Anti Depressant Anti Depressant AgentsAgents

Anti Depressant Anti Depressant AgentsAgents

What is depression?• Depressed mood• Feelings guilt• Impaired

concentration• Loss of interest• Fatigue• Sleep & weight

changes• Suicidal thoughts

Types of Depression• Reactive

– Adverse life event– Physical illness– Drugs– senility

• Major Depressive– Family history– May occur at any

age– Unresponsive to

changes in life

(endogenous)

DSM-IV-TR Criteria for Major Depressive

Episode• 5 or more present during same 2

week period & represents a change from previous functioning.

• Depressed qd – fatigue – death thoughts- agitation - retardation

• Diminished interest- feelings guilt• Weight loss - insomnia -worthless

How do the drugs work?

• Manipulation of neurotransmitter metabolism

• Prevention of neurotransmitter re-uptake

• Selective receptor antagonism

Indications• Depression• Obsessive-Compulsive Disorder• Panic Disorders• Enuresis• Chronic Pain

Therapeutic Classes• Tricyclic Anti-depressants• Imipramine(Tofranil)

Amitriptyline(Elavil– MOA– System Effect (sedation, weight gain,

orthostatic hypotension)– Overdose

2nd & 3rd Generation• Amoxapine• Maprotiline• Trazadone• Bupropion• Venlafaxne• Mirtazapine• Nefazodone

• MOA

• System Effect

• Overdose

SSRI’s MAO’s• Selective Serotonin

Reuptake Inhibitors– MOA– Toxicity

• No sedation• Serotonin Syndrome

– Fluoxetine, Fluvoxamine Paroxetine Sertraline Venlafaxine

• Monoamine Oxidase Inhibitors– MOA– Toxicity

• Hypertensive crisis

– Drug Interactions Plentiful!

– No outpatient use– Phenelzine (Nardil)

Treatment Schedules• Find the right drug for the right patient• Empirical Determination

– Patient acceptance– Adverse effects– Tolerance

• Labs do not rule over clinical judgment• LOOK AT PATIENT!

Drug Interactions• CNS depressants & Etoh- enhance

depressant effect

• AntiThyroid drugs & TCA- increased risk of granulocytosis

• MAOI’s & TCA–contraindicated in outpt setting HTN crisis

• Sympathomimetics & TCA- increase CV toxicities (HTN, tachycardia, dysrhythmias)

Drug Interactions cont.

• SSRI’s & MAOI’s – HTN crises, serotonin syndrome, death

• SSRI’s & St Johns Wart – serotonin syndrome

Bad Wrap?!

Second Opinion

• Studies show that U.S. suicides have dropped 15% since SSRI’s were introduced

• Biggest cause of Suicide?