First things first
Depression is a medical condition & not any fault of the
Assessment & evaluation is mandatory-Severity, etiology
Treatment plan comprises of medication, psychological &
Moderate-Severe, Atypical, SAD, Depressive episode of
GAD, Panic Disorder, Social Anxiety, Adjustment disorders,
Agoraphobia, OCD, PTSD.
Mode of action
All antidepressants function by increasing availability
of monoamines (5-HT, NA or DA) by one of the
Presynaptic inhibition of reuptake of 5-HT, NA or DA.
Antagonist activity at presynaptic inhibitory 5HT or NA
receptors which enhances neurotransmitter release.
Inhibition of Monoaminase oxidase, reducing NT
Increasing availability of NT precursors.
Initial resolution of depressive symptoms takes minimum
of 2-4 weeks.
Arrhythmias & ECG
Cardiac function, LFTs,
Should be used
cautiously in elderly.
SNRIs (Serotonin-norepinephrine reuptake
Mechanism: Similar to SSRI, Inhibit 5HT & NA (high doses DA)
Indications: GAD, Depression.
Duloxetine (Oxcym DR, Hapibar, Lyta)
Tramadol (Tramal, Ultram)
Sibutramine (Meridia, Reductil)
Side-effects: Similar to SSRIs & may cause HTN.
MAOIs (Monoamine oxidase inhibitors)
Irreversible inhibition of MAO-A
(acts on NA, DA, 5HT & Tyramine) &
MAO-B (acts on DA, Tyramine,
leading to accumulation of
monoamines in Synaptic Cleft.
RIMAs: Reversible inhibition
Other disorders: panic disorder with agoraphobia,
social phobia, bulimia, PTSD, borderline personality
disorder, and bipolar depression.