Pharmacological management of
Depression
Classes of Drugs Used
-

SSRIs
SNRIs
TCAs
MAOIs
Atypical antidepressants
Agomelatine
Mechanism of Action : Inhibits the reuptake of serotonin from
synapse ; it takes (4-6 weeks) to see clinical effects, imme...
True Or False
- A Psychiatric prescribed Fluoxetine and
Isocarboxazide for a depressed Patient to get
the best outcomes.
-...
Mechanism of Action : Inhibits the reuptake of
serotonin and Norepinephrine from the
synapse.
Therapeutic Uses : Depressio...
Mechanism of Action : Inhibit reuptake of serotonin and NE ,
after chronic administration : increase in sensitization of 5...
Guess what will happen
- A depressed alcoholic came to the out-patient
clinic , the attending doctor prescribed
imipramine...
Mechanism of Action : Non –selective inhibition of MAO.
Therapeutic Uses : Depression .
Examples : Isocarboxazide , Phenel...
Bupropion
Nefazodone
Trazodone
Mirtazapine
- Melatonin receptor agonist , 5-HT2C receptor antagonist
- Do not use it with dementia
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Presentation week 8

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Presentation week 8

  1. 1. Pharmacological management of Depression
  2. 2. Classes of Drugs Used - SSRIs SNRIs TCAs MAOIs Atypical antidepressants Agomelatine
  3. 3. Mechanism of Action : Inhibits the reuptake of serotonin from synapse ; it takes (4-6 weeks) to see clinical effects, immediate action : increase in S. level in synapse , later action : down regulation of presynaptic inhibitory receptors. Therapeutic Uses : first line of drugs in Depression. Examples : Fluoxetine , paroxetine , Fluvoxamine , Sertraline , Trazodone , Nefazodone Adverse effects : Nausea , sexual dysfunction -- > what drug to you give to these Pt.s?, Insomnia , Drowsiness , Anxiety. Important to know : - Fluoxetine has a long half life ? And an active metabolite which is ? - Fluoxetine , paroxetine inhibit CYP-450 2D6 - CAN NOT GIVE THEM WITH MAO inhibitors - Serotonin syndrome + Discontinuation syndrome
  4. 4. True Or False - A Psychiatric prescribed Fluoxetine and Isocarboxazide for a depressed Patient to get the best outcomes. - Paroxetine didn’t work with a Patient. The doctor immediately replaced it with Sertraline. - Bupropion was described to a depressed Patient as Fluoxetine was going to worsen his sexual dysfunction.
  5. 5. Mechanism of Action : Inhibits the reuptake of serotonin and Norepinephrine from the synapse. Therapeutic Uses : Depression that is accompanied with physical pain ( what is this pain called? And why these drugs work? ) Examples : Tricyclic Antidepressants , Venlafaxine , Duloxetine. Adverse effects : little adverse effects ,, why ?
  6. 6. Mechanism of Action : Inhibit reuptake of serotonin and NE , after chronic administration : increase in sensitization of 5-HT receptors. It acts on adrenergic , muscarinic and histamine receptors Therapeutic Uses : Major depression , Bipolar affective disorder, Enuresis , ADHD ( what other drug used ? What its action ?) , Anxiety disorder , Chronic pain. Examples : Imipramine , Desiipramine , Protryptyline , Nortryptyline , Amytryptyline Adverse effects : Atropine like side effects , sedation , weight gain , cardiac toxicity, orthostatic hypotension
  7. 7. Guess what will happen - A depressed alcoholic came to the out-patient clinic , the attending doctor prescribed imipramine for his depression ? - A lady with bipolar was sent to a psychiatric to treat her depression , He prescribed her Desipramine ?
  8. 8. Mechanism of Action : Non –selective inhibition of MAO. Therapeutic Uses : Depression . Examples : Isocarboxazide , Phenelzine , Tranylcypromine. Adverse effects : Interaction with tyramine . Explain what happens ?
  9. 9. Bupropion Nefazodone Trazodone Mirtazapine
  10. 10. - Melatonin receptor agonist , 5-HT2C receptor antagonist - Do not use it with dementia

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