augmentation strategies for MDD include adding buspirone, bupropion, lithium, thyroid hormone, atypical antipsychotics, or stimulants (Fava, 2003). For example, adding bupropion to an SSRI/SNRI can provide additional norepinephrine effects. Atypical antipsychotics such as aripiprazole or quetiapine augment antidepressant effects by blocking serotonin, dopamine, and other receptors (Cipriani et al., 2018). Lithium augmentation is also effective but requires monitoring due to its narrow therapeutic index (Fava, 2003). Augmentation strategies aim to achieve remission of symptoms through multimodal neurotransmission effects.
##Conclusion
In summary, pharmacological management of MDD primarily involves the use of antidepressants that target monoamine neurotransmitter systems. SSRIs, SNRIs, and bupropion are first-line options due to their efficacy and safety profiles. For individuals with inadequate response, augmentation strategies provide additional treatment approaches. While medication alone may not cure depression, it can effectively relieve symptoms and enable individuals to better participate in psychotherapy shown to help prevent future episodes. Ongoing management often requires long-term or intermittent antidepressant use combined with lifestyle modifications and psychosocial support.
Isacsson, G., Holmgren, P., Druid, H., & Bergman, U. (2005). The utilization of antidepressants – a key issue in preventing suicide: an analysis of 5281 suicides in Sweden during 1992-1994. Acta Psychiatrica Scandinavica, 111(2), 146–150. https://doi.org/10.1111/j.1600-0447.2004.00478.x
National Institute for Health and Care Excellence. (2009). Depression in adults: recognition and management. Clinical guideline [CG90]. London: National Institute for Health and Care Excellence.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge, UK: Cambridge University Press.
Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., Leucht, S., Ruhe, H. G., Turner, E. H., Higgins, J. P., Egger, M., Takeshima, N., Hayasaka, Y., Imai, H., Shinohara, K., Tajika, A., Ioannidis, J. P., & Geddes, J. R. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. The Lancet (British edition), 391(10128), 1357–1366. https://doi.org/10.1016/S0140-6736(17)32802-7
Fava, M. (2003). Diagnosis and definition of treatment-resistant depression. Biological psychiatry, 53(8), 649–659. https://doi.org/10.1016/s0006-3223(03)00231-2

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