Understanding Depression and Its Treatments
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Questions and Answers

What is primarily affected by tricyclic antidepressants in order to alleviate depression symptoms?

  • Both B and C (correct)
  • Noradrenaline uptake
  • Dopamine uptake
  • 5-HT uptake

    • Which neurotransmitter's uptake is the least affected by tricyclic antidepressants?

  • Serotonin
  • Acetylcholine
  • Dopamine (correct)
  • Noradrenaline

    • What is a characteristic pharmacokinetic property of tricyclic antidepressants?

  • High solubility in water
  • Good distribution across the blood-brain barrier (correct)
  • Quick onset of action within days
  • Rapid metabolism

    • What are the two main types of anticholinergic receptors influenced by tricyclic antidepressants?

    <p>Muscarinic and nicotinic receptors</p> Signup and view all the answers

    During which timeframe is the antidepressant action of tricyclic antidepressants typically observed?

    <p>During the first 4 weeks</p> Signup and view all the answers

    What is the first phase of pharmacological treatment for depression referred to?

    <p>Remission phase</p> Signup and view all the answers

    Which neurotransmitter is primarily associated with decreased levels in patients suffering from depression?

    <p>Serotonin</p> Signup and view all the answers

    Which treatment method is indicated for severe depression?

    <p>Hospitalization</p> Signup and view all the answers

    What is indicated as a characteristic of depression in the emotional symptoms category?

    <p>Apathy</p> Signup and view all the answers

    Which of the following is identified as a common form of depression?

    <p>Postpartum depression</p> Signup and view all the answers

    What is a common therapeutic application for imipramine?

    <p>Managing enuresis in children over 5 years old</p> Signup and view all the answers

    Which side effect is associated with Tricyclic Antidepressants (TCAs)?

    <p>Dry mouth and urinary retention</p> Signup and view all the answers

    What is a pharmacodynamic interaction of TCAs?

    <p>They enhance the actions of catecholamines.</p> Signup and view all the answers

    What potential risk is associated with TCA overdose?

    <p>Arrhythmias leading to convulsions and coma</p> Signup and view all the answers

    Which SSRIs are known to inhibit the reuptake of serotonin?

    <p>Fluoxetine and Sertraline</p> Signup and view all the answers

    What effect do oral contraceptives have on TCAs?

    <p>They inhibit the metabolism of TCAs.</p> Signup and view all the answers

    What condition is characterized by feelings of pain in a body part that has been amputated?

    <p>Phantom limb syndrome</p> Signup and view all the answers

    Which of the following is NOT a common side effect of TCAs?

    <p>Nausea and vomiting</p> Signup and view all the answers

    TCAs can potentiate the effects of which type of drugs, potentially leading to severe consequences?

    <p>Alcohol and anaesthetic agents</p> Signup and view all the answers

    What is a neurological side effect associated with TCAs?

    <p>Tremors in hands and head</p> Signup and view all the answers

    What is the primary neurotransmitter associated with decreased levels in depression, leading to the need for pharmacological treatment?

    <p>Serotonin</p> Signup and view all the answers

    What phase of treatment for depression typically involves monitoring and maintaining stability after achieving remission?

    <p>Continuation phase</p> Signup and view all the answers

    Which treatment method is commonly recommended as a first-line intervention for moderate depression?

    <p>Psychotherapy combined with pharmacological treatment</p> Signup and view all the answers

    Which emotional symptom is typically associated with depression?

    <p>Sadness</p> Signup and view all the answers

    Which of the following is NOT classified as a common form of depression?

    <p>Anorexia nervosa</p> Signup and view all the answers

    Which of the following describes a primary mechanism of action of tricyclic antidepressants (TCAs)?

    <p>Inhibition of noradrenaline and serotonin reuptake</p> Signup and view all the answers

    Which side effect is most closely associated with the antimuscarinic effects of TCAs?

    <p>Dry mouth</p> Signup and view all the answers

    What is a significant pharmacokinetic characteristic of tricyclic antidepressants?

    <p>High lipid solubility and long elimination half-life</p> Signup and view all the answers

    Which class of antidepressants is categorized as non-selective amine reuptake inhibitors?

    <p>Tricyclic antidepressants (TCAs)</p> Signup and view all the answers

    During which timeframe is the antidepressant effect of TCAs typically initiated?

    <p>Within the first 4 weeks of treatment</p> Signup and view all the answers

    What condition, often treated with imipramine, involves painful sensations in a removed body part?

    <p>Phantom limb syndrome</p> Signup and view all the answers

    Which side effect is most commonly associated with the antimuscarinic effects of TCAs?

    <p>Dry mouth</p> Signup and view all the answers

    Which of the following is a therapeutic application of selective serotonin reuptake inhibitors (SSRIs)?

    <p>Treatment of depressive syndromes</p> Signup and view all the answers

    What effect do monoamine oxidase inhibitors (MAOIs) have when taken with TCAs?

    <p>They enhance the actions of TCAs.</p> Signup and view all the answers

    What is a primary mechanism of action of selective serotonin reuptake inhibitors (SSRIs)?

    <p>Inhibit the reuptake of serotonin</p> Signup and view all the answers

    Which of the following represents a significant risk in patients experiencing TCA overdose?

    <p>Cardiac arrhythmias and convulsions</p> Signup and view all the answers

    Which of the following describes the neurological side effect associated with tricyclic antidepressants?

    <p>Tremors</p> Signup and view all the answers

    What potential effect do oral contraceptives have on the pharmacokinetics of TCAs?

    <p>Inhibit TCA metabolism</p> Signup and view all the answers

    Which of the following best describes an adverse cardiovascular reaction to tricyclic antidepressants?

    <p>Orthostatic hypotension</p> Signup and view all the answers

    What class of antidepressants can cause excessive sweating as a side effect?

    <p>Tricyclic antidepressants</p> Signup and view all the answers

    What is the primary action of tricyclic antidepressants (TCAs) in relation to neurotransmitters?

    <p>They block the uptake of noradrenaline and serotonin.</p> Signup and view all the answers

    Which of the following pharmacological actions of tricyclic antidepressants (TCAs) assists in improving sleep?

    <p>Antimuscarinic effects on cholinergic receptors.</p> Signup and view all the answers

    What characteristic of tricyclic antidepressants (TCAs) influences their side effect profiles?

    <p>Their ability to cross the blood-brain barrier.</p> Signup and view all the answers

    Which class of antidepressants is known for being non-selective amine reuptake inhibitors?

    <p>Tricyclic antidepressants (TCAs)</p> Signup and view all the answers

    What is a key pharmacokinetic feature of tricyclic antidepressants (TCAs)?

    <p>Long elimination half-life.</p> Signup and view all the answers

    What is a therapeutic application of tricyclic antidepressants beyond treating depressive syndromes?

    <p>Panic attacks</p> Signup and view all the answers

    Which adverse effect is primarily associated with the antimuscarinic action of tricyclic antidepressants?

    <p>Dry mouth</p> Signup and view all the answers

    What interaction do tricyclic antidepressants have with oral contraceptives?

    <p>Inhibit the metabolism of TCAs</p> Signup and view all the answers

    What is a common cardiovascular adverse reaction associated with tricyclic antidepressants?

    <p>Palpitations</p> Signup and view all the answers

    Which of the following conditions can TCAs help alleviate pain for?

    <p>Chronic somatic pain</p> Signup and view all the answers

    Which side effect is least likely to be associated with noradrenergic transmission?

    <p>Myocardial infarction</p> Signup and view all the answers

    What is the main therapeutic use of Atomoxetine?

    <p>Treatment of attention deficit/hyperactivity disorder</p> Signup and view all the answers

    Which of the following compounds does NOT primarily act on serotonin reuptake?

    <p>Bupropion</p> Signup and view all the answers

    What is a primary mechanism by which Agomelatine treats severe depression?

    <p>Agonism of melatonin receptors</p> Signup and view all the answers

    What potential serious complication is associated with the overdose of Duloxetine?

    <p>Cardiac conduction abnormalities</p> Signup and view all the answers

    What is the primary effect of Hypericum perforatum in the treatment of depression?

    <p>Inhibition of the reuptake of multiple neurotransmitters</p> Signup and view all the answers

    Which statement about Mirtazapine's mechanism of action is true?

    <p>It blocks alpha-2 receptors</p> Signup and view all the answers

    Which treatment option is indicated for patients who have not responded to traditional antidepressant medications?

    <p>Electroconvulsive therapy</p> Signup and view all the answers

    What common adverse effect may persist after electroconvulsive therapy?

    <p>Short-term memory loss</p> Signup and view all the answers

    Study Notes

    Depression

    • A mood disorder with cognitive, behavioral, and emotional alterations.
    • A long-term disease.
    • Can be treated and cured.
    • Anyone can experience it at any time.
    • Requires treatment by a medical specialist.
    • Symptoms:
      • Emotional: Apathy, pessimism, sadness
      • Biological: Low self-esteem, sleep disorders, loss of motivation, loss of appetite, suicidal thoughts, delayed thinking and action, loss of libido.
    • Other forms: Postpartum depression, premenstrual disorder, affective emotional disorder.

    Treatment of Depression

    • Prevention: To avoid reaching the point of medication, mental health awareness and practice.
    • Psychotherapy: For mild depression.
    • Psychotherapy + Pharmacological treatment: For moderate depression.
    • Hospitalization: For severe depression.
    • ECT (Electroconvulsive Therapy): Used as a last resort for severe depression.

    Pharmacological Treatment of Depression

    • Associated with a decrease in the release of neurotransmitters in the synapse, particularly Dopamine and 5-HT.
    • Treatment phases:
      • Remission phase: Takes 2-4 weeks for antidepressants to start working.
      • Continuation phase: 6-12 months.
      • Maintenance phase: Depends on the evolution of the disease.

    Mechanism of Depression Onset

    • Prodepressive pathways: Involve the hypothalamic and pituitary adrenal axis.
    • Antidepressive pathways: Involve NA, 5-HT, and BNDF.
    • BNDF: Brain-Derived Neurotrophic Factor.

    Classification of Antidepressants

    • Tricyclic antidepressants (TCA): Non-selective amine reuptake inhibitors.
    • Selective serotonin reuptake inhibitors (SSRIs):
    • Monoamine oxidase inhibitors (MAOI-A y B):
    • Serotonin and Noradrenaline Uptake Inhibitors (SNRIs):
    • Others:
      • Bupropion
      • Reboxetine
      • Atomoxetine
      • Natural compounds (Hypericum perforatum)

    Tricyclic Antidepressants (TCA)

    • Examples: Imipramine, Desipramine, Amitriptyline, Nortriptyline, Clomipramine, Doxepin.
    • Mechanism of action: Inhibit the reuptake of NA and Serotonin (less effect on Dopamine) in the synapse cleft, increasing their concentration.
    • Anticholinergic receptors: Two types - antimuscarinic and antinicotinic.
    • Effects:
      • Antidepressant: Improves sleep, appetite, psychomotor activity, mood.
      • Anxiolytic and sedative:
      • Analgesic: Especially in chronic pain, when pain is part of the somatization of depression.
    • Used to treat:
      • Depressive syndromes.
      • Anxiety syndromes (panic attacks).
      • Hyperactivity syndrome, imipramine.
      • Treatment of enuresis: Children > 5 years old.
      • Pain: Neurogenic (phantom limb syndrome), oncological, headaches.

    Selective Serotonin Reuptake Inhibitors (SSRIs)

    • Examples: Fluoxetine, Paroxetine, Citalopram, Sertraline.
    • Mechanism of action: Inhibit the selective reuptake of Serotonin in the synapse cleft, increasing its concentration.

    Monoamine Oxidase Inhibitors (MAOI)

    • Mechanism of action: Inhibit the enzyme monoamine oxidase (MAO), which breaks down neurotransmitters like serotonin, norepinephrine, and dopamine.
    • Pharmacokinetics: Well absorbed orally, metabolized in the liver, short elimination half-life, multiple daily doses.
    • Therapeutic effect: Takes 1-3 weeks to appear.
    • Limited use: Due to toxicity and drug interactions.
    • ADRs: Hypotension, tremors, excitement, insomnia, convulsions, increased appetite.
    • Drug interactions:
      • Tyramine: Hypertensive crisis (Cheese effect).
      • SSRIs or TCAs: Serotonin syndrome.
      • Other drugs: Enhancement of depressant actions.
    • Therapeutic applications: Reserve antidepressants when other treatments fail.

    Serotonin and Noradrenaline Uptake Inhibitors (SNRIs)

    • Examples: Venlafaxine, Desvenlafaxine, Duloxetine.
    • Mechanism of action: Non-selective inhibition of 5-HT and NA uptake.
    • Effects: Effective in some anxiety disorders, may be beneficial in treating perimenopausal symptoms, Duloxetine used for neuropathic pain, fibromyalgia, urinary incontinence.
    • Pharmacokinetics: Orally active, venlafaxine has a slow-release formulation.
    • ADRs: Headache, insomnia, sexual dysfunction, dry mouth, dizziness, sweating, decreased appetite, serotonin toxicity, convulsions, cardiac conduction abnormalities, hepatotoxicity.

    Other Noradrenaline Uptake Inhibitors

    • Bupropion: Inhibits noradrenaline and dopamine, not abuse potential, used to treat nicotine dependence, may cause seizures at high doses.
    • Reboxetine and Atomoxetine: Highly selective for NA uptake, less efficacy in depression, Atomoxetine used in treatment of attention deficit/ hyperactivity disorder.

    Natural Compounds

    • Hypericum perforatum (St. John’s Wort): Main active ingredient is Hyperforin.
    • Effects: Inhibition of reuptake or 5-HT, Dopamine, NA, GABA, and glutamate.
    • Therapeutic applications: Antidepressant and anxiolytic effects.

    Monoamine Receptor Antagonists

    • Mirtazapine: Blocks alfa 2, 5-HT2C (antidepressant effects), and H1 receptors.
    • Trazodone: Combines 5-HT2A and 5-HT2C receptor antagonism with 5-HT reuptake inhibition.

    Melatonin Agonist

    • Agomelatine: Agonist of MT1 and MT2 receptors, short biological half-life.
    • Therapeutic applications: Treatment of severe depression.
    • Effects: Correcting disturbances in circadian rhythms.
    • Potential risks: Hepatotoxicity.

    Electroconvulsive Therapy (ECT)

    • Used for severe depression, unresponsive to antidepressant drugs.
    • Effectiveness in severe suicidal depression.
    • Side effects: Confusion and memory loss lasting for days or weeks.
    • Repetitive transcranial magnetic stimulation (TMS): Another treatment option for patients unresponsive to drugs.

    Depression

    • A mood disorder affecting cognitive, behavioral, and emotional spheres.
    • A long-term but treatable and curable disease.
    • Can affect anyone at any time.
    • Requires specialist treatment.
    • Not a sign of weakness.

    Depression Symptoms

    • Emotional Symptoms: Apathy, pessimism, sadness, low self-esteem
    • Biological Symptoms: Sleep disorders, loss of motivation, loss of appetite, suicidal thoughts, delayed thinking and action, loss of libido.

    Other forms of Depression

    • Postpartum depression
    • Premenstrual disorder
    • Affective emotional disorder

    Treatment of Depression

    • Prevention
    • Psychotherapy: For mild depression
    • Psychotherapy + Pharmacological Treatment: For moderate depression
    • Hospitalization: For severe depression
    • ECT (Electroconvulsive Therapy)

    Pharmacological Treatment of Depression

    • Depression is associated with decreased neurotransmitter release in the synapse, especially dopamine and 5-HT.
    • Treatment phases:
      • Remission Phase: Antidepressants start working after 2-4 weeks.
      • Continuation Phase: 6-12 months.
      • Maintenance Phase: Depends on disease evolution.

    Mechanism of Depression Onset

    • Prodepressive Pathways: Involve the hypothalamic and pituitary adrenal axis.
    • Antidepressive Pathways: Involve NA, 5-HT, and BDNF (Brain-Derived Neurotrophic Factor).

    Classification of Antidepressants

    • Tricyclic Antidepressants (TCA): Non-selective amine reuptake inhibitors.
    • Selective Serotonin Reuptake Inhibitors (SSRIs):
    • Monoamine Oxidase Inhibitors (MAOI-A y B):
    • Serotonin and Noradrenaline Uptake Inhibitors (SNRIs):
    • Others:

    Treatment of Depression: TCA

    • Examples: Imipramine, Desipramine, Amitriptyline, Nortriptyline, Clomipramine, Doxepin.
    • Mechanism of Action: Inhibit the reuptake of NA and Serotonin (less Dopamine) in the synaptic cleft, increasing their concentration.
    • Anticholinergic Receptors:
      • Antimuscarinic
      • Antinicotinic
    • Pharmacokinetics:
      • Highly liposoluble drugs with good distribution (BBB)
      • Taken orally with progressively increasing doses
      • Fixed to plasma proteins
      • Hepatic metabolization with active metabolites
      • Long elimination half-life (10-80 hours), longer in elderly patients
    • Pharmacological Actions:
      • Antidepressant effect seen after 4 weeks of treatment, improving sleep, appetite, and psychomotor activity.
      • Improves depressed mood and feelings of despondency and hopelessness after the fourth week.
      • Anxiolytic and sedative action.
      • Analgesic action in chronic pain, especially when pain is part of depression somatization. Some TCAs are used for neuropathic pain.

    Treatment of Depression: TCA Adverse Drug Reactions (ADRs)

    • Cardiovascular: Orthostatic hypotension, palpitations, tachycardia.
    • Antimuscarinic Effect: Dry mouth, constipation, urinary retention, nasal congestion, blurred vision.
    • Neurological: Tremors in hands and head.
    • Other: Weight gain, excessive sweating, photosensitivity, gastrointestinal discomfort.
    • Intoxication: Overdose is common due to suicidal tendencies in some depressive patients. Symptoms include arrhythmias, convulsions, coma.

    Treatment of Depression: TCA Drug Interactions

    • Pharmacodynamic Interaction: Enhances the actions of catecholamines and MAOIs (Monoamine oxidase inhibitors).
    • Pharmacokinetic Interaction:
      • Increases the activity of oral anticoagulants (warfarin) and increases the risk of bleeding (PP-binding).
      • Oral contraceptives inhibit metabolism of TCAs (metabolism).
      • TCAs potentiate the effects of alcohol and anaesthetic agents (unknown mechanism), potentially leading to death.
      • Interfere with antihypertensive drugs.

    Treatment of Depression: TCA Therapeutic Applications

    • Depressive syndromes
    • Anxiety syndromes (panic attacks)
    • Hyperactivity syndrome: Imipramine
    • Treatment of enuresis: Children over 5 years old (imipramine)
    • Pain: Neurogenic (phantom limb syndrome), oncological, headaches.

    Treatment of Depression: SSRIs

    • Examples: Fluoxetine, Paroxetine, Citalopram, Sertraline.
    • Mechanism of Action: Inhibition of Serotonin reuptake in the synaptic cleft, increasing its concentration.
    • ADRs: Headache, insomnia, sexual dysfunction, dry mouth, dizziness, sweating, decreased appetite.
    • Overdose: CNS depression, serotonin toxicity, convulsions, cardiac conduction abnormalities.
    • Duloxetine: Can cause hepatotoxicity, contraindicated in patients with hepatic impairment.

    Treatment of Depression: Other Noradrenaline Uptake Inhibitors

    • Bupropion:
      • Inhibits noradrenaline and dopamine.
      • No abuse potential.
      • Used to treat nicotine dependence.
      • May induce seizures at high doses.
    • Reboxetine and Atomoxetine:
      • Highly selective for NA uptake, but less effective in depression than TCAs.
      • Atomoxetine is used to treat attention deficit/hyperactivity disorder.

    Treatment of Depression: Others: Natural Compounds

    • Hypericum perforatum (St. John's Wort):
      • Herbal preparation containing hyperforin.
      • Inhibits the reuptake of 5-HT, dopamine, NA, GABA, and glutamate.
      • Antidepressive and anxiolytic effects.

    Treatment of Depression: Monoamine Receptor Antagonists

    • Mirtazapine:
      • Blocks alpha 2, 5-HT2C (antidepressant effects), and H1 receptors.
    • Trazodone:
      • Combines 5-HT2A and 5-HT2C receptor antagonism with 5-HT reuptake inhibition.

    Treatment of Depression: Melatonin Agonist

    • Agomelatine:
      • Agonist of MT1 and MT2 receptors.
      • Short biological half-life.
      • Used to treat severe depression, usually taken once daily before bed.
      • Works by correcting disturbances in circadian rhythms.
      • May cause hepatotoxicity.

    Treatment of Depression: Electroconvulsive Therapy

    • ECT (Electroconvulsive Therapy) and TMS (Repetitive Transcranial Magnetic Stimulation): Used for patients who have not responded to antidepressant drugs.
    • ECT: Effective for severe suicidal depression, but can cause confusion and memory loss.
    • TMS: Less effective than ECT.

    Treatment of Depression: Antidepressant Clinical Uses Summary

    • Mild depression is often initially treated with non-drug measures.
    • Antidepressant drugs are advisable for moderate to severe depression.
    • The efficacy of antidepressant drugs varies between individuals.
    • Different classes of antidepressants have similar efficacy but different side effects.
    • Drug choice is based on individual aspects, including concomitant disease.
    • SSRIs are preferred due to better tolerance and lower overdose risk.
    • Antidepressant effects take several weeks to appear; decisions on changes in dose or drug should not be rushed.
    • MAOI usage is restricted to specialists.
    • An effective regimen should continue for at least two years.
    • Specialist consideration for possible use of electroconvulsive therapy in urgent situations.
    • Anxiolytics (e.g., benzodiazepines) or antipsychotic drugs are useful adjuncts for some patients.

    Bipolar Disorder

    • A mental health condition marked by extreme mood swings, including episodes of mania and depression.
    • These phases can significantly impact behavior, energy levels, and daily functioning.

    Treatment of Bipolar Disorder: Lithium Salts

    • Lithium Carbonate:
      • Administered orally.
      • Excreted by the kidneys.
      • Narrow therapeutic margin, requiring monitoring of plasma concentration.
      • Mechanism of action is unknown.
      • Effective in both manic and depressive phases, considered a mood stabilizer.
      • Increases release of NA and 5-HT in the brain.
      • May have beneficial effects in neurodegenerative diseases like Alzheimer's disease.

    Treatment of Bipolar Disorder: Lithium Salts ADRs

    • Gastrointestinal: Gastric discomfort, nausea, vomiting, diarrhea, anorexia, weight gain.
    • Renal: Polyuria, thirst due to inhibition of antidiuretic hormone.
    • Neurological: Trembling hands.
    • Chronic Administration: Thyroid disorders, kidney disorders.

    Depression

    • Maintenance phase of depression treatment depends on the evolution of the disease.
    • Prodepressive pathways involve the hypothalamic-pituitary-adrenal axis.
    • Antidepressive pathways involve NA, 5-HT, and BDNF.
    • Tricyclic antidepressants (TCAs) are non-selective amine reuptake inhibitors
    • Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants that selectively inhibit the reuptake of serotonin in the synapse.
    • Monoamine oxidase inhibitors (MAOIs) inhibit the enzyme monoamine oxidase, which breaks down neurotransmitters like serotonin, norepinephrine, and dopamine.
    • Serotonin and Noradrenaline Uptake Inhibitors (SNRIs) are a class of antidepressants that work by inhibiting the reuptake of both serotonin and norepinephrine.

    Treatment of Depression: Tricyclic Antidepressants (TCAs)

    • Mechanism of action: TCAs block the uptake of amines, specifically inhibiting norepinephrine and serotonin reuptake (with less effect on dopamine reuptake).
    • Pharmacokinetics: TCAs are highly liposoluble drugs, allowing for good distribution throughout the body, including the blood-brain barrier.
    • Pharmacological actions: TCAs have antidepressant, anxiolytic, sedative, and analgesic actions.
    • Adverse Drug Reactions (ADRs): TCAs can cause cardiovascular, antimuscarinic, neurological, and other side effects.
    • Drug Interactions: TCAs can enhance the actions of catecholamines and MAOIs. They can also increase the activity of oral anticoagulants (warfarin) and potentiate the effects of alcohol and anesthetic agents.

    Treatment of Depression: Selective Serotonin Reuptake Inhibitors (SSRIs)

    • Mechanism of action: SSRIs selectively inhibit serotonin reuptake in the synaptic cleft.
    • Adverse Drug Reactions (ADRs): SSRIs may cause headache, insomnia, sexual dysfunction, dry mouth, dizziness, sweating, and decreased appetite.

    Treatment of Depression: Other Noradrenaline Uptake Inhibitors

    • Bupropion: Inhibits both noradrenaline and dopamine; used to treat nicotine dependence.
    • Reboxetine and Atomoxetine: Highly selective for NA uptake.
    • Atomoxetine: Used in the treatment of attention deficit/hyperactivity disorder.

    Treatment of Depression: Others

    • Hypericum perforatum (St John’s wort): Depressive and anxiolytic effects; inhibits the reuptake of serotonin, dopamine, norepinephrine, GABA, and glutamate.
    • Mirtazapine: Blocks alfa2, 5-HT2C, and H1 receptors.
    • Trazodone: Combines 5-HT2A and 5-HT2C receptor antagonism with 5-HT reuptake inhibition.
    • Agomelatine: Agonist of MT1 and MT2 receptors; used to treat severe depression.
    • Electroconvulsive therapy (ECT): Effective treatment for severe suicidal depression.
    • Repetitive transcranial magnetic stimulation (TMS): Less effective than ECT.

    Clinical Uses of Antidepressants

    • Mild depression: Often treated with non-drug measures.
    • Moderate to severe depression: Antidepressant drugs are advisable.
    • Efficacy: Varies between individuals. Antidepressants take several weeks to take effect.
    • Choice of drug: Based on individual aspects including concomitant disease.
    • SSRI preference: Generally better tolerated and less dangerous in overdose.
    • MAOIs: Prescribed by specialists.
    • Long-term use: Effective regimen should be continued for at least 2 years.
    • Urgent situations: Specialist consideration should be given to possible use of electroconvulsive therapy.
    • Anxiolytic (e.g.benzodiazepine) or antipsychotic drugs: Useful adjuncts in some patients.

    Bipolar Disorder

    • Marked by extreme mood swings, including episodes of mania and depression.
    • Lithium salts: The drug of first choice in the control of manic phases and prophylaxis of bipolar disorder.
    • Antiepileptic drugs: Effective in treating acute attacks of mania and long-term treatment.
    • Atypical antipsychotic drugs: Effective against mania and bipolar depression; often used in combination with other medications.

    Lithium Salts

    • Pharmacokinetics: Orally administered; excreted by the kidney. Narrow therapeutic margin; requires monitoring of plasma concentration.
    • Mechanism of action: Unknown; effective in both manic and depressive phases.
    • Adverse Drug Reactions (ADRs): Gastric discomfort, nausea, vomiting, diarrhea, anorexia, weight gain, polyuria, tremor, thyroid disorders, kidney disorders, fetal malformations (during first months of pregnancy).

    Antiepileptic Drugs

    • Carbamazepine: Enzyme inducer.
    • Valproate: Highly teratogenic (can cause spina bifida).
    • Lamotrogine: Effective in preventing the recurrence of both mania and depression.

    Atypical Antipsychotic Drugs

    • Olanzapine, Risperidone, Quetiapine, Aripiprazole: Second generation drugs developed for schizophrenia; effective against mania and bipolar depression.
    • Haloperidol: Indicated for prophylaxis of maniac-depressive disease.

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