Healthcare Management Assignment Help Services

Running head: HEALTHCARE
Depression
Name of the Student
Name of the University
Author Note

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Class of antidepressants
Prozac that has the generic name of Fluoxetine is an antidepressant, and it is primarily
used for the management of major depressive disorder, panic disorder, obsessive compulsive
disorder, premenstrual dysphoric disorder, and bulimia nervosa. This drug belongs to the class of
selective serotonin reuptake inhibitor (SSRI). SSRI drugs are primarily administered owing to
the function that they exert, by augmenting the extracellular amount of serotonin
neurotransmitter (Pawluski, Brain, Hammond & Oberlander, 2019). This is brought about by
restricting the reuptake or reabsorption of the aforementioned neurotransmitter in presynaptic
cell, which in turn results in an increase in the amount of serotonin that is available in the
synaptic cleft, in order to bind to the existing postsynaptic receptors. Messages are generally
transported across neurons, through chemical synapse in the brain (Drukarch et al., 2018). The
presynaptic cell that is responsible for conveying information triggers the release of
neurotransmitter serotonin in the synapse. This neurotransmitter is then identified by receptors
that are present on the surface of the postsynaptic cell, following which the signal get
transmitted.
This class of drugs is predominantly used for the treatment of depression, based on
evidences from monoamine theory, which elaborates that inadequate activity of different
monoamine neurotransmitters such as, serotonin, epinephrine, and dopamine result in
depression. In addition, depression is also associated to tryptophan depletion, which is an
important precursor of the serotonin neurotransmitter, thus highlighting the role of reduced
serotonin neurotransmission in depression (Elliott, Lukic, Koren & Getselter, 2019). Since SSRI
class of drugs are responsible for inhibiting serotonin reuptake, the neurotransmitter remains in

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the synaptic cleft for a longer period, than usual circumstances and repeatedly triggers the
receptors located on the post-synaptic cells. This eventually results in amplification of signaling
of synapses, where the primary neurotransmitter is serotonin.
Mechanism of action
Norepinephrine and serotonin, the biological amines have been associated with signs and
symptoms of depression. According to research evidences low amount of serotonin in the
cerebrospinal fluid is commonly reported amongst patients who are diagnosed with depression
(Shao et al., 2018). In addition, decreased amount of serotonin reuptake sites have also been
identified in the platelets of individuals diagnosed with depression. 5HT1A pre-synaptic
serotonin receptors are predominantly located in the dorsal raphe nucleus (Li et al., 2019). These
receptors primarily project to prefrontal cortex. Fluoxetine is normally administered once the
day, in oral formulation, beginning at a dosage of approximately 20 mg each day. Typically a
dosage of 20-80 mg is required for most individuals (Preston, 2002). Fluoxetine has not been
found to appreciably reduce the amount of dopamine or norepinephrine on therapeutic
dose. However, evidences have associated fluoxetine with a delay in serotonin reuptake, which
results in persistence of serotonin for a longer period, after its release from the neurons.
Fluoxetine results in an increase in the concentration of allopregnanolone (Paul, Pinna &
Guidotti, 2020). Also referred to as brexanolone, this medication acts in the form of a potential
positive elastic modulator of the GABAA receptor, located in the brain.
On chronic dosage with the aforementioned drug, there occurs an increase in the
occupancy of the serotonin receptors that are located in the postsynaptic cell. This sends signal to
the presynaptic neuron in order to synthesize less amount of serotonin, which in turn decreases
its release from the neuron. The levels of serotonin in the synapse therefore reduces, following

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which it rises again, eventually resulting in a downregulation of the serotonin receptors that are
located in postsynaptic cells. Fluoxetine creates mild impact on the 5HT2C and 5HT2A receptors
(Baptista-de-Souza et al., 2020). The active metabolite of the drug fluoxetine is norfluoxetine
that gets synthesized due to the action of cytochrome P450 enzyme (CYP2D6).
“Home remedies” or “natural supplements”
Though conventional treatment for depression is based on a combination of counseling
and prescription medication, ongoing research focuses on the efficacy of numerous supplements
for determining the benefits that they exert on people with depression. St. John’s wort or
Hypericum perforatum grows wild all across Asia, Africa, Europe, and western region of the
United States, and its leaves and flowers are used in the form of medicine. Although it was
earlier used for its antibacterial anti-inflammatory and antiviral properties, it has gained attention
in recent years as a popular antidepressant supplement, particularly in European Nation. The
flowers of the plant are used for developing the supplement typically in the form of tablets,
capsules, or teas. It is often found that people suffering from severe depression consume this
supplement on a regular basis (Ng, Q. X., Venkatanarayanan & Ho, 2017).
S-adenosyl-L-methionine (SAMe) is a dietary supplement that has received approval
from FDA, and is used in the form of a prescription drug in Europe since the 70s. This dietary
supplement has been found effective in the treatment of depression. It has been associated with
the production of serotonin, dopamine, and melatonin (De Berardis et al., 2016). Research
evidences have also highlighted that individuals who consume prescribed SSRI also gain benefit
on consuming SAMe. 5-hydroxytryptophan (5-HTP) is produced from L-tryptophan (Jacobsen,
Krystal, Krishnan & Caron, 2016). Taking into consideration the fact that there exists a
correlation between tryptophan depletion and depression, individuals suffering from depression

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often show dietary modification. They focus on consumption of dietary sources that are rich in
tryptophan such as, chicken, turkey, milk, sunflower seed, and seaweed, pumpkin, potato, turnip
and collard greens. Similar to the aforementioned supplement, 5-HTP also plays a significant
role in increasing level of serotonin in the brain, thus alleviating signs and symptoms of
depression (Javelle et al., 2020). It is also manufactured from Griffonia simplicifolia seeds, and
consumed in the form of capsules or tablets.
Home remedies also focus on consumption of Piper methysticum, popularly known as
Kava Kava that offers relief from symptoms of depression. This particular plant is found in
South Pacific and often leads to intoxication on consumption. Tinctures and tea produced from
roots of this plant have been used in several decades for decreasing anxiety, and bring about a
relaxation effect (Lee & Bae, 2017). Although it does not directly treat depression, it induces a
feeling of calmness and relaxation. Omega 3 fatty acids are generally found in fish like sardine,
trout and salmon. There is a growing body of evidence that individuals having decreased levels
of brain chemicals namely, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) that
are generally present in fish oil supplement demonstrate and increased likelihood of suffering
from depression (Parletta et al., 2019). Therefore, consumption of omega-3 fish oil supplements
on a regular basis is a common practice amongst depression patients.
Possible drug/supplement interactions
Contraindications of fluoxetine before its treatment with other monoamine oxidase
inhibitors like tranylcypromine and phenelzine is commonly observed due to the risk of
serotonin syndrome (RxList, 2020). This refers to several signs and symptoms that often occur
with consumption of serotonergic medications. The signs commonly comprise of
agitation, dilated pupil, sweating, tremor, high body temperature, and increased reflexes.

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Therefore, the use of the aforementioned drugs should generally be avoided in individuals who
are known to demonstrate hypersensitive reactions to fluoxetine. In several cases, the
administration of cough suppressant, dextromethorphan, along with fluoxetine is not advisable
(Sohel, Shutter & Molla, 2019). This can be accredited to the impact of fluoxetine on an increase
in serotonin level, in addition to the fact of it being a substantial cytochrome P450 2D6 inhibitor.
This prevents metabolism of dextromethorphan at a normal rate, thereby augmenting the risk of
suffering from serotonin syndrome. Patients who are prescribed nonsteroidal anti-inflammatory
drugs or anticoagulants must also remain careful during the consumption of fluoxetine, since it
often increases the blood thinning impacts of the aforementioned medication.
Several isozymes related to cytochrome P450 system also get inhibited by fluoxetine. It is
found to be important inhibitor of the chief enzyme CYP2C19 and CYP2D6, in addition to
CYPC9 and CYPB6. Not only does fluoxetine prevent P-glycoprotein activity that plays a
significant role in transport and metabolism of drugs, but also increases the potential of
contraindications with other medications (RxList, 2020). Fluoxetine can remain in the body for
several weeks after administration of the last dosage. Thus, it often decreases removal of
additional drugs from the human body such as, antiarrhythmics, thioridazine and vinblastine. It is
also necessary to inform the physician about consumption of other products that lead to
drowsiness such as antihistamine, marijuana, sedatives, alcohol, narcotic pain relievers or muscle
relaxants (Sohel, Shutter & Molla, 2019). The medication also creates an impact on particular
laboratory and medical tests such as, brain scan, thus introducing false test results.
Patient education
Under circumstances when the client informs that supplementary comments are being
consumed for the management of depression, they will be educated on the fact that the natural

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remedies and supplements treatments are not an appropriate replacement for clinical treatment
and medications. It will be elucidated that there is little evidence for the positive impacts that the
supplement treatments exert on signs and symptoms of depression, and the side effects that they
might lead to. Lack of evidence regarding the same makes it difficult to determine efficacy of the
treatment for management of the mental disorder. There are several supplements that have not
yet received approval from the Food and Drug Administration in the USA, or its corresponding
agencies in other nations (Mischoulon & Iovieno, 2019). Therefore, the clients will be informed
about the serious side effects that they might have to encounter, after consumption of the
supplements. Patient education will also focus on highlighting the fact that several dietary and
herbal supplements might interfere with prescription medications, thereby leading to dangerous
interactions, and taking a toll on the physical and mental health of the patient.
“Safer” alternatives
Safer alternative for depression management includes physical exercise, meditation, and
yoga. Yoga practice has been associated with a reduction in perceived stress that results in a
modulation of the stress response system. Not only does this decrease heart rate and elevated
blood pressure, but also eases respiration. Research evidences have established the benefits of
yoga that comprises of meditation, deep relaxation or controlled breathing, in alleviating signs of
depression and have also stated that the impacts are long term (Prathikanti et al., 2017).
Meditation encompasses active training of human mind, in addition to acceptance of thoughts
and feelings, without any opinion. Research evidences have found that meditation plays an
important role in decreasing symptoms of both depression and anxiety (Alderman, Olson, Brush
& Shors, 2016). Regular physical exercise not only decreases stress but also improves symptoms
of depression and leads to relaxation. It also has the added advantage of enhancing energy level,

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balance, and flexibility. According to Olson (2018) daily exercise helps in depression
management, by augmenting the levels of the neurotransmitter serotonin, and improving the
pattern of sleep. The clients will also be advised to consume magnesium chloride as a safe
alternative, since findings from a randomized open label study have established a clinically
significant correlation between magnesium chloride consumption and improvement of
depression (Tarleton, Littenberg, MacLean, Kennedy & Daley, 2017). Furthermore, shared care
that involves joint management of the health of an individual by specialty and primary
physicians has also been correlated with an improvement of depression outcomes (Smith,
Cousins, Clyne, Allwright & O'Dowd, 2017).

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