Serotonin–norepinephrine reuptake inhibitors (SNRIs)

What they are?

Serotonin–norepinephrine reuptake inhibitors (SNRIs) are a class of antidepressant drugs used in psychiatric treatment. They are primarily used in the treatment of clinical depression, but also in the treatment of anxiety disorders, obsessive-compulsive disorder (OC), attention deficit hyperactivity disorder (ADHD), chronic neuropathic pain, fibromyalgia syndrome (FMS) and other mood disorders. Sometimes serotonin–norepinephrine reuptake inhibitors are even used to relieve menopausal symptoms.

How do they work?

Serotonin–norepinephrine reuptake inhibitors (SNRIs) are different from

other classes of antidepressants because they affect only neurotransmitters serotonin and norepinephrine. Research has shown that the neurotransmitters serotonin and norepinephrine play an important role in the regulation of mood and that mood disorder, such as medical depression or anxiety, can sometimes be explained by abnormal neurotransmitter activity. SNRIs correct imbalances of serotonin and norepinephrine levels.

SNRIs achieve this by blocking the reuptake of serotonin and norepinephrine, this allows more serotonin and norepinephrine to be available in the brain. That is believed to increase the effect of these neurotransmitters. As serotonin can elevate mood and cause a calming effect and norepinephrine can increase alertness, concentration and motivation, SNRIs are believed to relieve clinical depression and other mood disorders.

Do SNRIs have any side effects?

Yes. Side effects of serotonin-norepinephrine reuptake inhibitors (SNRIs) are similar to side effects of selective serotonin reuptake inhibitors (SSRIs) as they have a similar mechanism of action.

Side effects include: drowsiness, headache, nausea, changes in appetite, vivid dreams, sexual dysfunction, dry mouth, anorexia, sweating, insomnia, nervousness, tremor and hypertension.

Are SNRIs addictive?

No but like SSRIs, Serotonin–norepinephrine reuptake inhibitors can also have unpleasant withdrawal symptoms with the most serious symptoms relating to withdrawal syndrome.

Withdrawal symptoms include: dizziness, nausea, vomiting, headache, irritability, unpleasent sensations, such as tingling, burning and shocks, nightmares, tremors, lack of coordination, aggressiveness, suicidal thoughts and balance problems.

What types of Serotonin–norepinephrine reuptake inhibitors are currently availabe?

• Effexor ( Effexor or Efexor) - the first and most commonly used SNRI, works also on dopamine, but mostly effects serotonin and norepinephrine.
• Nefazodone (Serzone, Nefadar) - Serzone is without sexual side effects.
• Duloxetine (Cymbalta, Ariclaim, Xeristar, Yentreve, Duzela)
• Desipramine (Norpramin, Pertofane) - technically a tricyclic antidepressant, but works on both serotonin and norepinephrine, so it can aslo be categorized as an SNRI.
• Milnacipran (Ixel, Savella, Dalcipran, Toledomin)  - is not approved for the clinical treatment of clinical depression in the USA, but is available in Europe and Asia.

Selective serotonin reuptake inhibitors

Selective serotonin reuptake inhibitors (SSRIs) are a class of compounds typically used as antidepressants in the treatment of depression, anxiety disorders, depersonalization disorder and some other personality disorders.

Do they work?

A meta-analysis done in 2010 states that "The magnitude of benefit of antidepressant medication

compared with placebo ... may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial."

Thus we can draw a conclusion that they do relieve severe depression.

How do they work?

SSRIs are believed to block the reuptake of the neurotransmitter serotonin in the brain. Changing the balance

of serotonin seems to help brain cells send and receive chemical messages, which is believed to boost mood. SSRIs are called selective because they seem to only affect serotonin, not other neurotransmitters.

Do SSRIs have any side effects?

Yes.

Very common - more than 1 person out of 10 may experience these - side effects are the following: nausea, low sex drive and withdrawal effects when stopping taking SSRIs.

Common - 1 person out of 10 may experience these - side effects are the following: blurred vision, dizziness, dry mouth, insomnia or hypersomnia, low appetite, sweating, diarrhoea or obstipation and agitation.

Less common - 1 person out of 100 may experience - are the following: bruising, bleeding, vomiting and vomiting blood, lack of movement, stiffness, abnormal movements of the mouth and tongue, hallucinations, inability to urinate and weight gain.

Rare and very rare side effects are the following: restlessness, convulsions or worsening of epilepsy, elevated mood, anxiety, allergic reaction (breathing difficulties, skin rashes, swelling of the eyelids, face, lips or tongue, itching), serotonin syndrome and glaucoma.

Are they addictive?

No. But SSRIs can have unpleasant withdrawal symptoms (aka discontinuation syndrome) when taking the drugs is stopped suddenly. These are usually avoided or minimised by gradually decreasing the doses of SSRIs over a period of few weeks, before quiting entirely.

What are the withdrawal symptoms?

Dizziness, numbness, nausea, vomiting, headache, sweating, anxiety and sleep disturbances.

Which are the most recommended SSRIs?

The one prescribed by your doctor.

In Unites States, only 5 manufacturers of SSRIs are approved by the U.S. Food and Drug Administration.

Approved are the following: fluvoxamine maleate (Luvox), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and fluoxetine (Prozac).

Antidepressants

What are antidepressants?

Antidepressants are psychiatric medications used to relieve mood disorders, such as depression, dysthymia and anxiety disorders.

 Do antidepressants work?

Yes and no.

An article published in the Journal of the American Medical Association concluded that antidepressants are no more effective than placebos. In the other hand, there are many psychiatrists who protect the clinical efficacy of antidepressants. For an example, psychiatrist Peter Kramer wrote in his best-selling book Listening to Prozac that this miracle drug made patients "better than well." Data from clinical trials has shown that people treated with placebos improve about 75% as much as patients treated with antidepressants. Therefore, there is proof of efficacy.

How do they work?

There are many different classes of antidepressants. Each of them work on your brain chemistry in a different way. Each increases certain neurotransmitters in the brain and may do this in different parts of the brain.

Different types of antidepressants include:

• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs)
• monoamine oxidase inhibitors (MAOIs)
• tricyclic antidepressants
• miscellaneous antidepressants and others.

Are there any side effects of taking antidepressants?

Yes! Different classes have different side-effects. It is very important to let your doctor know or to be reminded of medical conditions you have had in the past or have at the moment.

Are antidepressants addictive?

One-third of people who stop taking SSRIs and SNRIs have withdrawal symptoms. They can last from 2 weeks to 2 months.

Are nutritional deficiencies causing violent behaviour?

A study in a high-security prison for young offenders in the UK shows that violent behaviour may be attributable at least in part to nutritional deficiencies.

 ...the number of violent offences they committed fell by 37%
The UK prison trial at Aylesbury jail showed that when prisoners were put on a healthy diet consisting of multivitamins, minerals and essential fatty acids, the number of violent offences they committed fell by 37%. Once the trial had finished and the prisoners were off the healthy diet, the number of offences went up by the same amount.

 Joseph R. Hibbeln, MD, acting chief, Section on Nutritional Neurosciences at the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, said that the results of this trial are not a miracle, but simply what you might predict if you understand the biochemistry of the brain and the biophysics of the brain cell membrane. His hypothesis is that modern industrialised diets may be changing the very architecture and functioning of the brain.

Hibbeln explained that over the last century most western countries have undergone a dramatic shift in the composition of their diets. The omega-3 fatty acids that are essential to the brain have been flooded out by omega-6 fatty acids, mainly from industrial oils - soya, corn, sunflower. For an example, in 1909 soya oil made up only 0.02% of all calories available in that year, but by 2000 it was up to 20%.

For the most part, these omega-6 fatty acids come from industrial frying for takeaways, ready meals, margarine and snack foods such as crisps, chips, ice-creams and biscuits.What makes the situation even worse is alcohol consumption. Alcohol uses up omega-3s in the brain.

As the consumption of omega-6 goes up, so do homicides...
Joseph R. Hibbeln and his colleagues have mapped the growth in consumption of omega-6 fatty acids from seed oils in 38 countries since the 1960s against the rise in murder rates over the same period and in all cases there is disquieting match. As the consumption of omega-6 goes up, so do homicides in a linear progression. The countries like Japan where omega-3 consumption has remained high (because people in those countries eat a lot of fish), have lower rates of murder and depression.

As many other things besides the consumption of omega-3 fatty acids have changed in the last century, this study doesn't prove that high omega-6 and low omega-3 fat consumption causes violence, but I do think that at least in part violent behaviour can be attributable to nutritional deficiencies. Also, I advise everyone to add more fish and seafood to their diet.

And now, last but not least, let's take a look at the diet of one young offender (sentenced by the British courts on 13 occasions for stealing trucks).

Bernard Gesch, a senior research scientist in the Department of Physiology, University of Oxford, recorded the boy's daily diet as follows:

• Breakfast: nothing (asleep)
• Mid morning: nothing (asleep)
• Lunchtime: 4 or 5 cups of coffee with milk and 2½ heaped teaspoons of sugar
• Mid afternoon: 3 or 4 cups of coffee with milk and 2½ heaped sugars
• Tea: chips, egg, ketchup, 2 slices of white bread, 5 cups of tea or coffee with milk and sugar
• Evening: 5 cups of tea or coffee with milk and sugar, 20 cigarettes, £2 worth of sweets, cakes and if money available 3 or 4 pints of beer.

Sources:
http://www.empowher.com/users/capt-joseph-r-hibbeln
http://www.guardian.co.uk/politics/2006/oct/17/prisonsandprobation.ukcrime 

Image from www.freedigitalphotos.net

6 Steps for Beating Depression

1. Step one - professional help - Although there are many ways one suffering from depression can improve his/her condition without professional help, it is still highly recommended to see a psychologist. Depression is a very serious illness and needs appropriate treatment. Without appropriate treatment, it may deepen. As depression saps energy and self-esteem, making the person feel tired, helpless, worthless, and hopless,
it is very important for family and friends to encourage the person suffering from depression to seek treatment.

2. Step two - communication and support - A person suffering from depression is likely to isolate himself/herself socially and avoid any kind of social activities. This may cause further problems. Therefore it is very important to force yourself to take part in group activities and communicate with friends and family. Talk to them not only about everyday stuff, but also about your problems. You may have yourself convinced that you are a strong person and that you don't need to talk about your problems nor seek for the approval of others, but it is not true. Humans are social creatures and it is in our nature to seek the for the approval of others. Therefore it is very important to discuss your problems with close friends or family. Also, group therapy can be very helpful to overcome depression. In fact, a meta-analysis of 48 studies has shown that psychotherapy for depression is effective. Talking with people who are dealing with similar problems is good for many reasons - they can understand you better, you feel like you belong to somewhere and don't feel so alone with what you are going through anymore.

3. Step three - pharmaceuticals - Depression can be caused by hormonal disbalance. Therefore to overcome depression you may have to take medicines. As we are all different, the ways we need to be treated can be different as well. That's why it is important to not use drugs that are not specially prescribed for you.

4. Step four - right nutrition - nutritional deficiencies can be one of the contributory causes of depression. A nutrient deficiency can be caused by an overgrowth of yeast in the digestive system which can directly alter your mood. Researches have shown that nutritional approaches to treating depression are as effective as using antidepressants. To keep a healthy diet, one of the most important things to avoid are candies, other sweets, alcohol and refined foods. They have a very strong effect on your brain chemistry. They will interfere with the receptors in the brain for key neurotransmitters. If the brain identifies that the receptor of a certain neurotransmitter is already filled (with refined foods), it reduces the amount of neurotransmitters it produces. When the level of neurotransmitters drop, you begin to have cravings. As the receptors empty, the cravings increase even more. At some point it is no longer possible to fill the receptors with refined foods and then you start experiencing mood changes and signs of depression.

In addition to avoiding refined food and too much refined sugar, follow a healthy diet from which the entire body can benefit from. Very important is to consume plenty of good quality protein, essential fatty acids, high-fiber foods, vegetables and fruits. Also, don't be afraid to contact a dietician.

5. Step five - exercise - eating healthy food is very important, but if your digesting system doesn't work properly, it's in no good use. Exercising helps your body to digest food faster. Also, many studdies suggest that exercise can help alleviate depression. Learning and mastering new health-related skills can give you more confidence. Confidence can help you a lot in a battle against depression. In addition, exercising can help you get a good night sleep and it releases endorphins in the brain, which gives you a feeling of euphoria.

6. Step six - sunlight - the brain requires light in order for chemicals and hormones to be properly balanced. Lack of exposure to light reduces the production of melatonin and serotoin which can be directly linked to depression symptoms and SAD(seasonal affective disorder). Therefore it is essential to your health and recovery process from depression that you receive enough sunlight. (Watch out for overdoing it, getting sunburned wouldn't help your recovery)

What is depression?

A lof of people like to say that they are "depressed" when they feel sad or just a little out of mood. Sadness and not always being in the best mood, happens to all of us, is totally natural and usually goes away itself. However, depressive disorder - clinical depression - is far more serious than a little bad mood and unfortunately, it doesn't go over quickly.

What exactly is depression?

According to MediLexicon's Medical Dictionary, depression is "a mental state or chronic mental disorder characterized by feelings of sadness, loneliness, despair, low self-esteem, and self-reproach; accompanying signs include psychomotor retardation (or less frequently agitation), withdrawal from social contact, and vegetative states such as loss of appetite and insomnia."

Common symptoms of depression:

• a depressed mood during most of the day, particularly in the morning
• fatigue or loss of energy almost every day
• feelings of worthlessness or guilt almost every day
• impaired concentration, indecisiveness
• insomnia (sleeplessness) or hypersomnia (excessive sleeping) almost every day
• markedly diminished interest or pleasure in almost all activities nearly every day
• recurring thoughts of death or suicide
  
• a sense of restlessness - known as psychomotor agitation - or being slowed down - retardation
• significant weight loss or gain (more than 5% of body weight in a month)

How to know if You suffer from depression or not?

It is possible that you are suffering from depression if you have at least five of the nine symptoms (see above: common symptoms) at the same time.

Don't get alarmed if you have experienced at least five symptoms at the same time for a short period of time. But You should start to worry if you have been experiencing at least five of these symptoms for over two weeks.

What to do when You think you might suffer from depression?

Depression is a serious illness. Therefore the most important step on fighint depression is getting professional help. In addition to professional help, a lot can be improved with communicating and some changes in your everyday life. Exercising and eating healthy food can do miracles.You can read more about winning the fight against depression on here.