Published on June 27, 2014
Introduction and mechanism of action By : Ola S. Eldardiry
Anti depressants Psychiatric medications given to patients with depressive disorders to alleviate symptoms. Types: 1. Monoamine oxidase inhibitors (MAOIs) 2. Noradrenaline and specific serotoninergic antidepressants (NASSAs) 3. Serotonin and noradrenaline reuptake inhibitors (SNRIs) 4. Selective serotonin reuptake inhibitors (SSRIs) 5. Tricyclics (TCAs) Onset: delayed up to few weeks. Duration of treatment: few months or several years Serious problem = lack of compliance
Uses • Agitation • Obsessive compulsive disorders (OCD) • Childhood enuresis (bedwetting) • Depression • Generalized anxiety disorder • Major depressive disorder • Manic-depressive disorders • Posttraumatic stress disorder (PTSD) • Social anxiety disorder Primary (approved)
• Binge eating disorder • Bulimia nervosa • Chronic urticaria (hives) • Fibromyalgia • Osteoarthritis pain • Hot flashes • Diabetic peripheral neuropathic pain • Neuropathic pain • Hyperhidrosis (drug-induced) • Premenstrual symptoms • Tourette syndrome • Ruritus (itching) • Migraines • Snoring “Off-label” – unapproved indication
Mechanism of action Monoamine Oxidase Inhibitors (MAOIs)
Tricyclic Antidepressants (TCAs)
Selective Serotonin Reuptake Inhibitors (SSRIs)
Serotonin/ Norepinephrine/ Dopamine Reuptake Inhibition (SNRI) (Venlafaxine)
On comparison with SSRI: • 5-HT2 receptors are blocked • Don’t cause some side effects such as: • Short-term increase in anxiety or insomnia • Akathisia • Sexual dysfunction Serotonin-2 Receptor Antagonism with Serotonin Reuptake Blockade (Nefazodone, Trazodone)
Norepinephrine and Dopamine Reuptake Inhibition (Bupropion)
α-2 Antagonism plus Serotonin-2 and Serotonin-3 Antagonism (Mirtazapine)
Noradrenalin Specific Reuptake Inhibitor (NRI) (Reboxetine)
Serotonin Reuptake Enhancer (Tianeptine) • Tricyclic compound of diabenzothiazepine type • Increases presynaptic uptake of serotonin after single + repeated administration • Not linked to any effects on 5-HT post-synaptic systems • No affinity for: o α1 adrenergic o H1 antihistaminic o Muscarinic receptors • Similar to TCAs but with faster onset • Not stimulating nor sedative • No anticholinergic effect • No cardiovascular effect
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