Dr. Aviv Ouanounou comes back to speak about depression and anti-depressant medication and the main considerations in treating patients who are taking anti-depressants.
Depression is a common disease that affects the elderly and is the 4th highest cause of disability worldwide. The disease can affect not only the individual diagnosed with depression but, also his/her family and friends. Genetics, biochemical imbalances, stress, personality type, certain medications as well previous depressive episodes can predispose one to depression. Signs and symptoms vary from one individual to another but include suicidal thoughts, sadness, low self-esteem, disturbed sleep patterns and irritability.
Types of depression include: major depression, chronic depression (mild), atypical depression, bipolar disorder/manic depression, season affective depression (SAD). The general pathophysiology of depression involves the monoamine oxidase neurotransmission in the CNS as well as abnormalities in the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-thyroid axes. Treatment of depression includes medications that increase the levels of serotonin and noradrenaline. The common classes of anti-depressants are: tricyclic antidepressants (TCA), selective serotonin reuptake inhibitors (SSRI), monoamine oxidase inhibitors (MAOI) and others. There are drug interactions that must be taken into consideration when treating these patients.
Many patients with depression may not have the motivation or means to care for their oral health. As a result, as dental professionals it is important for us to educate the patient and family members on preventive measures such as toothbrushing and flossing to maintain plaque control. A chlorhexidine gluconate rinse may be indicated as well. Treatment plans must also take into account the patients overall oral health which may include side-effects from medications, level of compliance and motivation as well as financial resources.