Lecture by Dr. Yolanda Pinkett on SSRIs and Depression Treatment

Introduction

• Presenter: Dr. Yolanda Pinkett, Geriatric Psychiatrist
• Affiliation: Large home care agency in the Bronx
• Topic: Use of Selective Serotonin Reuptake Inhibitors (SSRIs) in treating depression

Serotonin: An Overview

• Nature: Hormone & Neurotransmitter
• Locations: Digestive tract, central nervous system, pineal gland, blood platelet cells
• Functions Affected by Serotonin:
  • Mood
  • Sleep
  • Appetite
  • Sexual desire
  • Cognition
• Depression Link: Decrease in serotonin leads to depressive symptoms

Causes of Serotonin Deficiency

1. Low production of serotonin in brain cells
2. Decrease in receptor sites
3. Inability to bind to receptor sites
4. Reduction of tryptophan (precursor chemical for serotonin production)

SSRIs: Mechanism of Action

• Role: Increase serotonin levels by preventing its reabsorption into presynaptic neurons
• Process:
  • Serotonin produced and transported to nerve endings
  • Released into synaptic region and binds to postsynaptic receptors
  • Electrical impulses transmitted from presynaptic to postsynaptic nerve
  • SSRIs block reabsorption, prolonging serotonin presence in synaptic region
• Outcome: Improved serotonin binding; better mood regulation

Common SSRIs

• Fluoxetine (Prozac): Introduced in 1987
• Others: Paxil, Zoloft, Celexa, Lexapro
  • All available in generic forms

SSRIs in Older Adults

• Considerations: Start with low doses, increase slowly
• Precautions:
  • Prozac & Paxil: Potential for drug interactions; cognitive effects; sedation (fall risk)
  • Celexa: Cardiac side effects (limit dose to ≤ 20 mg)
  • Luvox: Used for OCD, not depression

Common Side Effects of SSRIs

• Headache
• Reduced libido
• Insomnia

Patient Management

• Timing of Symptoms: Determine if side effects are pre-existing depression symptoms
• Intolerance: Adjustments or switches possible if intolerable side effects persist

Drug Interactions and Contraindications

• Increase Medication Concentration: Warfarin, Digoxin
• Interaction Monitoring: Lab tests for some medications
• Reduction of SSRI Levels: Ibuprofen, Naproxen (common in chronic pain and arthritis)
• Increase SSRI Levels: Alcohol, diuretics, Ambien
  • Risks: Mental status changes, hyperthermia, hypertension, serotonin syndrome (can be fatal)

Conclusion

• Additional Resources: Visit the presenter’s web library for more lecture topics