Tx of Depression
Terms
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- Action of Antidepressants
- Target Serotonin and NE levels
- Amine Hypothesis
- Decreased levels of important monoamines in brain is responsible for depression (ie. Serotonin & NE)
- Problems with Amine Hypothesis
-
5-HT or NE depletion in healthy people doesn't result in depression
-efficacy in tx takes weeks - Effects of prolonged tx wth antidepressants
- -Repeated exposure to ADs may lead to a decrease in the number of autoreceptors for 5-HT & Serotonin
- Classes of Antidepressants
-
+Tricyclics
+MAO Inhibators
+SSRIs (most commonly used)
+Atypical - Mechanism for Tricyclics
-
-All block reuptake of NE
-Some block reuptake of 5-HT - Mechanism for SSRIs
- -Selectively block serotonin uptake
- Mechanism for MAO Inhibitors
-
-Prevents metabolism of monoamines
-MAO A metabolizes 5-HT & NE - Mechanism for Atypical
- Blocks uptake of NE, 5-HT, and dopamine
- Tx of Major Depression
- All antidepressants are equally effective
- Tx of Bipolar
-
-Lithium--evens out mood swings
-Antipsychotic/benzos
-Antidepressants
-Anticonvulsants (Valproic Acid)
++Must closely monitor liver function when taking lithium or valproic acid++ -
Adverse Effects
Tricyclics, MAO Inhibitors, SSRIs, Atypical -
Tricyclics have varied sites of action -->more likely to produce side effects
(sedation, weight gain, hypotension, constipation)
MAO Inhibitors = sleep disturbances, weight gain, postural hypotension
SSRIs-nausea, vomitting, headache, sexual dysfunction, and insomnia
(BEST TOLERATED) - Overdose Tricyclic/MAO Inhibitors
-
Coma, Respiratory Depression, agitation or delirium, seizures, cardiac manifestations
Can be FATAL! - Treatment Duration
-
-If pt. responds to treatment, medication should be continuted for 6-12 months.
-Up to 50% of pts. do not experience full therapeutic effects though...
-If resistant, try increasing dose, increasing duration or switch compounds