Drugs for Depression (Anti-depressants) Flashcards
State the symptoms of depression (5)
- emotional - misery, apathy, pessimism, low self-esteem, indecisiveness, loss of motivation
- retardation of thoughts and actions
- loss of libido
- sleep disturbances
- loss of appetite
Name the 2 types of depression and state the distinctive characteristic of each type.
- unipolar depression - mood swings in one direction
- bipolar depression - alternating depression and mania
State the 2 types of unipolar depression and state some differences between the two.
- reactive depression
- non-familial
- associated with life events and accompanied by anxiety and agitation - endogenous depression
- familial
- not associated with life events and may not be accompanied by anxiety and agitation
Bipolar depression results in patient experiencing ____ moods of ____ and ____.
- periodicity of oscillations in mood will vary
- common in ____
- very ____
- genetic similarities to susceptibility to ____ (condition)
Bipolar depression results in patient experiencing ALTERNATING moods of DEPRESSION and MANIA.
- periodicity of oscillations in mood will vary
- common in EARLY ADULTHOOD
- very FAMILIAL
- genetic similarities to susceptibility to SCHIZOPHRENIA (condition)
Monoamine theory states that deficits in ____ neurotransmitters cause ____.
Monoamine theory states that deficits in MONOAMINE (5-HT and NA) neurotransmitters cause DEPRESSION.
State the 5 drug classes used in anti-depressant medications.
- monoamine oxidae inhibitor
- tricyclic antidepressants
- selective serotonin reuptake inhibitor
- noradrenaline reuptake inhibitor
- serotonin and noradrenaline reuptake inhibitor
Name a common monoamine oxidase inhibitor used in clinical practice.
State the MOA of MAO-I.
State the AE of MAO-I
PHENELZINE
MOA = increase biological availability of monoamines by inhibiting breakdown of monoamine by monoamine oxidase
- mao-a - breaks down 5-HT, dopamine, NA
- mao-b - breaks down dopamine and NA
Adverse effects:
1. postural hypotension - due to to sympathetic block produced by accumulation of dopamine in cervical ganglia
2. restlessness and insomnia - due to CNS stimulation
3. DO NOT COMBINE WITH OTHER DRUGS ENHANCING SEROTONINERGIC FUNCTION (eg: PETHIDINE)
State the adverse effects of MAO-I
- postural hypotension - due to sympathetic block caused by accumulation of dopamine in cervical ganglia
- insomnia and restlessness - due to CNS stimulation
- DO NOT COMBINE WITH OTHER DRUGS ENHANCING SEROTONINERGIC FUNCTION (PETHIDINE)
State the action of MAO-B and state the clinical use of MAO-B-I.
MAO-B acts to breakdown monoamines, namely dopamine and NA while sparing 5-HT.
MAO-B-I is used in Parkinson’s disease to increase dopamine availability.
Name some tricyclic antidepressants.
State the MOA of the drug.
State the AE of the drug
Selective for NET (noradrenaline transporter) = DESIPRAMINE
Non-selective for NET/SERT (serotonin transporter) = IMIPRANINE, AMITRIPTYLINE, NORTRIPTYLINE
MOA = tricyclic antidepressants that act at NET/SEERT to inhibit reuptake of 5-HT and NE to increase availability of 5-HT and NE in synaptic cleft
Adverse effects:
1. Antihistamine (H1 histamine-receptor antagonism) = sedation, weight gain
2. Anticholinergic (Muscarinic receptor antagonism) = xerostomia, constipation, blurred vision
3. Alpha-1 adrenoceptor sympathetic block = tachycardia, postural hypotension
C = contraindicated in liver cirrhosis patients
Name some Selective Serotonin Reuptake Inhibitors
State the MOA of the drug.
State the AE of the drug
State some advantages of the drug.
FLUOXETINE, CITALOPRAM
MOA = selectively inhibits 5-HT reuptake to increase 5-HT availability in synapse ‘
Adverse effects:
1. nausea
2. insomnia
3. sedation (citalopram - due to some h1 histamine-receptor antagonism)
4. sexual dysfunction (administer cyproheptadine or other 5-HT blockers to prevent)
5. serotonin syndrome - tremor, hyperthermoa. cardiovascular collapse
Advantages:
1. greater 5-HT reuptake selectivity than TCA
2. fewer AE than TCA
3. Lack of effect at H1 histamine receptor –> less sedation
4. Low affinity for alpha-adrenoceptors –> lack of CVS effect –> safer in overdose
5. Low affinity for muscarinic cholinergic receptor –> less xerostomia, constipation, blurred vision
6. Better tolerance and compliance
Name some Noradrenaline Reuptake Inhibitors
State the MOA of the drug.
State the AE of the drug
State some advantages of the drug.
REBOXETINE
MOA = selective noradrenaline reuptake inhibitor that increases availability of noradrenaline in synapse
Adverse effects:
1. Anticholinergic - xerostomia, constipation, blurred vision
2. Insomnia - due to increased sympathetic activity in CNS
3. Tachycardia - due to increased availability of noradrenaline at sympathetic synapses
Advantages:
1. Greater NA reuptake selectivity than TCA
2. Fewer AE than TCA and SSRI
Name some Noradrenaline Reuptake Inhibitors
State the MOA of the drug.
State the AE of the drug
State some advantages of the drug.
DULOXETINE, VENLAFAXINE, DESVENLAFAXINE
MOA = serotonin and noradrenaline reuptake inhibitors –> increase availability of 5-HT and NA in synapse
Adverse Effects:
1. Nausea
2. Insomnia
3. Sexual dysfunction
4. Serotonin syndrome
5. Withdrawal is stronger than SSRI and TCA
Advantages:
1. Fewer AE than TCA
2. Works faster than other antidepressants
3. Works better in treatment-resistant patients
Name a drug from each of the 5 classes of anti-depressants.
- monoamine oxidase inhibitors (MAO-I) = phenelzine
- tricyclic antidepressants (TCA) = desipramine, imipramine, amitriptyline, nortriptyline
- selective serotonin reuptake inhibitor (SSRI) = fluoxetine, citalopram
- noradrenaline reuptake inhibitor (NARI) = reboxetine
- serotonin and noradrenaline reuptake inhibitor (SNRI) = duloxetine, venlafaxine, desvenlafaxine
