This document discusses anti-depressant drugs used to treat depression. It outlines that depression affects 17% of people worldwide and will be the second most common disease by 2020. It describes the typical symptoms of depression and two main theories for its pathophysiology. It then discusses the modes of action and effects of different classes of anti-depressants including TCAs, SSRIs, MAOIs, SNRIs, and 5-HT2 antagonists. For each class it provides examples of drugs, how they work, their indications, adverse effects, and contraindications.

1. CENTRAL NERVOUS SYSTEM
Dr. Nadeem akhtar
MBBS.M.Phil
Asst. Professor Pharmacology
Amna Inayat Medical College
Shaikhupura

2. ANTI-DEPRESSANTS
Drugs which are prescribed
to relieve depression

3. Depression
• Low mood
• Depressed feelings
• Lonely living
• Lack of energy
• Other physical problems

4. • 17 % world wide prevalence
• 4 th number in the list of 10 world wide
common diseases ,noted by WHO
• This will be on second number in 2020

5. Typical pic of depressed individual

6. Pathophysilogy
• 1. Amines hypothesis
• 2.Neurotrophic hypothesis

7. Physical or Pharmacological treatment
• A)Trycyclic antidepressants (TCAs)
• Imipramine
• Clomipramine
• Amitriptyline

8. Mode of action
• They inhibit re-uptake mechanisms
• Terminate synaptic actions of NE & 5-HT in the
brain

9. Effects
• A.N.S
• produce anticholinergic actions
• C.V.S
• Ventricular dysrythmias
• Hypertension (rarely)

10. Drug interactions
• Antagonize the centrally acting drug
antihypertensive agents e.g Clonidine
• If given with MAOS, patient develop severe
hypertension

11. Indications
• Major depressive disorder (MDD)
• Panic disorder (PD)
• Obsessive compulsive disorder (OCD)
• Enuresis
• Chronic fatigue
• Diabetic neuropathy
• Eating disorders

12. Adverse effects
• Dryness of mouth
• Constipation
• Tachycardia
• Blurring of the vision
• Retention of urine
• Postural hypotension
• Sedation
• Weight gain
• Tremors
• Sexual problems

13. Contra-indications
• Glaucoma
• Pregnancy
• Benign prostate hypertrophy (BPH)

14. Selective serotonin reuptake inhibitors
(SSRIs)
• Fluxetine
• Citalopram
• Escitalopram
• Paroxitine

15. Mode of action
• Highly selective on 5-HT receptors
• Minimal inhibitory effect on NE transporters
or blocking actions on adrenergic or
cholinergic receptors

16. Adverse effects
• Minimal anticholinergic action and mild
constipation
• Suicidal ideation with long term use
• Erectile dysfunction

17. Monoamine oxidase inhibitors
• Phenalzine
• tranylcypromine

18. Mode of action
• Increase amine level by interfering their
• metabolism at nerve endings and
• increasing storage of NE & 5-HT

19. usage
• Indicated when other treatment fail
• Dangerous drug-drug or drug & food
interactions can develop

20. Serotonin-norepinephrine reuptake
inhibitors (SNRIs)
• Venlafaxine
• Duloxetine
• Milancipran

21. 5-HT2 Antagonists
• Trazodone
• Nefazodone