MAOIs SSRIs TCAs

1. Overview on
pharmacological
management of
depression
By: ph. Abeer abd elrahman

2. What is depression?
•Depression is a state of low mood that
can affect a person's thoughts,
behavior, feelings, and sense of well-
being.
•It's caused mainly by deficiency in
some neurotransmitters in the brain or
more specifically in the synaptic cleft
like nor-epinephrine and serotonin.

3. Types of depression:
• A) major depression
• B) bipolar depression
mood episodes that range from extremes of high energy
with an "up" mood to low "depressive" periods.
Traditional antidepressants are not always recommended
as first-line treatments for bipolar depression

4. At the beginning we should know how
a nervous signal is transmitted
through nervous cells:
• Nervous action potential is transmitted from the
axon of one nerve cell to the dendrimers of the
next nerve cell via chemical signals mediated by
neurotransmitters such as nor-epinephrine,
serotonin and dopamine

5. • after doing their action by docking to receptors
of the next nerve cell they undergo two
processes:
a) Broken down by mono amine oxidase enzyme
b) Are reuptaken back into nerve cells
• So the idea of treating the deficiency of nor-
epinephrine and serotonin (depression) is by
acting on these two mechanisms

6. Major lines od pharmacological ttt

7. 1) mono-amine-oxidase inhibitors
MAOI
• Monoamine oxidase inhibitors are drugs inhibiting the
action of mono-amine-oxidase enzyme (MAO) which is
responsible for the breakdown of nor-epinephrine and
serotonin so increase their amount and action in the
synaptic cleft

8. There are two forms of monoamine
oxidase enzyme
(MAO-A)
•tyramine
•norepinephrine
•serotonin
•dopamine
(MAO-B)
•dopamine

9. Examples for available MOAI in the
markets:
non-selective
MAOI
• Phenelzine
• Tranylcypromine
(Parnetil)
Selective MAO-A I
•No longer
commercially
available
Selective MAO-
B I
•Rasagiline
(parkintreat)
•Selegiline
(parkineast)

10. Atypical MAOIs:
• Linezolid (averzolid) is an antibiotic drug with weak
MAO-inhibiting activity.
• Methylene blue (provay blue), the antidote indicated
for drug-induced methemoglobinemia (hemoglobin that
contains the ferric [Fe3+] form of iron) is a highly
potent, reversible MAO inhibitor.

11. side effects of MOAI:
• it increases the level of many neurotransmiiters
1) Increase
sympathetic tone
(HTN,TACHYCARDI
A)
2) Atropine like
action

12. Hypertensive crisis
• The intake of non-selective MAOI Increases NE, EPI and
tyramine which are excitatory NT Alone not a big deal
• The problem happens with the intake of tyramine containing
food as aged cheese, smoked or proccessed meat

13. 2) Tricyclic antidepressants (TCAs):
• They act by inhibiting reuptake of nor-epinephrine and
serotonin by blocking the transporters responsible for
reuptake of these neurotransmitters.

14. •This inhibition elevates the concentration
of neurotransmitters in the synapses and
triggers further neurotransmission.
• Tricyclic antidepressants are used to treat
depression, bipolar disorder, anxiety,
obsessive-compulsive disorder and other
mood disorders.
•They are also effective as analgesics so are
used to treat chronic pain and used for
migraine prophylaxis.

15. Examples for available TCAs :
• Anafranil generic name: clomipramine
• tryptizol generic name: amitriptyline
• Tofranil generic name: imipramine
• Main side effects: Urinary retention so it has off lable
use in treatment of nocturnal enuresis.
•

16. 3) Selective serotonin reuptake
inhibitors(SSRI):
• Unlike TCA, SSRIs are believed to increase the
extracellular level of the serotonin specifically by
limiting its reabsorption into the presynaptic cell

17. Examples for SSRIs:
• Citalopram citalo, depram
• Escitalopram cipralex, citapronex
• Fluoxetine prozac, depreban
• Fluvoxamine faverin
• Paroxetine seroxat, cetralin
• Sertraline lustral, moodapex, deprestat

18. Cautions:
•Not recommended for bipolar depression.
•Not used less than 6 months
•Should be withdrawn gradually to avoid
withdrawal symptoms (rebound
depression).
•Withdrawal regimen is to decrease doses
each dose reduction for 2 weeks at least.

19. SSRIs
• Longest t1/2 (1week).
• For patients with problems with dose remembering.

20. • One of the safer SSRi for pregnant and breast feeding.
• Taken after meals due to gastric upsets

21. • The most rapidly absorbed SSRI so used in acute
depression.

22. • Highly tolerable and less interacting SSRI.
• Not for below 18 YO

23. • The active form of citalopram
• The most tolerable the most safe the least interacting.
• used for 12 YO and older

24. • FDA approved for obsessive compulsive disorder (OCD)
•

26. References:
• https://www.webmd.com/depression/guide/depression-
types#2-4
• https://www.researchgate.net/figure/Physiological-
functions-of-MAO-and-types-of-MAO-inhibitors-with-their-
drawbacks-and_fig2_279306450
• https://www.youtube.com/watch?v=pGEQILM7C7Y
• https://www.drugs.com/drug-class/tricyclic-
antidepressants.html
• http://www.mayoclinic.org/diseases-
conditions/depression/in-depth/maois/art-20043992
• https://www.youtube.com/watch?v=l8pObJTzRzY