Pharmacology of Antidepressants Class Comparison

Pharmacology of Antidepressants Douglas L. Geenens, D.O. The University of Health Sciences

Classes of Antidepressants Tricyclic-tertiary amines ,[object Object],[object Object],[object Object],[object Object],[object Object]

Classes of Antidepressants Tricyclic-secondary amines ,[object Object],[object Object],[object Object],[object Object]

Classes of Antidepressants Atypical (non-tricyclic) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Classes of Antidepressants Specific serotonin reuptake inhibitors (SSRIs) ,[object Object],[object Object],[object Object],[object Object],[object Object]

Classes of Antidepressants Monoamine oxidase inhibitors (MAOIs) ,[object Object],[object Object],[object Object],[object Object]

Classes of Antidepressants Psychostimulants ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Evaluation of the depressed patient Goals of the evaluation ,[object Object],[object Object],[object Object],[object Object]

Evaluation of the depressed patient ,[object Object],[object Object],[object Object]

Evaluation of the depressed patient ,[object Object],[object Object],[object Object],[object Object],[object Object]

Is an antidepressant indicated? ,[object Object],[object Object],[object Object],[object Object],[object Object]

Predictors of antidepressant response. ,[object Object],[object Object],[object Object],[object Object]

How to start antidepressants? ,[object Object],[object Object],[object Object]

Most common reasons antidepressants fail ,[object Object],[object Object],[object Object],[object Object]

What is an adequate trial? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Indications for serum levels ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Therapeutic Blood Levels for antidepressants ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

How Antidepressants Work ,[object Object],[object Object]

“Synaptic Pharmacology” of antidepressants ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

After Dosing Antidepressants (days) Series 1 Synaptic effects: hours to days Side effects: hours to days Therapeutic effect: 1 to 6 weeks

Pharmacokinetics of Antidepressants ,[object Object],[object Object],[object Object],[object Object],[object Object]

Antidepressant half-lives (hrs)

Cardiac Side-effects of tricyclic antidepressants ,[object Object],[object Object],[object Object],[object Object]

How to choose an antidepressant ,[object Object],[object Object],[object Object]

Norepinephrine uptake blockade Possible clinical consequences ,[object Object],[object Object]

Norepinephrine uptake blockade (potency)

Serotonin reuptake blockade Possible clinical consequences ,[object Object],[object Object],[object Object]

Serotonin uptake blockade (potency)

Blocking selectivity 5-HT vs. NE

Dopaminergic uptake blockade Possible clinical consequences ,[object Object],[object Object],[object Object],[object Object]

Dopamine uptake blockade (potency)

Histamine H 1 blockade Possible clinical consequences ,[object Object],[object Object],[object Object]

Histamine H 1 receptor blockade (affinity)

Muscarinic receptor blockade possible clinical consequences ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Muscarinic receptor blockade (affinity)

alpha – 1 receptor blockade possible clinical consequences ,[object Object],[object Object],[object Object]

alpha-1 receptor blockade (affinity)

imipramine (Tofranil) receptor affinities

fluoxetine (Prozac) receptor affinities

Pharmacology of Antidepressants Class Comparison

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