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Presented by:Zafreen chaudary
Definition of Depression
“An affective disorder characterized by loss of interest or pleasure in almost all a person’s usual activities or pastimes.”
Symptoms Associated With Depression Sadness, Despair,
Guilt, Pessimism Decrease in energy Decrease in sex
drive Insomnia and fatigue Thoughts of death
and suicide Mental slowing, lack
of concentration
Treatment of Depression
Antidepressant Pharmacology First introduced 40 years ago Also used for treatment of other
disorders including:Anxiety disorders, dysthymia, chronic pain and behavioral problems
Treatment
Evolution of drug therapy Antidepressants discovered accidentally while
investigating antipsychotic efficacy of modifications of phenothiazines
Imipramine - first antidepressant discovered Around the same time, monoamine oxidase
inhibitors were identified Late 1980’s- SSRI’s were developed Now working on other antidepressant treatments
Serotonin - Specific Reuptake Inhibitors (SSRI’s) Available for the past 15 years Allows for more serotonin to be
available to stimulate postsynaptic receptors
Available to treat depression, anxiety disorders, ADHD, obesity, alcohol abuse, childhood anxiety, etc.
Citalopram
Citalopram (Celexa) – well absorbed orally, few drug interactions, treats major depression, social phobia, panic disorder and OCD its side effects are as follow:
drowsiness, tired feeling; sleep problems
(insomnia); mild nausea, diarrhea,
upset stomach, dry mouth;
cold symptoms such as stuffy nose, sneezing, sore throat, cough;
increased sweating or urination, weight changes; or.
decreased sex drive, impotence, or difficulty having an orgasm.
Escitalopram
It prevents the reuptake of one neurotransmitter, serotonin, an action which results in more serotonin in the brain to attach to receptors. The FDA approved escitalopram in August 2002. But it has some side effects drowsiness, dizziness; sleep problems (insomnia);mild nausea, gas, heartburn, upset stomach, constipation; weight changes; decreased sex drive, impotence, or difficulty having an orgasm; or. dry mouth, yawning, ringing in your ears
Fluoxetine
Fluoxetine (Prozac) – first SSRI available, long half life, slow onset of action, can cause sexual dysfunction, anxiety, insomnia and agitation
Fluvoxamine (Luvox) – structural derivative of Prozac, became available for OCD, also treats PTSD, dysphoria, panic disorder, and social phobia
SSRI’s
Paroxetine (Paxil) – third SSRI available, more selective than Prozac, highly effective in reducing anxiety and posttraumatic stress disorder (PTSD) as well as OCD, panic disorder, social phobia, premenstrual dysphoric disorder, and chronic headache
Sertraline (Zoloft) – second SSRI approved, low risk of toxicity, few interactions, more selective and potent than Prozac
SSRI’s
Serotonin syndrome At high doses or combined with other drugs an
exaggerated response can occur This is due to increased amounts of serotonin Alters cognitive function, autonomic function and
neuromuscular function Potentially fatal
Serotonin withdrawal syndrome With discontinuation of any SSRI onset of withdrawal
symptoms occur within a few days and can persist 3-4 weeks
Symptoms: disequilibrium, gastrointestinal problems, flu-like symptoms, sensory disturbances, sleep disturbances
SEROTONIN/NOREPINEPHRINE REUPTAKTE INHIBITORS SNRIs
SNRIs may be effective in treating depression in patient in whom SSRIs are ineffective
Depression is often accompanied by chronic painful symptoms such as, backache, and muscle ache. Both SNRIs and TCAs with their dual inhibition of both serotonin and norepinephrine reuptake are effective in relieving such pains.
VENLAFAXINE
Venlafaxine (VEN-la-fax-een) is potent inhibitor of serotonin reuptake.
The most common side effects of venlafaxine are nausea, headache, sexual dysfunction, dizziness, insomnia, sedation and constipation.
High doses may be increase blood pressure and heart rate.
DULOXETINE
Duloxetine (doo-LOX-e-teen) inhibit serotonin and norepinephrine reuptake at all doses.
G1 side effects are common with duloxetine.
Overdose may increase blood pressure and heart rate.
LEVONMILNAXCIPRAN
Levonmilnacipran (leevo-mil-NA-si-pran) use for treatment of depression and its side effects are same as the other SNRIs.
Second Generation (Atypical) Antidepressants Developed in the late 1970’s and 1980’s Bupropion – selectively inhibits Dopamine reuptake,
used for ADHD, side effects include: anxiety, restlessness, tremors, and insomnia
Mirtazapine- it enhances serotonin and norepinephrine neurotransmitter. Mirtazapine is used to treat Major depressive disorder, side effect includes: Dizziness, Drowsiness ,Dry Mouth, Feeling Weak, High Cholesterol, Incomplete or Infrequent Bowel Movements, Increased hunger, Weight Gain.
Trazodone
Trazodone probably improves symptoms of depression by inhibiting the uptake of serotonin by nerves in the brain. This results in more serotonin to stimulate other nerves. Trazodone also may increase directly the action of serotonin.
Side effects including: Headache, Muscle ache, Nausea, vomiting, loss of appetite, or stomachache.Constipation or diarrhea, Loss of interest in sex (erectile dysfunction in men) Dizziness or loss of balance, Dry mouth or dry eyes, Numbness, burning, or tingling sensations.
It will not cause of weight gain.
Tricyclic Antidepressants Effectively relieve depression with anxiolytic (used to
reduce anxiety) and analgesic action (a remedy that relieves pain)
First choice for treatment of depression Pharmacological properties
Block presynaptic norepinephrine reuptake transporter Block presynaptic serotonine reuptake transporter Block postsynaptic histamine receptors Block postsynaptic acytalcholine receptors
Imipramine and Amitriptyline Prototypical Tricyclic Antidepressants Desipramine (Norpramin) –
pharmacologically active intermediate metabolite of imipramine (tofranil)
Nortriptyline (Pamelor) – an active intermediate metabolite of amitriptyline (elavil)
Clinical Limitations of Tricyclic Antidepressants Slow onset of action Wide variety of effects on CNS (adverse side effects):
Can directly impair attention, motor speed, dexterity (learning skills), and memory
Cardiotoxic and potentially fatal in overdoses
Pharmacological Effects of Tricyclic Antidepressants In CNS: blocks presynaptic serotonin, norepinephrine
receptors Blocking of Acetylcholine receptors leads to dry mouth,
confusion, blurry vision and mental confusion Blocking of histamine receptors leads to drowsiness and
sedation Effects on the Peripheral nervous system include: cardiac
depression, increased electrical irritability, can be life threatening with over dosages
THANKYOU