Antidepressants pharmacology

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CONCEPT OF DEPRESSION
&
ANTIDEPRESSANT DRUGS
Noem Dawood
Lecturer
Dow Institute of Nursing And Midwifery ,
DUHS.
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INTRODUCTION OF TEACHER
AND ROLE IN INSTITUTE
Noem Dawood
Lecture – DIONAM,DUHS
RN, Post RN BSN, MSN, PB, Psych
Specialization.
In BSN Semester VI- I will teach and facilitates
mental health nursing theory as well as clinical
rotation in different psychiatric setting at both private
and public sectors hospitals of Karachi .
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AGENDA
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INTRODUCTION OF THE
TOPIC
While no single person can be
credited with the discovery of
depression, there are many
great thinkers whose ideas
contributed—and continue to
contribute—to our growing
knowledge of what this illness
really is .
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MECHANISM OF DEPRESSION AND ANTIDEPRESSANT DRUGS
Subtitle

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DEPRESSION
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MONOAMINE HYPOTHESIS

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MECHANISM OF DEPRESSION
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IMAGE BASE QUESTION
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IMAGE BASE QUESTION
WHAT SPEAKS LEFT AND RIGHT SIDE FACES
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ANTIDEPRESSANTS

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SYNAPTIC TRANSMISSION
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MODE OF ACTIONS
 All antidepressant functions by increasing availability of monoamines (5-HT ,
NA or DA) by one of the following methods
 Presynaptic inhibition of reuptake of 5-HT, NA or DA.
 Antagonist activity at presynaptic inhibitory 5HT or NA receptors which
enhances neurotransmitter release.
 Inhibitions of monoamines oxides, reducing NT breakdown
 Initial regulation of depressive symptoms takes minimum of 2+4 Weeks.
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CLASSIFICATION
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ALL ANTIDEPRESSANTS (EXCEPT MAO'S INHIBITORS) BLOCK
MONOAMINE TRANSPORTER PROTEINS
 Serotonin transporter (SERT)
 Norepinephrine Transporter (NET)
 Dopamine Transporter (DAT)
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PLASMA MEMBRANE MONOAMINE TRANSPORTERS: STRUCTURE,
REGULATION AND FUNCTION
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ANTIDEPRESSANT
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TCA'S ANTI HAM EFFECTS
 TCAs Inhibit axonal reuptake of NA and 5HT in neurons –and increase concentration of these
neurotransmitters in brain.
 Classification of TCAs
 Potent anti cholinergic, more sedative.
 Imipramine
 Clomipramine
 Amitryptyline
 Less Sedative
 Desipramine
 Amoxapine
 Nortriptyline
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TRICYCLIC ANTIDEPRESSANT TOXICITY
 Fatal in toxicity
 Most important toxic effect is
 Slowing od depolarization of the cardiac action potential by blocking fast
sodium channels (Quinidine- like effect)
 Delays propagation of depolarization through both myocardium and
conducting tissue
 Cardiac arrhythmias
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USE OF TRICYCLIC ANTIDEPRESSANT
 Tricyclic antidepressant are approved by the food and drug administration
(FDA) for treating
 Several types of depression , (Primary drug for depression)
 OCD ( Primary SSRIs)
 Bedwetting (nocturnal enuresis)
 Imipramine at low dose.
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MONOAMINE OXIDASE INHIBITORS
 Monoamine Oxidase Inhibitors (MAOIs) are a class of powerful
antidepressant drugs. They are particular effective in treating
atypical depression, panic disorders, social phobia.
 Due to potentially lethal dietary and drug integrations , MAOIs had
been reserved as a last line of Rx, used only when other classes
of antidepressant drugs (eg. SSRIs and TCAs) have failed
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MONOAMINE OXIDASE?
 MAO is a mitochondrial enzyme found in most tissue; liver, gut (presynaptic
nerves)
 The enzyme is responsible for the degradation of monoamine
neurotransmitters
 There are two forms of monoamine oxidase.
 MAO-A and MOA-B
 MAO-A is responsible for NE, 5-HT and Tyramine metabolism
 MAO-B is more selective for dopamine metabolism
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QUESTION TIME
 Anti depressant having both high sedative and high anticholinergic
activity
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SSRI BLOCK REUPTAKE OF SEROTONIN INTO PRESYNAPTIC NEURON
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OTHER INDICATOIN FOR SSRI
 Sertraline
 Fluoxetine
 Citalopram
 Escitalopram
 Paroxetine
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SELECTIVE SEROTONIN REUPTAKE INHIBITORS
ADVERSE DRUG REACTIONS
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SELECTIVE SEROTONIN REUPTAKE INHIBITORS
ADVERSE EFFECT
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HALF-LIVES OF THE SSRI
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 ___________ has the lower risk of causing an
SSRIs discontinuation syndrome?
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 Venlafaxine
 Desvenlafaxine
 Duloxetine
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SEROTONIN /NE REUPTAKE INHIBITORS
 Selectively inhibit the reuptake of both serotonin and NE
 SNRIs unlike the TCAs, have no activity at adrenergic
,muscarinic, or histamine receptors and thus have fewer side
effects than the TCAs.
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ATYPICAL ANTIDEPRESSANT
 Bupropion (DAT+NET)
 Nicotine withdraw and smoking
 Mirtazapine (Alpha2 Antagonist & 5HT2A)
 Antihistamine
 Trazodone (SERT+5HT2A)
 Anti alpha 1, Antihistamine
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Noem Dawood
Noem.dawood@duhs,edu.pk
DIONAM-DUHS
+92 343 3057812