Symposium

1. BY DR SUBHAYAN DAS
DEPT OF PHARMACOLOGY
MIDNAPORE MEDICAL COLLEGE
08-04-2020
ANTI-PSYCHOTIC AND
ANTIDEPRESSANT DRUGS

2. PSYCHIATRIC ILLNESS
PSYCHOSIS
( INSIGHT ABSENT)
NEUROSIS
( INSIGHT  PRESENT)
MAJOR PSYCHOSIS/
PSCHIZOPHRENIA
GENERALISED ANXIETY
DISORDER
MOOD DISORDERS : PHOBIA
A) MANIA OBSCESSIVE COMPULSIVE
DISORDER
B) DEPRESSION BULIMIA
C) MANIC DEPRESSIVE
PSYCHOSIS
POST TRAUMATIC STRESS
DISORDER

3. ANTI- PSYCHOTIC DRUGS
 MAINLY ARE OF TWO MAJOR TYPES
 BASED ON D2# PROPERTY( D2/5HT2 # RATIO)
 TYPICAL ANTI-PSYCHOTIC DRUGS
STRONG D2
BLOCKERS
• HALOPERIDOL
• DROPERIDOL
INTERMEDIATE D2
BLOCKERS
• THIOTHIXENE
• CHLORPROTHEXINE
WEAK D2 BLOCKERS
• CHLORPROMAZINE
• THIORIDAZINE

4. EXTRA PYRAMIDAL
SIDEEFFECTS
 DYSTONIA EARLIEST
 AKATHISIA MOST COMMON
EXTRAPYRAMIDAL SYMPTOM ( DOC-
PROPRANOL)
 PARKINSONISM ( DOC- BENZHEXOL)
 TARDIVE DYSKINESIA LATEST
 MALIGNANT NEUROLEPTIC SYNDROME (
DOC- DANTROLENE).
 Highest risk of EPS: HALOPERIDOL

5. OTHER SIDE EFFECTS
 HYPERPROLACTINEMIA
 DRYNESS OF MOUTH
 BLURRING OF VISION
 URINARY RETENTION
 HYPOTENSION
 SEDATION
 PREDISPOSES TO SEIZURES

6. ATYPICAL ANTIPSYCHOTICS
LESS SIDE EFFECTS AND EFFECTIVE AGAINST NEGATIVE
SYMPTOMS
CLOZAPINE RISPERIDONE
OLANZAPINE PALIPERIDONE
QUETIAPINE ZIPRASIDONE
ZOTEPINE LURASIDONE

7. SIDE EFFECTS OF ATYPICAL
ANTIPSYCHOTICS
 HYPERGLYCEMIA
 HYPERLIPEDEMIA
 WEIGHT GAIN
 INSULIN RESISTANCE
 AGRANULOCYTOSIS ( DOSE-INDEPENDENT)(
CLOZAPINE)
 MYOCARDITIS ( CLOZAPINE)
 SEIZURES( DOSE-DEPENDENT)
 MYOCARDITIS
 PROLONGED QT INTERVAL ( ZIPRASIDONE)

8. NEWER DRUGS
 PIMAVANSERIN: BLOCKS 5HT2 RECEPTORS.
APPROVED FOR TREATMENT OF PSYCHOSIS
IN A PATIENT OF PARKINSONISM.
 BREXANOLONE: NEUROSTERIOD.
APPROVED IN TREATMENT OF POST-PARTAM
PSYCHOSIS.

9. OTHER USES OF
ANTIPSYCHOTICS
 ANTI-EMETIC DRUG ( PROCHLORMAZINE)
 ANTI-MANIC DRUG
 HUTINGTON’S CHOREA
 TICS DISORDER( HALOPERIDOL)

10. DEPRESSION: OVERVIEW
 DEFICIENCY OF MONOAMINES IN THE BRAIN
CAUSES DEPRESSION.
 MONOAMINES ARE 5HT> NA> DA.
 MOA: MONOAMINES BRAIN DERIVED
NEUROTROPHIC FACTOR NEURONAL
PLASTICITY PREVENTS DEPRESSION.

11. ANTIDEPRESSANT DRUGS
 TYPICAL ANTIDEPRESSANTS: ( Increases 5HT
mainly)
 ATYPICAL ANTIDEPRESSANTS: ( Other
mechanism).
 TYPICAL ANTIDEPRESSANTS: TWO TYPES
MAO A INHIBITORS AND REUPTAKE
INHIBITORS
 REUPTAKE INHIBITORS : TWO TYPES
SELECTIVE AND NONSELECTIVE.
 NON-SELECTIVE REUPTAKE INHIBITORS :
TRICYCLIC ANTIDEPRESSANTS AND
SEROTONIN- NORADRENERGIC REUPTAKE

13. CONT.......
MAO-A
INHIBITORS
TRICYCLIC
ANTIDEPRE
SSANTS(TC
A)
SNRIs SSRIs ATYPICAL
ANTIDEPRE
SSANTS
MOCLEBEMI
DE
IMIPRAMINE VENLAFAXIN
E
FLUOXETIN
E
BUPROPION
DESIPRAMIN
E
DULOXETIN
E
PAROXETIN
E
AMINEPTIN
CLOMIPRAM
INE
MILNACIPRA
N
FLUVOXAMI
NE
TIANEPTIN
AMITRIPTYLI
NE
DESVENLAF
AXIN
CITALOPRA
M
AMOXAPINE
NORTRYPTI
LINE
LEVOMILNA
CIPRAN
ESCITALOP
RAM
ATOMOXETI
NE

14. NEWER ANTIDEPRESSANTS
 ESKETAMINE: S-ISOMER OF KETAMINE.
 MOA: NMDA RECEPTOR BLOCKER
 USED AS NASAL SPRAY FOR TREATMENT OF
DEPRESSION.
 BREXANOLONE/ ALLOPREGNENOLONE:
NEUROSTEROID
 USED IN POST PARTUM DEPRESSION.

15. LITHIUM ( SALIENT FEATURES)
 USED FOR TREATMENT OF BIPOLAR
DISORDER.
 DIFFERENT MOA FOR MANIA AND
DEPRESSION
 NARROW THERAPEUTIC INDEX
 PL LEVEL OF LITHIUM: Acute 0.8-1.2 meq/l ,
Prophylaxis 0.5-0.8 meq/l, Toxic >2 meq/l.
 SIDEEFFECTS: Leucocytosis, Tremor,
Hypothyroidism, Poly uric renal failure.
 CONTRAINDICATED IN PREGNANCY: Ebstein’s
Anomaly.

16. Mechanism of Action( Lithium)
 MANIA: It prevents the overactivity of
neurotransmitters in the brain . It prevents
recycling of PIP2 by causing inhibition of
phosphatase enzyme and thus blocks
excitotoxicity of neurotransmitters.
 DEPRESSION: Increases the level of
monoamines in the brain and thus increases the
level of BDNF , which maintains neuronal
plasticity( establishment of connections between
neurons).

17. Thank you all...........