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DEPRESSION
Types
Symptoms
Diagnosis
Causes
Treatment
TYPES OF DEPRESSION
Major depression
Chronic depression (Dysthymia)
Atypical depression
Bipolar disorder/Manic depression
Seasonal depression (SAD)
SYMPTOMS
DIAGNOSIS
Extensive patient and family history
Blood test for hypothyroidism
Current medication
DSM-IV
One
CAUSES OF DEPRESSION
Genetics
Death/Abuse
Medications
SSRIs
MAOIs
TCAs
SNRIs
NDRIs
TeCAs
History
Isoniazid
Iproniazid
Current Drugs
Mechanism of Action
Side Effects
Isoniazid
Iproniazid
(Nardil)
Tranylcypromine (Parnate)
Isocarboxazid (Marplan)
(Emsam)
High
TRICYCLIC ANTIDEPRESSANTS
(TCAS)
History
Imipramine
Current Drugs
Mechanism of Action
Side Effects
Imipramine
Increased
LDH leakage
Slow cardiac conduction
with
persons with bipolar
disorder or manic depression
TETRACYCLIC ANTIDEPRESSANTS
(TECAS)
Current Drugs
Mirtazapine
Mechanism of Action
Same
(Remeron)
as TCAs
Side Effects
Serotonin
Fluoxetine 1:1
Sertraline
Brain
zaps
Sexual dysfunction
SEROTONIN-NOREPINEPHRINE
REUPTAKE INHIBITORS (SNRIS)
Slightly greater efficacy than SSRIs
Slightly fewer adverse effects than SSRIs
Current drugs
Venlafaxine
(Effexor)
Duloxetine (Cymbalta)
Mechanism of Action
Very
similar to SSRIs
Works on both neurotransmitters
Side effects
Similar
Suicide
to SSRIs
Venlafaxine 1:1
Duloxetine
NOREPINEPHRINE-DOPAMINE
REUPTAKE INHIBITORS (NDRIS)
Current drugs
Bupropion
(Wellbutrin)
Mechanims of Action
Similar
Adverse effects
Lowers
Suicide
Does
Bupropion 1:1
seizure threshold
ASSIGNED READING
Optional Reading:
Wong, David T.; Perry, Kenneth W.; Bymaster, Frank P. Case
History: The Discovery of Fluoxetine Hydrochloride (Prozac).
Nature Reviews Drug Discovery (2005), 4(9), 764-774.
Krishnan, K. Ranga. Revisiting monoamine oxidase inhibitors.
Journal of Clinical Psychiatry (Memphis, TN, United States)
(2007), 68(Suppl. 8), 35-41.
HOMEWORK QUESTIONS
1.
2.
3.
Illustrate how the TCAs and SSRIs might resemble the monoamine
neurotransmitters, providing one example of each class of antidepressant.
REFERENCES
http://ajp.psychiatryonline.org/cgi/reprint/157/11/1901
http://www.webmd.com/depression/
http://pn.psychiatryonline.org/content/41/24/21.full
http://www.mayoclinic.com/health/maois/MH00072
http://www.springerlink.com/content/b9b8668ff59f89d7/fulltext.pdf
http://www.emsam.com/pi_emsam.pdf
http://www.nevdgp.org.au/info/topics/depression_theory.htm
http://www.uspharmacist.com/content/t/psychotropic_disorders/c/11467/
http://www.jbc.org/content/284/15/10276.full.pdf+html
http://www.aafp.org/afp/981200ap/cadieux.html
http://www.mayoclinic.com/health/antidepressants/MH00071
http://books.google.com/books?
id=R0W1ErpsQpkC&pg=PA565&lpg=PA565&dq=tcas+mechanism+of+action&source=bl&ots=oASl
e2Zpr&sig=36CB_3JY4uD3LIYvqXWmAb3nliY&hl=en&ei=HzfFS9OrB4Tu9gTD6_ixDg&sa=X&oi=bo
ok_result&ct=result&resnum=8&ved=0CCoQ6AEwBw#v=onepage&q=tcas%20mechanism%20of
%20action&f=false
http://www.informaworld.com/smpp/content~content=a916036122&db=all