High Yield Anti-depressants PDF

WE MAKE DOCTOR S  High yield Anti-depressants Simón Quetzalcoatl Rodríguez Lara MD, PhD. Patricia Anaid Romero MD. Sonia Guadalupe Barreno Rocha MD. Sandra Guzmán Silahua MD, PhD. Objectives Differentiate the pharmacokinetics and pharmac...

WE MAKE DOCTOR S  High yield Anti-depressants Simón Quetzalcoatl Rodríguez Lara MD, PhD. Patricia Anaid Romero MD. Sonia Guadalupe Barreno Rocha MD. Sandra Guzmán Silahua MD, PhD. Objectives Differentiate the pharmacokinetics and pharmacodynamics of the main Anti-depressants. Understand the pharmacokinetics, pharmacodynamics, adverse effects, and drug interactions of Anti- depressants. Affective Disorders Affective disorders are also called mood disorders. The two most common affective disorders are: Major depressive Bipolar disorder Disorder The primary drugs used in their treatment are antidepressant drugs and mood-stabilizing drugs. Major Depressive Disorder (Unipolar depression) Depressed mood Loss of interest or pleasure in life Characteriz Sleep disturbances ed by Feelings of worthlessness Diminished ability to think or concentrate Recurrent thoughts of suicide Depressed patients can also be irritable or Bipolar Disorder Characterized by recurrent fluctuations in mood, energy, and behavior that encompass the extremes of human experience. This disorder differs from major depression in that periods of mania alternate or occur simultaneously with depressive symptoms. ↑ mood Inflated self-esteem (grandiosity) As the manic phase ↑ talking (pressure of speech) intensifies, some Mania Racing thoughts (flight of ideas) patients experience ↑ social or work activity psychotic ↓ need for sleep. symptoms such as delusions. Typically, the manic phase occurs just before or just after a depressive episode. In many patients, depressive and manic episodes last several weeks or months. ANTIDEPRESS ANT DRUGS 2.- Selective Serotonin Reuptake Because Inhibitors depressed (SSRIs) patients might 3.- 1.- Serotonin attempt suicide, Tricyclic and the safety of an Norepineph antidepre rine antidepressant ssants Depressi Reuptake in overdose is (TCAs) on can inhibitors an important be (SNRIs), treated consideration with: when selecting a drug for a 5.-If patients 4.- Other particular patient. fail to respond antidepressants to these drugs, that have monoamine different oxidase structures and inhibitors act by various (MAOIs) can be mechanisms of used. action.  Selective Serotonin Reuptake Inhibitors SSRI Family Selective serotonin Reuptake inhibitors Fluoxetine, fluvoxamine, paroxetine, sertraline, escitalopram, citalopram. MOA Clinical Adverse Use effects Inhibit 5-HT Depression Fewer than TCAs. reuptake Generalized anxiety disorder Serotonin syndrome, Panic disorder GI distress, SIADH, OCD sexual dysfunction Bulimia (anorgasmia, erectile Binge-eating disorder dysfunction, ↓ libido), Social anxiety disorder mania precipitation if PTSD underlying bipolar Premature ejaculation disorder Premenstrual dysphoric disorder  Serotonin-Norepinephrine Reuptake Inhibitors (SNRI) Family Venlafaxine, desvenlafaxine, duloxetine, levomilnacipran, milnacipran. MOA Clinical Adverse Use effects Depression ↑BP Inhibit 5-HT Generalized Anxiety Disorder Stimulant effects and NE Diabetic neuropathy Sedation reuptake Sexual dysfunction Venlafaxine: is also indicated for Nausea. social anxiety disorder, panic disorder, PTSD, OCD. Duloxetine and milnacipran: are also indicated for fibromyalgia.  Atypical anti-depressants Family (Unicyclic) Bupropion. MOA Clinical Adverse Use effects Stimulant effects Norepinephrin Depression Tachycardia, insomnia e/dopamine- Smoking cessation Headache, and reuptake seizures in patients inhibitor with bulimia and anorexia nervosa. Less risk to develop sexual adverse effects and weight gain compared to another antidepressants  Atypical anti-depressants Family (Tetracyclic) Noradrenaline and Specific Serotonin Antidepressant (NaSSA) Mirtazapine. MOA Clinical Adverse Use effects α2-adrenergic receptors Depression Sedation Anorexia nervosa, weight gain, Increase appetite, antagonist (which increase sleep disturbances, pain-relieving weight gain, dry the effect of NE and effect. mouth, suicidal serotonin). 5-HT2 and 5-HT3 receptors ideation and antagonist. behavior. Peripheral α1-adrenergic antagonist. Histamine H1 receptor antagonist Kappa-type opioid receptor  Atypical anti-depressants Family (Serotonin modulator) Trazodone. MOA Clinical Adverse Use effects Sedation, nausea, Strong 5-HT2 antagonist Primarily in insomnia priapism, postural Low antagonist effect in Depression hypotension and QT- 5-HT3. interval prolongation. α1-adrenergic and α2- adrenergic receptor antagonist. Histamine H1 receptor antagonist.  Atypical anti-depressants Family (Serotonin partial agonist reuptake inhibitor) Vilazodone. MOA Clinical Adverse Use effects Headache, diarrhea, 5-HT3 Depression nausea, antagonist [Major depressive disorder (MDD)] anticholinergic effect. 5-HT1A Increase the risk of agonist serotonin syndrome if is taken with other serotonergic agents.  Atypical anti-depressants Family (Serotonin modulator and stimulator) Vortioxetine. MOA Clinical Adverse Use effects Nausea, sexual 5-HT3, 5-HT1D and 5- Depression dysfunction, sleep HT7 receptors [Major depressive disorder (MDD)] disturbances, antagonist. anticholinergic effects, 5-HT1A agonist. and may cause 5-HT1B partial agonist. serotonin syndrome if taken with other serotonergic agents.