Antidepressant Medications - Handbook Of Clinical Psychopharmacology For Therapists

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Iproniazid

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In 1950 was an agent used to treat tuberculosis and it was found to produce improvements in mood.

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MAO

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An enzyme used to break down catecholamines (dopamine, norepinephrine, and serotonine) in neurons.

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Imipramine

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was first produced and it was originally developed as an antipsychotic

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Six major groups of antidepressants

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Selective serotonine reuptake inhibitors SSRIs, Serotonine and norepinephrine reuptake inhibitors SNRIs, Norepineprhine reuptake inhibitors NRIs, MAOIs, and the atypicals.

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Other antidepressant treatments

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Stimulants and Buspirone.

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Tricyclics

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Called "dirty” drugs, as they react with a number of receptors besides the one responsible for the therapeutic effect and this produces a host of side effects.

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Tricyclics side effects

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are anticholinergic, antiadrenergic, antihistaminic, and miscellaneous

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Anticholinergic side effects

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from unpleasant (dry mouth, dry skin, blurred vision, and constipation) to serious (paralytic ileus, cessation of movement of the intestine, urinary retention, inability to urinate).

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Antiadrenergic side effects

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are sweating, sexual dysfunction, and orthostatic hypotension.

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Antihistaminic side effects

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are sedation and weight gain

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Miscellaneous side effects

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are lowered seizure threshold, cardiac arrhythmia, hepatitis, agranulocytosis, rashes, sweating, anxiety, and elevated heart rate.

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SSRIs

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Newer class of antidepressants. Have significantly fewer side effects and are safer in overdosage compare to the tricyclics.

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First SSRI

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Was fluoxetine

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Five newer agents (SSRIs)

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Citalopram (Celexa), escitalopram (Lexapro), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft)

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SSRIs unlike the tricyclics

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Are relative "clean" and interact very little with other receptors besides the 5-HT reuptake receptor

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SSRIs side effects

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Tend to be related to increased serotonin activity: Nausea, gastrointestinal upset, sweating, anxiety, insomnia, headache, restlessness, and sexual dysfunction.

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Patients taking SSRIs can develop a syndrome

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Includes: loss of energy, passivity, decreased pleasure, and decreased libido.

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SSRIs syndrome can be treated

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with bupropion or a stimulant such as methylphenidate or modafinil.

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Other common SSRIs side effects

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sexual dysfunction, delayed or absent ejaculation in men, and anorgasmia in men and woman

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A long half-life has the advantage of

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maintaining a stable blood level, but it takes longer to eliminate the drug from the body

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SNRIs are

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dual-action antidepressants (affecting both serotonin and norepineprhine)

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SNRIs include

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Venlafaxine (Effexor), desvenlafaxine (Pristiq), duloxetine (Cymbalta), and mirtazapine (Remeron).

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Venlafaxine and duloxetine

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are blockers of the reuptake of both 5-HT and norepineprhine.

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Mirtazapine

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is an alpha-2-adrenoreceptor blocker.

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Duloxetine, venlafaxine, and mirtazapine

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more effective than SSRIs in the treatment of severe depression.

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NRIs

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Atomoxetine (Strattera) and reboxetine (Vestra).

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NRIs side effects

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Anxiety, loss of appetite, and sedation.

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Atypical antidepressants

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Bupropion and buspirone.

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MAOs

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used when other antidepressants have failed in the treatment of depression and anxiety disorders.

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MAOs side effects

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can cause a severe and sudden rise in blood pressure.

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Two most common MAOs

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Phenelzine (Nardil) and tranylcypromine (Parnate)

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Stimulants

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Dextroamphetamine (Dexedrine) and methylphenidate (Ritalin).

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Mechanisms of action of antidepressants

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Blocking the reuptake of one or more neurotransmittes (norepinephrine, serotonin, and dopamine) which leads to a decrease of the number of postsynaptic receptors.
- MAO block monoamine oxidase, which metabolizes NE, 5-HT, DA
- Stimulants increase release of catecholamines
- Buspirone is a 5-HT IA receptor blocker

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Antidepressants produce effects

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within 2 or 3 weeks

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Three side effects that can lead to patient discontinuation

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Activation, switching and inorgasmia.

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Difference between activation and switching

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is that switching does not occur after several weeks and activation occurs within the first few hours

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Activation

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the acute onset of side effect seen within the first few hours after starting an antidepressant or when doses are increased.

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Switching

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occurs when a person being treated with an antidepressant is provoked into a manic state.