2. Classes of Drugs Used
-
SSRIs
SNRIs
TCAs
MAOIs
Atypical antidepressants
Agomelatine
3. Mechanism of Action : Inhibits the reuptake of serotonin from
synapse ; it takes (4-6 weeks) to see clinical effects, immediate
action : increase in S. level in synapse , later action : down
regulation of presynaptic inhibitory receptors.
Therapeutic Uses : first line of drugs in Depression.
Examples : Fluoxetine , paroxetine , Fluvoxamine , Sertraline ,
Trazodone , Nefazodone
Adverse effects : Nausea , sexual dysfunction -- > what drug to
you give to these Pt.s?, Insomnia , Drowsiness , Anxiety.
Important to know :
- Fluoxetine has a long half life ? And an active metabolite
which is ?
- Fluoxetine , paroxetine inhibit CYP-450 2D6
- CAN NOT GIVE THEM WITH MAO inhibitors
- Serotonin syndrome + Discontinuation syndrome
4. True Or False
- A Psychiatric prescribed Fluoxetine and
Isocarboxazide for a depressed Patient to get
the best outcomes.
- Paroxetine didn’t work with a Patient. The
doctor immediately replaced it with Sertraline.
- Bupropion was described to a depressed
Patient as Fluoxetine was going to worsen his
sexual dysfunction.
5. Mechanism of Action : Inhibits the reuptake of
serotonin and Norepinephrine from the
synapse.
Therapeutic Uses : Depression that is
accompanied with physical pain ( what is this
pain called? And why these drugs work? )
Examples : Tricyclic Antidepressants ,
Venlafaxine , Duloxetine.
Adverse effects : little adverse effects ,, why ?
6. Mechanism of Action : Inhibit reuptake of serotonin and NE ,
after chronic administration : increase in sensitization of 5-HT
receptors. It acts on adrenergic , muscarinic and histamine
receptors
Therapeutic Uses : Major depression , Bipolar affective disorder,
Enuresis , ADHD ( what other drug used ? What its action ?) ,
Anxiety disorder , Chronic pain.
Examples : Imipramine , Desiipramine , Protryptyline ,
Nortryptyline , Amytryptyline
Adverse effects : Atropine like side effects , sedation , weight
gain , cardiac toxicity, orthostatic hypotension
7. Guess what will happen
- A depressed alcoholic came to the out-patient
clinic , the attending doctor prescribed
imipramine for his depression ?
- A lady with bipolar was sent to a psychiatric to
treat her depression , He prescribed her
Desipramine ?
8. Mechanism of Action : Non –selective inhibition of MAO.
Therapeutic Uses : Depression .
Examples : Isocarboxazide , Phenelzine , Tranylcypromine.
Adverse effects : Interaction with tyramine . Explain what
happens ?
