New Generation Anti-Depressants and SSRIS

Question: Describech about the New Generation Anti-Depressants And SSRIS. Answer: Introduction Depression is always counted amongst the most powerful psycho-social risk factor for the poor condition of cardiovascular prognosis even after the myocardial infarction (Hemingway Marmot, 1999). In fact, it is the most common phenomenon amongst old-age people causing greater affect on those who live in a community. (McDougall Mathews, 2007). According to a recent meta analysis, (Van Melle et Al, 2004), the depression after myocardial infarction associates particularly with the 2-2.5 fold higher risk of cardiovascular mortality, all-cause mortality as well as cardiovascular events. Additionally, the depression after myocardial infarction also emerges as a major source for poor life quality (Beck et al, 2001), incomplete recovery (Ladwig et al, 1994), delay in return towards work (Soderman et al, 2003), non-attendance in cardiac rehabilitation (Lane et al, 2001), and non-adherence (Carney et al, 1995). Particularly talking about the United Kingdom, the primary level of care that is rendered to the patients suffering from depression are antidepressant drugs. They were largely prescribed to the patients of all age groups (The NHS Information Centre, 2010). However, according to a distinctive systematic review conducted majorly over the older people, both SSRIs (Selective Serotonin Reuptake Inhibitors) and tricyclic antidepressants showed equivalent outcomes in efficacy, but there were higher chances of discontinuation associated with classical tricyclic antidepressants that may lead to several adverse effects. (Motram, Strobl Wilson, 2006). Looking at such systematic review, NICE (National Institute for Health Clinical Excellence) strongly recommends the practitioners to prescribe antidepressants only after considering their side effects along with the preferences of the patients. However, normally the selection should be made of a generic SSRI for treatment (NICE, National Clinica l Practice Guideline 90, 2009). While considering the patterns of the antidepressant treatment, it was found that SSRIs were amongst the most common class of drug prescriptions. The ten most common prescriptions of antidepressant drugs amongst practitioners may include Citalopram hydrobromide, fluoxetine hydrochloride, amitriptyline, dosulepin hydrochloride, paroxetine hydrochloride, sertraline hydrochloride, venlafaxine hydrochloride, mirtazapine, escitalopram and lofepramine. When tricyclic antidepressants were compared with SSRIs in terms of outcomes such as mortality, attempted suicides, strokes, fractures and epilepsy, it was found that SSRIs were associated with higher rates than tricyclic antidepressants. SSRIs like citalopram, fluoxetine and escitalopram were particularly associated with increased level of risk for hyponatraemia whereas sertraline and paroxetine were out of this risk. (Movig, 2002; Kirby, 2002; Jacob, 2006). However, increased risk rates for adverse reactions of drugs were associated with S ertraline and lofepramine. According to the study of SADHART (Glassman et al, 2002), Sertraline has been found as the safe treatment measure for patients suffering from depression after myocardial infarction. The tricyclic antidepressants are responsible for affecting the cardiac rhythm as well as conduction that can also turn out cardio-toxic for patients. Thus, the PDR (Physicians Desk Reference) strongly suggests taking close supervision or extreme precautions while prescribing these drugs to any patient having cardiovascular disease (Oradell, 1998). Although, limited long-term data is available, the researchers have suggested that using SSRIs is comparatively safer than any other antidepressant or tricyclic agent when it particularly comes to patients of cardiovascular diseases (Glassman, 1998). Moreover, while considering the efficacy or safety of these tricyclic antidepressants and SSRIs in introductory findings of a meta-analysis on antidepressant trials, no crucial difference was observed. (Goode, 1999). According to this analysis, the major provisions for safety were related to discontinuation of the treatment along with discontinuation resulting out of adverse effects. Particularly talking about UK, the treatment of depression is largely done by making use of antidepressant drugs among which the SSRIs are the most common. In the year 2009, in a community of England, about more than 39 million of antidepressants were prescribed across different ages that come across a 35 percent increase over the past five years (the NHS information centre, 2010). The increase in prescriptions for SSRIs was found about 47 percent whereas for other tricyclic antidepressants, the increase percentage was 18 percent. The major aim for conducting this meta-analysis is to research and examine the possible effects of using new generation anti-depressants and SSRIs on total cholesterol level of the patients over 16, or you can say to examine whether they have any side-effect or not. References: Beck, C. A., Joseph, L., Belisle, P.,et al(2001)Predictors of quality of life 6 months and 1 year after acute myocardial infarction.American Heart Journal,142,271 279. Carney, R.M, Rich, M.W, and Freeland, K.E.Major depressive disorder predicts cardiac events in patients with coronary artery disease.Psychosomat Med.1988;50:627633. 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