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At least 5 of the following symptoms for 2 weeks (criteria 1 or 2 essential): 1. Depressed mood. 2. Loss of interest or pleasure. 3. Significant weight loss or gain. 4. Insomnia or hypersomnia. 5. Psychomotor agitation or retardation. 6. Fatigue or loss of energy. 7. Feelings of worthlessness or excessive guilt. 8. Impaired thinking or concentration; indecisiveness. 9. Suicidal thoughts/thoughts of death.
Depression
Likely cause: inadequate monoamine levels Treatment :
Blocking NT reuptake by presynaptic end
Antidepressants
Used to relieve symptoms of depression as well as help patients with anxiety disorders Major groups:
1) 2) 3) 4) 5) Tricyclic antidepressants Heterocyclic antidepressant Selective serotonin reuptake inhibitors Monoamine oxidase inhibitors Atypical antidepressants
Antidepressants
They now have recognised roles in the treatment of generalized anxiety disorder, panic disorder, obsessive compulsive disorder, social phobia, bulimia nervosa, chronic pain and Nocturnal enuresis (Imipramine)
Antidepressants
On balance, the selective serotonin reuptake inhibitors (SSRIs) and other newer antidepressants may be better tolerated and have a wider safety margin than the tricyclic antidepressants (TCAs) and irreversible nonselective monoamine oxidase inhibitors (MAOIs).
Antidepressants
A delay in onset of antidepressant response of at least 1 to 2 weeks occurs with all antidepressants.
Antidepressants
Tricyclic Antidepressants (TCAs):
Prototype = Imipramine Mechanism of Action:
Block neuronal reuptake of norepinephrine and serotonin which intensifies their effects Uses: Depression, bipolar disorder, Considerations: Initial responses develop in 1-3 weeks; maximal responses over 1 to 2 months.
Antidepressant Mechanism
TCAs & SSRIs Block Here
Heterocyclic antidepressant
Second generation antidepressant (e.g., Amoxapine, bupropion, maprotiline, trazodone) and newer, third generation drugs (duloxetine, mirtazapine, nefazodone, venlafaxine). It has less cardiovascular and anticholinergic adverse effects than the TCAs and has a wider margin of safety in overdose.
Antidepressants
Selective Serotonin Reuptake Inhibitors (SSRIs):
Most commonly prescribed group of antidepressants As effective as TCAs but do not cause hypotension, sedation, or anticholinergic effects (dry mouth, blurred vision, photophobia, constipation, urinary hesitancy, tachycardia). Use: major depression/ Prototype = Fluoxetine (Prozac) Mechanism of action:
Produces selective inhibition of serotonin reuptake Blockade of transmitter uptake occurs quickly, therapeutic effects are the result of adaptive cellular changes that take place in response to prolonged uptake blockade
Antidepressants
Monoamine Oxidase Inhibitors (MAOIs):
Most dangerous: risk of triggering hypertensive crisis by eating foods rich in tyramine. MAO is an enzyme found in the liver, the intestinal wall, and terminals of monoamine-containing neurons. Their function is to convert NE, serotonin, and dopamine into inactive products. MAO inhibitors block this process. Uses: depression, bulimia, obsessive-compulsive disorder, reduce panic attacks Caution: many drug interactions
Antidepressant Mechanism
TCAs & SSRIs Block Here
Antidepressants
Atypical Antidepressants:
Bupropion (Wellbutrin) Bupropion is an antidepressant which inhibits neuronal reuptake of dopamine and is a noncompetitive nicotine antagonist at nicotinic cholinergic receptors.
Adverse effects include nausea, rashes, facial swelling, insomnia and dry mouth. Contraindicated in patients with a seizure disorder; bulimia or anorexia nervosa; monoamine oxidase inhibitor treatment in the previous 14 days
Antidepressants Agents
TCAs
imiprimine (Tofranil) amitriptyline (Elavil) nortriptyline (Pamelor )
MAOIs
phenelzine (Nardil) Moclobemide Second generation antidepressant (eg, Amoxapine, bupropion, maprotiline, trazodine and newer, third generation drugs (duloxetine, mirtazapine, nefazodone, venlafaxine).
SSRIs
fluoxetine (Prozac) paroxetine (Paxil) sertraline (Zoloft) Fluvoxamine