Anti-Depressants Flashcards
Two Primary Types of Depression Classification
Differentiation?
MDD or Unipolar
Bipolar - has manic episodes
Key is MANIC EPISODES
Chemical Anti-Depressant Important Considerations (3)
Ineffective in 30% of patient population
Therapeutic response takes weeks to months
Side effects can limit dosing - elderly are more likely to experience adverse effects
Two Hypotheses of Depression
Monoamine/Biogenic Amine
Neurotrophic
Monoamine/Biogenic Amine Hypothesis
Depression may be related to DEFICIENCY OF 5-HT, NE, and DA
Neurotrophic Hypothesis
Loss of NEUROTROPHIC GROWTH FACTORS
BDNF - “brain fertilizer”
MAOI Mechanism of Action
block MAO enzyme (MAO a or b)
increases synaptic availability of NE AND 5-HT
MAO-A targets
MAO-B targets
A - Tyramine, NE, 5-HT, DA
B - DA
Phenelzine
MAO-A and B inhibitor
irreversible
WORSE SIDE EFFECT PROFILE
Tranylcypromine
MAO-A and B inhibitor
Irreversible
WORSE SIDE EFFECT PROFILE
Selegiline
Dose dependent uses?
MAO-B Inhibitor (low dose)
Non-selective (High dose)
Low dose - Parkinsons
High dose - Antidepressant
MAOI Most common side effects
ORTHOSTATIC HYPOTENSION - alpha-1 receptor inhibition in brainstem
WEIGHT GAIN
Irreversible MAOi’s have HIGHEST RATE OF SEXUAL DYSFUNCTION
Food Interactions
Tyramine
HYPERTENSIVE CRISIS
Tricyclic Antidepressant Important clinical use
CHRONIC PAIN CONDITIONS
tricyclic - three ring structure
Tricyclic Antidepressant MOA
block reuptake of 5-HT AND NE
inhibits SERT and NET
Imipramine - drug type? MOA? Important characteristic?
inhibits SERT and NET
PROTOTYPE TCA
has some anti-cholinergic effect
Used to treat enuresis