SV_Antidepressant Drugs.pptx

Drugs Used to Treat Depression Dr. Abel Antidepressants Major Groups of Antidepressant Drugs:  Tricyclic antidepressants (TCA’s)  Selective serotonin reuptake inhibitors (SSRI’s)  Serotonin/norepinephrine reuptake inhibitors (SNRI’s)  Monoamine oxidase inhibitors (MAOI’s)  Atypical drugs Bipola...

Drugs Used to Treat Depression Dr. Abel Antidepressants Major Groups of Antidepressant Drugs:  Tricyclic antidepressants (TCA’s)  Selective serotonin reuptake inhibitors (SSRI’s)  Serotonin/norepinephrine reuptake inhibitors (SNRI’s)  Monoamine oxidase inhibitors (MAOI’s)  Atypical drugs Bipolar Disorder:  Mood stabilizers - Lithium, valproic acid, etc. Depression Features:  Depressed mood  Loss of pleasure and interest Symptoms:  Sleep disturbances  Weight changes  Fatigue  Self doubt, guilt, worthlessness  Inability to think, concentrate  Suicidal thoughts Monoamine Neurotransmitter Deficiency Hypothesis of Depression Normal Depression Deficiency of norepinephrine (NE) and/or serotonin (5-HT) Antidepressants – Mechanism of Action Depression Depression + Drugs (TCAs, SNRIs, SSRIs) Tricyclic antidepressants (TCA’s)   Drugs – Desipramine (Norpramin), doxepin (Sinequan), clomipramine (Anafranil) Mechanism of action   Therapeutic use    Block the reuptake of norepinephrine and serotonin into nerves. Second line drugs for depression. Higher incidence of adverse effects and less safe. Antidepressant effects of tricyclic antidepressants take weeks to develop. Months may be necessary for maximal antidepressant effects. Other uses include:  First-line drugs for neuropathic pain and fibromyalgia. Used for insomnia, ADHD, panic disorder, etc. Tricyclic Antidepressants (TCA’s) Mild mania, agitation Overdose – lower margin of safety, cardiac arrhythmias cause toxicity Suicidal thinking in the young Yawngasm - clomipramine Selective Serotonin Reuptake Inhibitors (SSRI’s) Depression SSRI’s Selective serotonin reuptake inhibitors (SSRI’s)  Mechanism   Therapeutic use      Selectively block the reuptake of serotonin into nerves. Drugs - fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro). First line drugs. Most used antidepressant drugs. Effective with fewer adverse effects. Antidepressant effects develop in weeks. Maximal antidepressant effects in months. Other uses  Obsessive compulsive disorder, panic disorder, bulimia nervosa, post-traumatic stress disorder, etc. 1-2 Selective Serotonin Reuptake Inhibitors (SSRI’s) Withdrawal syndrome – Headache, nausea, anxiety, dysphoria – taper dose off Serotonin syndrome – Agitation, confusion, incoordination, tremor, fever Neonatal effects in newborn – Abstinence syndrome, pulmonary hypertension Abnormal bleeding Suicidal thinking in the young Black Box Warning! Suicidality in Children, Adolescents, Young Adults Antidepressants increase the risk of suicidal thinking and behavior (suicidality) in children, adolescents and young adults with major depressive disorder and other psychiatric disorders. Anyone considering the use of antidepressants in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Serotonin/norepinephrine reuptake inhibitors (SNRI’s)  Venlafaxine (Effexor), desvenlafaxine (Pristiq), Duloxetine (Cymbalta) – Commonly used drugs. Effects similar to SSRI’s but have more adverse effects. Sexual dysfunction - anorgasim, decreased libido Nausea, insomnia, sweating, dry mouth Withdrawal syndrome – taper dose off Suicidal thinking in the young Atypical Drugs Bupronion and mirtazapine are often used. Other atypical drugs have less use. Release Bupropion (Wellbutrin, Zyban) – Has stimulant activity. Increased sexual desire and no weight gain. Used to treat depression and for smoking cessation. Can cause agitation and tachycardia. Mirtazepine (Remeron) - Releases the neurotransmitters NE and 5-HT. Little sexual dysfunction. Drowsiness and weight gain are common. Monoamine Oxidase Inhibitors (MAOI’s) – Phenelzine (Nardil) These drugs are effective but are third line antidepressants that can have severe adverse effects which limits their use. T = NE, 5-HT Adverse effects: CNS stimulation- anxiety, agitation, mania Orthostatic hypotension Hypertensive crisis with norepinephrine releasing drugs St. John’s Wort Warning Bipolar Disorder   Fluctuations in mood. Mania (euphoric, mild or psychotic) – euphoria, hyperactivity etc. - alternating with depression. Drugs used for bipolar disorder include:  Mood stabilizers – lithium, valproate (most commonly used drugs), carbamazepine. Reduce mania and depression symptoms.  Antidepressants – bupropion, venlafaxine, SSRI’s including fluoxetine and others.  Antipsychotic drugs – olanzapine, risperidone for psychotic mania and to prevent bipolar mania and depression.  Various combinations of these drugs may be used. Bipolar Disorder - Lithium   Low therapeutic index. Measurement of plasma lithium levels may be necessary. Adverse effects of lithium:    Therapeutic doses -Teratogenesis, fine hand tremor, polyuria, GI upset, fatigue. Excessive doses - Coarse tremor, confusion, sedation, incoordination, hypotension, seizures, coma, ECG changes. Low plasma sodium causes retention of lithium and toxicity can occur.