Kid gloves and some science

I feel like people sometimes handle me with kid gloves.  I really do not want anyone to walk on eggshells or to treat me differently than they used to or would treat anyone else.  Would you treat someone with high blood pressure or migraines differently than someone who didn't have a dissese or illness?  It is pretty much the same thing with depression.  I'm not an outcast, I'm not broken, I'm not something you need to avoid.  You want catch what I have from me.  It is not contagious.  It's depression not the plague.  

The other day at the pharmacy getting my prescriptions refilled the tech or whoever was checking me out looked at each bottle then up at me.  For all three.  She had this look on her face like "Are you a psycho or something?"  It was really awkward, but that is the price you pay when you get three antidepressants at the same time. 

So, as I said above I am on three medications right now.  Zoloft, Remeron, and Wellbutrin XL is my cocktail at the present time.  All three are antidepressants.  None are anti-psychotics.  So why treat me like I am psychotic?  Maybe it stems from a lack of knowledge.  Maybe people just need more information to understand.  That's why I am here.

So I am sure there are some of you out there that are familiar with antidepressant medications and some of you that are not.  Here is a brief rundown of the different medications used in treating depression and anxiety.

The most common class of medications used in the treatment of depression are known as SSRIs or Selective Serotonin Reuptake Inhibitors.  Basically you have neurons that put out serotonin, a monoamine neurotransmitter attributed to feelings of well-being and happiness, into the gap between that neuron and another neuron, known as the synaptic gap or cleft.  SSRIs come in and block the serotonin from going back into the neuron that released them, known as the presynaptic terminal or axon terminal.  The reabsorbing of neurotransmitters by the axon terminal is also known as reuptake.  When reuptake is blocked, it allows for the serotonin to stay in the synaptic gap longer, thus allowing more to be transmitted to the receptors on the second neuron or dendrite.

Here is a picture of a neuron.  Neurons are the building blocks of the nervous system.  Note the dendrites on one end and the axon terminal on the other. 

When lined up in a row these neurons create a pathways for signals to travel within the brain and spinal column as well as transmit from the rest of the body to the brain.  Even though it sounds like it may be a long process, the neurons communicate very quickly.  Think about how when you get a paper cut or a pin prick and how quickly you feel pain.  Sensory neurons carried that pain signal from the site to your brain in a fraction of a second.

They do that in much the same way as described above with serotonin, just with a different neurotransmitter.  Here is a picture of the area between an axon terminal of one neuron and the dendrite of another.

So SSRIs block the reuptake allowing more time for serotonin to sit in the synaptic gap so more can be taken in by the receptor cell.  Common SSRIs include: Zoloft, Paxil, Prozac, Lexapro, and Celexa.  Some of the side effects you see with these most commonly are dry mouth, extremely vivid or strange dreams, weight loss/gain, sexual side effects, and suicidal thoughts, especially in patients in their teens and early 20's.  SSRIs are very popular as it is difficult to overdose on most of them.  However, large amounts can cause serotonin syndrome which can be fatal or leave the person with permanent damage.  Serotonin syndrome is rare, but is known to happen when large amounts are taken or SSRIs are combined with other Serotonin acting medicines.  Funny story, when I was first put on an SSRI (Celexa) I had what was thought to be a mild serotonin syndrome reaction: fast heart rate, tremors, sweating, and color hallucinations.  Fun right?  Well severe serotonin syndrome is no fun.  High temperature (106 F), severe increase in heart rate and blood pressure, uncontrolled muscle movements and spasms (can be permanent), seizures, and mental status changes.  A common over-the-counter herbal medication called St. John's Wort if taken with an SSRI can lead to serotonin syndrome.  So make sure, if you are on medications or thinking about going on them, to let your doctor know all things you take.  This includes vitamin/mineral supplements, homeopathic/holistic medications, pain relievers, or antacids to name a few.  Also, some foods can trigger bad reactions as well, the main one being grapefruit and grapefruit juice.  You wouldn't believe all the medications affected by grapefruit juice.  If you get bored and want some knowledge you can google it sometime.

Another class of medications are SNRIs or Serotonin-Norepinephrine Reuptake Inhibitors.  They work in similar ways as the SSRIs, but they also block the reabsorbtion of norepinephrine, also known as noradrenaline.  One of the main functions in the body is acting as part of the fight or flight syndrome, but it is also increases energy and elevates mood.  SNRIs that are commonly prescribed are: Effexor, Pristiq, and Cymbalta.  Cymbalta also works to reduce neurologic pain such as fibromyalgia.  Many of the side effects of SNRIs are the same as SSRIs.

Next you have tricyclic antidepressants or TCAs.  They work on similar levels blocking the reuptake of neurotransmitters.  However, with the rise of SSRIs and SNRIs, which have fewer and less severe side effects, TCAs are not prescribed as much anymore.  The most popular one still prescribed is Elavil.  TCAs interact with many other medications and can cause fatal implications if paired with medications like Calcium Channel Blockers and antipsychotic medications.  It was also possible to overdose on TCAs, which isn't always the greatest thing to give a depressed person something they can overdose on.

Tetracyclic antidepressants or TeCAs are very similar to TCAs, but are not as prone to overdose.  TeCAs such as Remeron and Asendin compare to SSRIs in that toxicity is improbable with overdose.  Side effects are much the same as the rest, but also cause drowsiness due to histamine effect, and weight gain. 

The next category has fallen primarily towards the wayside because of their side effects and drug interactions.  Monoamine oxidase inhibitors or MAOIs are typically the last line of medications tried to treat depression.  Next time you see a commercial for a medication and towards the end typically you will hear something like "Tell your doctor if you are on MAOIs."  MAOIs take a different approach than the reuptake inhibitors.  Monoamine oxidase is responsible for the removal of neurotransmitters from the synapse.  So in effect, MAOIs keep PacMan from chomping up all the serotonin, melatonin, epinephrine, norepinephrine, and dopamine dots.  People taking MAOIs need to watch their medications, supplements, and diet very carefully.  Some cheeses, chocolate, and alcohol can cause a spike in blood pressure which can lead to stroke or heart attack.

The final category are atypical antidepressants.  These don't really fit into the other groups, but are still antidepressants.  Wellbutrin and trazodone are popular atypicals.  Wellbutrin is a dopamine and norepinephrine reuptake inhibitor.  It also has a mild stimulant effect and is used in smoking cessation.  The major side effect different from the other antidepressants is a risk for seizures.  If you have had seizures in the past you should not take Wellbutrin.  Doses over 600mg cause a tenfold increase in seizures.

There is your science lesson for the day.  I figured I would have an educational post and subject you all to the basic pharmacology of antidepressants.

Ok, so back to me.  I had my faculty meeting with the instructors this morning and it went well.  Most of them were surprised by the news, but were very supportive.  I knew they would be, how couldn't a group of nurses be empathetic right?  There is a certain comfort that comes with having people know.  Like before, it was almost like living a lie.  I had to keep straight who knew what and which story they knew.  No more though.  Everyone gets the same story and it is nice to know how much people care.

I am pretty sure I was always meant to help people.  I guess that is why I was drawn to nursing.  That, and the science of it all.  So if you are reading this, and you appreciate what I have to say, and think someone could benefit from it I urge you to share this blog.  Even though you may not know of anyone who is depressed, they are out there.  The silent ones.  The ones like me a few months ago.  I am happy and more than willing to talk to anyone who needs someone to talk to.  So please, help your friends who do not know how to get help, or feel like they are not worth getting help.  Friday and Saturday nights can be some of the roughest days for someone with depression.  For most people it means the weekend and time to party, hang out with friends, go do something.  For someone who is clinically depressed weekends are lonely.  Weekends are scary.  Weekends mean, to put it bluntly, more people end up in psychiatric facilities.  It is no secret why I was released on a Thursday.  Friday and Saturday were the busiest intake days at the hospital I was at, and I assume it is like that elsewhere.  So please, take the time to share this site with your friends on Facebook, your followers on Twitter, anyone you can, so maybe, just maybe they won't feel so alone. Thank you.