Anti-Depressants Flashcards
Psychological Symptoms of Depression:
- Low mood, negative thoughts
- Loss of motivation
- Low self-esteem
- Low ability to experience reward
Biological Symptoms of Depression:
- Cognitive deficits
- Loss of sex drive
- Sleep disturbance
- Loss of appetite
Depression treated via which pathways:
- Serotonergic and Noradrenergic pathways
Name of Serotonin receptor?
= 5-hydroxytryptamine (5-HT):
- Most common neurotransmitter in Enteric NS
- Induce nausea (esp. 5-HT3)
- Gastric changes (constipation/diarrhoea)
- GI bleeding
- Procoagulative signalling molecule released by & acting on platelets
- Uptake inhibitors = prevent accumulation of 5HT in platelets
Classes of Anti-Depressants:
TYPICAL =
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Serotonin/Noradrenaline Reuptake Inhibitors (SNRIs)
- Tricyclic Antidepressants
- Monoamine Oxidase Inhibitors (MAOIs)
ATYPICAL =
- Mirtazepine, Trazodone, Bupropion, Mianserin, Agomelatine
PARTLY ATYPICAL =
- Vortioxetine, Vilazodone
SSRIs (Selective Serotonin Reuptake Inhibitors):
Examples = Citalopram, Sertraline, Fluoxetine, Paroxetine (CSF)
- Serotonin cleared from synapse by the 5-HT re-uptake transporter
- Serotonin broken down by Monoamine Oxidase (MOA)
- All SSRIs are highly selective for the serotonin reuptake transporter
+ Long half-life (18+ hrs) + Cheap, modest efficacy
+ Oral tablets once daily + Low side effects
- Serotonin Syndrome (HTN, tremor, agitation)
- Nausea, diarrhoea, constipation
- Arrhytmia, bleeding
- Insomina, sexual dysfunction, weight gain, agitation, anxiety
SNRIs (Serotonin & Noradrenaline Reuptake Inhibitors):
Examples = Venlafaxine, Duloxetine
• Severe depression
- Decreased appetite (occassionally weight gain)
- Dry mouth, dizziness, increased seizure risk
- Significant overdose risk
!!! Careful in interactions with St John’s Wart
TCA’s (Tricyclic Antidepressants):
Examples = Amitryptiline, Nortriptyline, Dosulepin
- Recommended prescription by specialists only for severe depression/anxiety cases
- Antagonists at α1, 5-HT2A/C, mACh, Histamine H1
- Anticholinergic effects
- Sedation - Postural hypotension
- Impotence - Weight gain
!!! Be cautious: high overdose risk, interactions with CNS depressants & hepatic metabolism, CV disorders
MAOI (Monoamine Oxidase Inhibitors):
Examples = Moclobemide, Phenelzine
• Specialists use
- SE’s similar to SSRIs
- Anticholinergic SE’s
- INC. arrhythmia risk
- High overdose risk
- Hypertensive crisis
- Dietary restrictions
!!! Cautious = harmful drug restrictions
= musn’t give simultaenously with
antidepressants
Atypical NA Reuptake Inhibitors:
Examples = Buproprion (& Reboxtine, Maprotiline)
- Antidepressant + anxiolytic
- Noradrenergic reuptake inhibitors
- Inhibits dopamine uptake, 5-HT uptake
- Used mainly for smoking cessation
- Lower efficacy than TCAs
- CNS stimulant SE’s (dry mouth, insomnia, dizziness,
dizziness, tachycardia, constipation)
Atypical Monoamine Receptor Antagonists:
• Examples = Mirtazepine, Trazodone, Agomelatine,
Mianserin
• Antagonists at pro-depressive, pro-anxiolyic 5-HT2A/B/C receptors
• MIRTAZEPINE = a2 Adrenergic Antagonist
= Faster onset
• TRAZODONE = 5-HT reuptake inhibitor & H1
Antagonist
• AGOMELATINE = agonist at Meltaonin MT1 receptor
= Low SE’s, sleep sparing
