L50. Depression Pharmacology

MAOIs indirectly activate amines (including norepinephrine, serotonin, dopamine, and dietary tyramine). A build up of tyramine can lead to excessively high levels of norepinephrine ---> HTN Crisis

Isocarboxazid, Phenelzine, Selegiline

TCA used for OCD - targets serotonin transporter

TCA used for depression and pain management

Escitalopram, Fluoxetine, Paroxetine, and Sertraline

SSRI's block the serotonin transporter, thus inhibiting its reuptake into the neuron and letting it stay in the synaptic cleft for longer thus potentiating serotonin's effect on the brain/body. This is effective for depression as pt's with depression usually have lo levels of serotonin.

SSRI's block the serotonin AND norepinephrine transporter, thus inhibiting their reuptake into the neuron and letting it stay in the synaptic cleft for longer thus potentiating serotonin's effect on the brain/body.

Venlafaxine and Duloxetine

SNRI used for ADHD

Ketamine Esketamine (this one approved for tx-resistant depression)

Carbamazepine Valproic Acid Lithium

TRUE - SSRIs block the serotonin transporter (SERT)

Can be used to tx OCD

Selective 5-HT1A serotonin agonist used for GAD

Benzos - alprazolam, clonazepam --> rapid acting anxiolytics but high dependence/tolerance

B-blockers to block autonomic manifestation of anxiety-induced SANS activation (fight or flight response) ---> e.g. feeling like you are going to vomit before exam

TCAs work by inhibiting serotonin and norepinephrine reuptake --> they block SERT (serotonin transporter) and NET (norephinephrine transporter) to allow these neurotransmitters to stay in the synaptic cleft for longer.

Inhibit monoamine oxidase (which is the enzyme that typically breaks down dopamine, norepinephrine, and serotonin) --> thus the levels of these neurotransmitters build up in the neuron and there will be more to release at the synapse

Imipramine: equally targets SERT and NET (serotonin and norepinephrine build up in synaptic cleft) Despramine: preferentially targets NET (norepinephrine builds up more) Clomipramine: preferentially targets SERT (serotonin builds up more)