Podcast
Questions and Answers
What is the primary therapeutic action of tricyclic and tetracyclic antidepressants (TCAs)?
What is the primary therapeutic action of tricyclic and tetracyclic antidepressants (TCAs)?
Which disorder is NOT typically treated with tricyclic antidepressants?
Which disorder is NOT typically treated with tricyclic antidepressants?
What side effect is associated with the anticholinergic properties of TCAs?
What side effect is associated with the anticholinergic properties of TCAs?
Which of the following neurotransmitters is decreased in depressed patients treated with TCAs?
Which of the following neurotransmitters is decreased in depressed patients treated with TCAs?
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Which of the following is a common non-therapeutic action of TCAs?
Which of the following is a common non-therapeutic action of TCAs?
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What is the primary action of Monoamine Oxidase Inhibitors (MAOIs)?
What is the primary action of Monoamine Oxidase Inhibitors (MAOIs)?
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Which condition is specifically indicated for treatment with MAOIs?
Which condition is specifically indicated for treatment with MAOIs?
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What can trigger a hypertensive crisis in patients taking MAOIs?
What can trigger a hypertensive crisis in patients taking MAOIs?
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Which of the following is NOT a symptom of hypertensive crisis?
Which of the following is NOT a symptom of hypertensive crisis?
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Which of the following medications is likely to cause issues when taken with MAOIs?
Which of the following medications is likely to cause issues when taken with MAOIs?
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Study Notes
Anti-Depressants Drugs
- Antidepressants are substances used to treat depression, elevate mood, and improve the sense of well-being.
- Actions of antidepressants include elevating mood, improving sleep, increasing appetite, increasing activity, helping patients become more sociable, and decreasing anxiety.
Classifications
- Tricyclic & tetracyclic antidepressants (TCAs)
- Monoamine oxidase inhibitors (MAOIs)
- Selective serotonin reuptake inhibitors (SSRIs)
- Novel or atypical antidepressants (post SSRIs)
Tricyclic & Tetracyclic Antidepressants (TCAs)
- Action of TCAs: Depressed patients have a decrease in serotonin, dopamine, and norepinephrine.
- TCAs block the reuptake of neurotransmitters, 5HT & NE, in the pre-synapse. This allows 5HT & NE to remain and be active longer in the synapse.
- Non-therapeutic actions:
- Block alpha receptors leading to vasodilation and orthostatic hypotension.
- Block histamine receptors leading to sedation and weight gain.
- Block acetylcholine receptors leading to anticholinergic side effects
Indications of TCAs
- Treatment of major depressive disorder
- Postpartum depression
- Premenstrual dysphoric disorder
- Depressive episodes
- Anxiety disorders (Generalized, obsessive-compulsive, panic, post-traumatic stress, specific and social phobia)
- Eating disorders (Bulimia and anorexia nervosa)
- Pain disorder
- Other disorders: Sleepwalking disorder, childhood enuresis, nightmare disorder
Side Effects of TCAs
- Anticholinergic effects: dry mouth, constipation, urinary retention, blurred vision
- Cardiac effects: ECG changes, tachycardia, arrhythmias, orthostatic hypotension
- Endocrine and sexual effects: impotence, hyperprolactenemia, anorgasmia, amenorrhea, and ejaculatory disturbances
- Neurological effects: sedation, dizziness, drowsiness, tremors, myoclonic twitches of the tongue and upper extremities
- GIT: weight gain, nausea, vomiting
Name of TCAs
- Tofranil
- Anafranil
- Tryptizol
- Elavil
- Vivactil
Monoamine Oxidase Inhibitors (MAOIs)
- Monoamine(MA): norepinephrine, dopamine, serotonin (neurotransmitters), food, drug
- Monoamine Oxidase(MAO): enzyme responsible for metabolism of monoamine and tyramine (end metabolite of protein)
- Monoamine Oxidase Inhibitors(MAOI): Inhibit the effect of MAO enzyme inhibiting the metabolism of monoamine and tyramine.
Action of MAOIs
- These drugs inhibit monoamine oxidase (MAO) activity, metabolizing neurotransmitters (norepinephrine, dopamine, or serotonin) in synapses.
- This inhibition allows neurotransmitters to remain active longer in the brain, correcting a presumed deficit in monoamine function
Indications of MAOIs
- For patients who do not respond to TCAs
- Atypical depression (hyperphagia, hypersomnia, phobic anxiety)
- Acute depression (rapid action)
- Anxiety disorders (panic disorder, social phobia, generalized, obsessive-compulsive, post-traumatic stress)
- Bulimia nervosa
Side Effects of MAOIs
- Liver: hepato cellular damage, severe liver necrosis
- Psychotic: (retarded depression can convert to agitated depression)
- Hypomania
- Peripheral neuropathy
- Hypertensive crisis: (the "cheese effect")
Mechanism of Hypertensive Crisis
- Foods containing monoamines (aged cheese, beans, yeast products, smoked salmon, pickles, chocolate, coffee, chicken liver, bananas) are usually deactivated by MAO.
- When a person taking MAOIs consumes these foods, the monoamines accumulate, stimulating the sympathetic nervous system and increasing heart rate and blood pressure.
- This reaction can cause blood pressure to increase enough to induce intracranial bleeding or cardiovascular collapse.
Triggering factors for Hypertensive Crisis
- Foods containing tyramine are a trigger,
- Certain medications (cough mixtures, antipyretic, antitussive, antibiotics) contain ephedrine.
Symptoms of Hypertensive Crisis
- Blood pressure above 180/90
- Dilated pupils
- Severe occipital headache
- Stiff neck
- Nausea and vomiting
- Severe nosebleeds
- Tachycardia
- Chest pain, coma, death
Management of Hypertensive Crisis
- Preventive measures - Avoid foods or medications containing tyramine
- Curative measures - Stop the medication, administer antihypertensive, close monitoring of the patient
Name of MAOIs
- Nardil
- Parnate
- Marplan
- Emsam
Selective Serotonin Reuptake Inhibitors (SSRIs)
- Action of SSRIs: Inhibit the reuptake of 5HT by blocking reuptake sites, allowing 5HT to remain active, thereby correcting any deficit in its activity
- High safety margin (difference between toxic and therapeutic dose).
Indications of SSRIs
- Depression during pregnancy and postpartum
- Depression in elderly/medical patients with no cognitive/behavioral issues
- Major depressive disorder
- Anxiety disorders
- Eating disorders
- Chronic pain disorders
Side Effects of SSRIs
- Serotonin syndrome: Concurrent administration with MAOIs can raise plasma serotonin, causing a serious, fatal syndrome. Symptoms include: diarrhea, restlessness, agitation, hyperreflexia, fluctuations in vital signs, hyperthermia, shivering, rigidity, delirium, coma, and cardiovascular collapse
- Serotonin withdrawal: Symptoms from abruptly stopping SSRIs - dizziness, weakness, nausea, headache, rebound depression, and anxiety.
- Sexual dysfunction, nausea, vomiting, loss of appetite, indigestion, diarrhea, nervousness, insomnia, anxiety, drowsiness
Name of SSRIs
- Prozac
- Felozac
- Zoloft
- Cipram
- Celexa
- Cetalo
Post Selective Serotonin Reuptake Inhibitors
- Advantage: Rapid improvement, less side effects
- Disadvantage: Very expensive
- Action: Some drugs act like SSRIs inhibiting the reuptake of 5HT, increasing serotonin in the synapse. Some drugs act like tricyclic antidepressants but do not affect alpha, histamine, or ACh.
Names of Post Selective Serotonin Reuptake Inhibitors
- Effexor
- Trittico
- Trazodone
Why high suicide risk with antidepressant use:
- Antidepressants can improve mood before improving thought processes.
- Patients may experience increased energy leading to suicidal ideation.
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Description
This quiz covers the essential aspects of antidepressant drugs, including their classifications and mechanisms of action. You'll explore tricyclic & tetracyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and selective serotonin reuptake inhibitors (SSRIs). Test your understanding of how these medications elevate mood and manage symptoms of depression.
