Central Nervous System ( Anti Depressants) Flashcards
What is depression?
Depression is a serious and often disabling condition that affects a persons overall health (eating, sleeping ) and ability to enjoy life(work, family).
Also defined as an alteration in mood characterized by sadness , worry and anxiety.
Risk factors (depression)
- Race (It is less common in black population)
- Sex (twice more in women )
- Age ( usually greater than 45 yrs)
- Medical condition
- Social isolation
- Family history
Signs and symptoms of depression
- Psychological symptoms :
- persistent sadness - anxiety - feelings of worthlessness
- persimism - helplessness - difficulty in thinking - difficulty in concentration - difficulty in remembering or taking decision. - Physical symptoms:
- Increase or decrease in weight or appepite - insomnia - oversleeping - fatigue - decreased energy.
Others:
- Withdrawal from social situations (family gathering )
- thought of death or suicide
-in children mainly moodiness , loss of interest in school.
Types of depression
- Major depressive disorders (MDD)
The symptoms last longer than 2 weeks and they interfere with everyday life.. - Bipolar depression
People with bipolar have alternating periods of low moods and high energy periods - Post partum depression :
It occurs after having a baby , people with this depression experiencs emotional high and lows, frequent crying , anxiety , fatigue , guilt and they may have problem caring for their baby.
Pathophysiology of depression?
States that depression is caused as a result of disturbance of CNS neurotransmitters which include :
Dopamine
Serotonin
Norepinephrine
Anti depressants classifications
- Tricyclic antidepressants (TCA)
- Selective serotonin reuptake inhibitors (SSRI)
- Serotonin- norepinephrine reuptake inhibitors (SNRI)
- Norepinephrine reuptake inhibitors (NRI)
- Norepinephrine Dopamine re-uptake inhitors (NDRI)
- Monamine oxidase inhibitors (MAOIS)
- Tricyclic antidepressants (TCA) :
- Tricyclic antidepressants (TCA) :
They are the oldest class of anti depressants examples are ; desipramine, doxepine , clomipramine.
MOA
They block the reuptake of certain neurotransmitters such as norepinephrine and serotonin , they act at the presynaptic terminal or nerve fibres , they are used less commonly now due to the development of more selective and safer drugs.
Side affects
- Dry mouth - confusion - postural hypertension.
Adverse effect
It potentiate the effect of alcohol and interact with anti hypertensive drugs
- Monoamine oxidase inhibitors
They are rarely prescribed anymore due to their fatal interactions with food specially those containing Tyramine as well as certain drugs ..
MOA
They block the enzyme monoamine oxidase which breakdown the neurotransmitters (dopamine , serotonin and norepinephrine)
Example of MAOI is phenelzine
3.Selective serotonin reuptake inhibitors:
Examples are :
Fluoxetine
Paroxetine
They are considered to be the current standard of drug treatments
MOA
They work by inhibiting the reuptake of serotonin .
They are selective to only serotonin.
Side effect
Dry mouth
Anxiety
Insomnia
- Serotonin -norepinephrine reuptake inhibitors
Examples are:
Duloxetine
- Norepinephrine Dopamine re-uptake inhitors:
Example:
Ritalin
Difference between old and new anti depressants
1)Old anti-depressants have more side effects
New anti depressants fewer side effects
2) old - cumbersome dosing ( drug administration)
New - Easy dosing
3 ) old - late onset of action
New - quick onset of action
- ) Old - poor complianceNew - Good compliance
