Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems .

1. Presented by Zuhaib Akhtar Baloch
Student of Pharm-D 5th Semester
From University of Balochistan sub Campus Mastung

2. Index
• Defination of depression
• Types of depression
• Pathophysiology of depreseion
• Symptoms of depression
• Factors effecting depression
• Neurotransmittor and depression
• Treatment of depression
• SSRIs drugs their side-effects , Contraindication and MoA
• SNRIs drugs their side-effects , Contraindication and MoA
• TCAs drugs their side-effects , Contraindication and MoA
• MAOIs drugs their Side-effects , Contraindication and MoA
• Motivational Quotes
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3. Depression
Depression is an unipolar or Bipolar
dis-order Which is a serious medical
condition in which a person feels very
Sad, hopeless,and unimportant and
often is unable to Live in a normal way
.
1. Uni-polar
2. Bi-polar
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4. Difference b/w unipolar and bipolar depression
Unipolar Depression
+ Also known as major depressive
disorder(MDD) or clinical depression,
The main pathophysiology of unipolar
depression includes an imbalance of
the brain chemicals known as
dopamine, norepinephrine, and
serotonin. A positive family history
and social issues such as poverty and
lack of support are also known to
have a major influence in this
condition. Patients affected by
Unipolar depression indicate extreme
levels of depressed mood, loss of
interest and pleasure, irritability for
most parts of the day.
Bipolar Depression
+ Bipolar depression is defined as
one of the two characteristic
phases of the condition known
as Manic depression, which is
defined as the change of
emotional or behavioral patterns
of an individual in contrast to his
normal or typical baseline
personality. In fact, these
hypomanic episodes, usually
lasting for days to weeks will be
alternating with periods
of mania.
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6. Pathophysiology of Depression :
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7. The pathophysiology of depression is unknown. However, the modified
biogenic amine theory is the most commonly accepted hypothesis. In
this theory, chronic dysregulation of the neurotransmitter systems (5-
HT, NE, and/or DA) occurs. As an example, the graphic focuses only
on serotonergic activity, but this same situation probably occurs for
other neurotransmitters.
Note that serotonergic activity can be altered by different
mechanisms. First there can be a depletion in the 5-HT supply due to
diet without tryptophan, a decrease in production of neurotransmitters
or a decrease in the amount of 5-HT released per nerve impulse. Also
an increased inhibition by pre-synaptic receptors can decrease
neurotransmitter release. So, decreased amounts of 5-HT in the
synaptic cleft lead to decreased activity of the postsynaptic receptors
and thus decreased signal transmission leading to symptoms of
depression. The postsynaptic cells try to compensate this decreased
activity by up-regulating postsynaptic 5-HT receptors.
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8. + The physiological result of the decreased receptor
activities can be determined by examining the neuronal
systems. Serotonin’s cell bodies are located in the
midbrain Raphe, and it's neurons project to the:
1. frontal cortex where they may have important
regulatory functions for mood
2. limbic areas where they may modulate emotions,
particularly anxiety
3. basal ganglia where they may regulate movements
4. hypothalamus where they can regulate eating, appetite,
weight, the sleep-wake cycle and sex drive
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9. + Norepinephrine’s cell bodies are located in the
locus coeruleus, and it's neurons project to the:
1. frontal cortex to regulate mood, cognition and
attention
2. limbic areas to regulate emotions and anxiety
3. hypothalamus for regulation of eating, appetite,
weight, sex drive, and pleasure
4. cerebellum which may modulate motor movements
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10. Symptoms of Depression :
Some following symptoms you might have are:
+ Loss of interest or pleasure in your activities
+ Weight loss or gain
+ Trouble getting to sleep or feeling sleepy during the day
+ Feelings restless and agitated, or else very sluggish and slowed
down physically or mentally
+ Being tired and without energy
+ Feeling worthless or guilty
+ Trouble concentrating or making decisions
+ Thoughts of suicide
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13. • Biological factors : If one of your family members has a
mood disorder like depression, you are much more likely to
develop one yourself. Even other mental illnesses, like
schizophrenia or alcoholism, increase your risk of developing
depression.
• Psychological factors: stressful or negative life events,
like death in the family, divorce, or loss of a job, often trigger
depression. When you experience trauma or stress consistently
and chronically, you are much more likely to have depression..
• Behavioral factors: increases in alcohol consumption or
drug use can lead to the development of depression and can often
make symptoms worse .
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14. • Social factors: Lack of social support, like
meaningful relationships with peers or family, is
associated with symptoms of depression .
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16. + Antidepressants are medications that can help relieve
symptoms of depression, social anxiety disorder, anxiety
disorders, seasonal affective disorder, and dysthymia,
or mild chronic depression, as well as other
conditions.They aim to correct chemical imbalances of
neurotransmitters in the brain that are believed to be
responsible for changes in mood and behavior.
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17. SSRIs :
+ Selective serotonin reuptake inhibitors (SSRIs) are the most
commonly prescribed antidepressants. They are effective in
treating depression, and they have fewer side effects than the
other antidepressants.
+ SSRIs block the reuptake, or absorption, of serotonin in the
brain. This makes it easier for the brain cells to receive and
send messages, resulting in better and more stable moods.
+ They are called "selective" because they mainly seem to affect
serotonin, and not the other neurotransmitters.
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18. Mechanism of Action
+ SSRIs ease depression by increasing
levels of serotonin in the brain.
Serotonin is one of the chemical
messengers (neurotransmitters) that
carry signals between brain cells.
SSRIs block the reabsorption
(reuptake) of serotonin in the brain,
making more serotonin available.
SSRIs are called selective because
they seem to primarily affect
serotonin, not other
neurotransmitters.
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19. Mechanism of action
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20. + Citalopram (Celexa)
+ Escitalopram (Lexapro)
+ Fluoxetine (Prozac)
+ Paroxetine (Paxil, Pexeva)
+ Sertraline (Zoloft)
+ Vilazodone (Viibryd)
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21. Side effects of SSRIs :
Possible side effects of SSRIs may include, among others:
+ Drowsiness
+ Nausea
+ Dry mouth
+ Insomnia
+ Diarrhea
+ Nervousness, agitation or
restlessness
+ Dizziness
+ Sexual problems, such as
reduced sexual desire or
difficulty reaching orgasm
or inability to maintain an
erection (erectile
dysfunction)
+ Headache
+ Blurred vision
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22. Contraindications of SSRIs :
+ Seizure disorder
+ Suicidal ideation
+ Hepatic disease (liver clearance can be decreased)
+ Anorexia (SSRIs can decrease hunger)-
+ Sleep disturbances
+ Children (about 1 out of 50 children become more
suicidal)
+ Pregnancy (only paroxetineis classified in FDA
pregnancy risk category D)
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23. SNRIs :
+ Serotonin and noradrenaline reuptake inhibitors (SNRIs) are used
to treat major depression , mood disorders, and possibly but less
commonly attention deficit hyperactivity disorder (ADHD)
, obsessive-compulsive disorder (OCD), anxiety disorders,
menopausal symptoms, fibromyalgia, and chronic neuropathic pain.
+ Antidepressant SNRIs help relieve depression symptoms, such as
irritability and sadness, but some are also used for anxiety
disorders and nerve pain.
+ SNRIs raise levels of serotonin and norepinephrine, two
neurotransmitters in the brain that play a key role in stabilizing
mood.
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24. Mechanism of Action :
+ SNRIs ease depression by impacting chemical
messengers (neurotransmitters) used to communicate
between brain cells. Like most antidepressants, SNRIs
work by ultimately effecting changes in brain chemistry
and communication in brain nerve cell circuitry known to
regulate mood, to help relieve depression.
+ SNRIs block the reabsorption (reuptake) of the
neurotransmitters serotonin and norepinephrine in the
brain.
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25. Side effects of SNRIs :
The most common possible side effects of SNRIs include:
+ Nausea
+ Dry mouth
+ Dizziness
+ Headache
+ Excessive sweating
+ Tiredness
+ Constipation
+ Insomnia
+ Changes in sexual function,
such as reduced sexual
desire, difficulty reaching
orgasm or the inability to
maintain an erection
(erectile dysfunction)
+ Loss of appetite
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26. Tricyclic antidepressants (TCAs) are so named because there
are three rings in the chemical structure of these medications.
Tricyclic and tetracyclic antidepressants, also called cyclic
antidepressants, are among the earliest antidepressants
developed. These drugs work by increasing the concentrations
of two mood-altering chemicals , the neurotransmitters
norepinephrine and serotonin in the brain. TCAs are thought to
increase neurotransmitter levels by preventing nerve endings
called synapses from drawing these chemicals back into their
tissues, which is normally how the body reduces their
concentrations.
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27. + They're effective, but they've generally been replaced
by antidepressants that cause fewer side
effects. They are used to treat depression,
fibromyalgia, some types of anxiety, and they can help
control chronic pain . Tricyclic antidepressants (TCAs)
are a group of drugs used to treat affective, or ‘mood’,
disorders. Side effects of the TCAs include sedation,
caused by histamine H1 receptor blockade; postural
hypotension, due to α adrenoreceptor blockade; and
blurred vision, dry mouth and constipation, due to
muscarinic acetylcholine receptor blockade.
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29. Examples of TCAs Drugs :
+ Amitriptyline
+ Amoxapine
+ Norpramin (desipramine)
+ Pamelor (nortriptyline)
+ Silenor (doxepin)
+ Surmontil (trimipramine)
+ Tofranil (imipramine)
+ Vivactil (protriptyline)
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30. + Increased appetite
+ Weight gain
+ Low sex drive
+ Difficulty achieving an
erection, and other
sexual difficulties
+ Low blood pressure when
rising to a stand
+ Confusion in the elderly
+ Racing heartbeat
+ Increased sweating
+ Urinary retention
+ Constipation
+ Tremor
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31. Monoamine oxidase inhibitors (MAOIs)
+ This type of antidepressant was commonly prescribed before the
introduction of SSRIs and SNRIs.
+ It inhibits the action of monoamine oxidase, a brain enzyme.
Monoamine oxidase helps break down neurotransmitters, such as
serotonin.
+ If less serotonin is broken down, there will be more circulating
serotonin. In theory, this leads to more stabilized moods and
less anxiety.
+ Doctors now use MAOIs if SSRIs have not worked. MAOIs are
generally saved for cases where other antidepressants have not
worked because MAOIs interact with several other medications
and some foods .
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32. + Antidepressants such as MAOIs ease depression by affecting
chemical messengers (neurotransmitters) used to communicate
between brain cells. Like most antidepressants, MAOIs work
by ultimately effecting changes in the brain chemistry that
are operational in depression.
+ An enzyme called monoamine oxidase is involved in removing
the neurotransmitters norepinephrine, serotonin and dopamine
from the brain. MAOIs prevent this from happening, which
makes more of these brain chemicals available to effect
changes in both cells and circuits that have been impacted by
depression.
+ MAOIs also affect other neurotransmitters in the brain and
digestive system, causing side effects. MAOIs are sometimes
used to treat conditions other than depression, such as
Parkinson's disease.
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33. Mechanism of action
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34. + Dry mouth
+ Nausea,
+ constipation
+ diarrhea
+ Headache
+ Drowsiness
+ Insomnia
+ Dizziness or lightheadedness
+ Skin reaction at the patch site
+ Involuntary muscle jerks
+ Low blood pressure
+ Reduced sexual desire or
difficulty reaching orgasm
+ Weight gain
+ Difficulty starting a urine flow
+ Muscle cramps
+ Prickling or tingling sensation in
the skin (paresthesia)
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35. + Isocarboxazid (Marplan)
+ Phenelzine (Nardil)
+ Selegiline (Emsam)
+ Tranylcypromine (Parnate)
+ rasagiline (Azilect),
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36. + Cerebrovascular disease
+ Hypertension
+ Kidney disease
+ Liver disease
+ Congestive heart failure
+ Food with tyramine and dopamine
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38. Any questions ?
You can find me at Instagramn @Zuaib_baloc
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