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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