Anti-depressant drugs Flashcards
What is depression characterizsed by?
↓ in NE and 5-HT activity
Traetment aim for depression?
increase monoaminergic neurotransmitters in the brain–> ↑ NE, 5-HT and DA
Categories of Anti-depressant drugs
1) Amine reuptake inhibitors
- TCAs- Tricyclic antidepressants
- SSRIs- Serotonin selective reuptake inhibitors
- SNRIs- Serotonin/Norepinephrine reuptake inhibitors
2) Monamine oxidase inhibitors (MOAIs)
3) Atypical anti-depressant drugs
TCAs drugs
1) Imipramine
2) clomipramine
3) Amitriptyline
MoA of TCAs?
Non-specific blockade of 5-HT
and NE reuptake
Clinical uses of TCAs?
1) Major depression
2) OCD
3) Phobic/anxious states
4) Neuropathic pain
Adverse effects of TCAs
- Sedation (H1 block).
- Postural hypotension (a-adrenoceptor block).
- Dry mouth, blurred vision, constipation (muscarinic block)
Toxicity:
The “3 Cs” –> Coma, Convulsions, and Cardiotoxicity
TCAs drug interactions
1) Hypertensive crisis with MAO inhibitors
2) Serotonin syndrome with SSRIs, MAO inhibitors, and meperidine.
3) Prevent antihypertensive action of a2 – agonists.
SSRIs drugs
1) Fluoxetine
2) Paroxetine
3) Citalopram
4) Sertaline
MoA of SSRIs
Highly selective blockade of serotonin transporter (SERT) –> ↓ 5-HT reuptake
Indication of SSRIs
1) Major depression
2) OCD
3) bulimia
4) Anxiety disorders ( chronic/acute Tx w/ BZPs)
Adverse effects of SSRIs
1) bruxism (teeth clenching)
2) Sexual Dysfunction
3) weightloss
Toxicity
Serotonin syndrom (sever muscle rigidity, Hyperthermia, cardiovascular instability& seizures)
SSRIs drug interactions?
Serotonin syndrome with MAO inhibitors, meperidine, and TCAs
A withdrawel syndrome of SSRIs are described as?
**FLUSH **
1) flue-like symptoms –> fatigue, nausea, Diarrhea, Diaphoresis (sweating)
2) Light headedness
3) Uneasiness/ restlessness
4) Sleep, sensory disturbance
5) Headache
SNRIs drugs
1) Duloxetine
2) Venlafaxine
Indication of SNRIs
**Venlafaxine and Duloxetine **
1) Major depression
2) chronic pain
3) OCD
**Duloxetine **
1) Neuropathic pain
2) Fibromylagia
Indications of Duloxetine
1) Major depression
2) Neuropathic pain
3) Fibromayalgia
MoA of SNRIs
SNRIs bind to transporters for both 5-HT and NE
Adverse effects of SNRIs
Toxicities:
1. Anti-cholinergic
2. Sedation
3. Hypertension (venlafaxine)
MOAIs drugs
1) Phenylzine
2) Tranylcypromine
MoA of MOAIs
Inhibition of MAO A and MAO B.
Indications of MOAIs
- Significant anxiety
- Phobia
- Hypochondriasis
Adverse effects of MOAIs
- ↑ NE leads to hypertensive crisis;
- ↑ 5-HT leads to serotonin syndrome
First line treatment for depression
SSRIs –> First line agents, particularly in patients with significant fatigue or pain syndromes associated with the episode of depression.
* SNRIs –> second-line agents in patients who have not responded to SSRIs.
* MAOIs –> most useful in patients with significant anxiety, phobic features and hypochondriasis
