‌
A
‌ NTIDEPRESSANTS‌   ‌ ‌
 ‌
‌CLASSIFICATION‌  ‌
Dose‌r‌ ange‌g‌ iven‌i‌n‌m
‌ g/day.‌  ‌

 ‌ Selective‌‌Serotonin‌‌Reuptake‌‌Inhibitor‌  ‌
(Inhibition‌‌of‌‌monoamine‌‌receptors‌‌by‌‌SSRi‌‌leads‌‌to‌‌decrease‌‌monoamine‌‌reuptake‌‌ 
‌SSRI‌  ‌ and‌‌increases‌‌Neurotransmitter‌‌in‌‌Synaptic‌‌Cleft.‌‌This‌‌leads‌‌to‌‌downregulation‌‌of‌‌ 
   ‌ ‌ 5HT‌1A‌‌ ‌Receptor.‌‌The‌‌Genome‌‌reaction‌‌to‌‌this‌‌information‌‌leads‌‌to‌‌a‌‌decreased‌‌ 
‌ ommon‌   ‌ ‌ 5HT‌1A‌‌ ‌Receptor‌‌expression.‌‌5HT‌‌release‌‌is‌‌increased‌‌and‌‌builds‌‌up‌‌in‌‌the‌‌synapse.‌‌ 
C
This‌‌leads‌‌to‌‌postsynaptic‌‌5HT‌1A‌‌ ‌Receptor‌‌to‌‌desentesize.)‌  ‌
F‌ eatures‌  ‌

 ‌ ‌Mechanism‌‌of‌‌actions‌‌and‌‌some‌‌important‌‌points.‌  ‌
Fluoxetine‌  ‌ SERTi‌+‌ ‌‌5HT‌2C‌i‌‌+‌‌NETi‌‌   5HT2Ci‌‌‌leads‌‌to‌‌increased‌‌cognition‌‌and‌‌ 
[20-60mg]‌  ‌ attention,‌‌reduced‌‌fatigue,anti‌‌bulimia‌‌effect‌‌ 
but‌‌also‌‌causes‌‌agitation,insomnia,‌‌anxiety.‌  ‌
Longest‌‌acting.‌  ‌

Fluvoxamine‌  ‌ SERTi‌+‌ ‌‌σ1‌a‌ gonism‌  ‌ σ1‌‌Binding‌c‌ auses‌‌anxiolytic‌‌and‌‌ 

[50-300mg]‌  ‌ antipsychotic‌‌properties.‌  ‌

S‌ ertraline‌  ‌ SERTi‌+‌ ‌‌σ1‌a‌ gonism‌+‌ ‌‌DATi‌  ‌ σ1‌‌Binding‌c‌ auses‌‌anxiolytic‌‌and‌‌ 

[50-200‌‌mg]‌‌   ‌ antipsychotic‌‌properties‌‌but‌‌this‌‌action‌‌is‌‌ 
less‌‌than‌‌fluvoxamine.‌  ‌

‌ italopram‌  ‌
C R‌‌+‌‌S‌‌Enantiomers‌‌   ‌ H1‌‌inhibition‌‌ l‌eads‌‌to‌‌sedation,‌‌and‌‌QTc‌‌ 
‌[20-40‌‌mg]‌  ‌
(H1‌‌i‌‌+‌‌SERT‌‌i)‌  ‌ prolongation.‌  ‌

Escitalopram‌  ‌
S‌‌Enantiomer‌‌(SERT‌‌i)‌  ‌ Pure‌‌SERT‌‌inhibition‌  ‌
‌[10-20‌‌mg]‌  ‌

‌ aroxetine‌  ‌
P SERTi‌‌+‌‌M1‌A‌ ntagonism‌‌ ‌+ ‌ M1‌‌Inhibition‌‌ s‌ edation‌‌and‌‌anticholinergic‌‌ 
‌[20-50mg]‌  ‌
 ‌
NETi‌  ‌ action.‌  ‌
NOS‌‌inhibition‌c‌ auses‌‌sexual‌‌dysfunction.‌  ‌

 ‌
  ‌ Serotonin‌‌Partial‌‌agonist/‌‌Reuptake‌‌Inhibitor‌  ‌
(Inhibition‌‌of‌‌monoamine‌‌receptors‌‌by‌‌blocking‌‌SERT‌‌and‌‌along‌‌with‌‌it‌‌has‌‌partial‌‌ 
‌SPARI‌  agonistic‌‌action‌‌on‌‌5HT‌1A‌‌ ‌Receptor‌‌leading‌‌to‌‌more‌‌rapid‌‌increase‌‌in‌‌5HT‌‌level‌‌in‌‌ 
  ‌  ‌ synaptic‌‌cleft.)‌  ‌
C‌ ommon‌   ‌ ‌
F‌ eatures‌  ‌

‌Vilazodone‌  ‌ SERTi‌+‌ ‌‌5HT1A‌ R

‌ ‌‌partial‌  ‌ 5HT1A‌‌receptor‌‌agonism‌‌‌leads‌‌to‌‌increased‌‌ 
‌[20mg]‌  ‌ further‌‌increases‌‌in‌‌the‌‌levels‌‌of‌‌5HT‌‌and‌‌ 
agonism‌  ‌ acts‌‌like‌‌artificial‌‌serotonin.Lesser‌‌sexual‌‌ 
dysfunction‌‌(Theoretically.)‌  ‌

 ‌
‌SNRI‌  ‌ Serotonin‌‌Norepinephrine‌‌reuptake‌‌Inhibitor‌  ‌
‌Common‌   ‌ ‌ (Inhibition‌‌of‌‌monoamine‌‌receptors‌‌by‌‌blocking‌‌SERT‌‌and‌‌NET‌‌and‌‌increase‌‌in‌‌5HT‌‌ 
F‌ eatures‌  ‌ and‌‌NE‌‌level‌‌in‌‌synaptic‌‌cleft.‌  ‌
Add‌‌on‌‌action‌‌NETi‌‌increases‌‌DA‌‌in‌‌the‌‌prefrontal‌‌cortex‌‌(not‌‌in‌‌any‌‌other‌‌areas‌‌of‌‌ 
the‌‌brain)‌‌DA+NE+5HT‌‌this‌‌is‌‌called‌‌as‌‌2.½‌‌Mechanism.)‌  ‌

‌ enlafaxine‌  ‌
V SERTi‌+‌ ‌‌NETi‌  ‌ SERTi‌‌Most‌‌potent‌‌and‌‌robust‌‌at‌‌lower‌‌ 
‌[75-375‌‌mg]‌  ‌ doses.‌  ‌
NETi‌‌action‌‌progressively‌‌increases‌‌as‌‌dose‌‌ 
increases.‌  ‌
Moderately‌‌potent‌‌and‌‌robust‌‌only‌‌at‌‌higher‌‌ 
doses.‌‌   ‌

DesVenlafaxine‌  ‌ SERTi‌+‌ ‌‌NETi‌  ‌ NETi‌‌>>‌‌SERTi.‌‌Women‌‌with‌‌vasomotor‌‌ 

[‌ 50mg]‌  ‌ symptoms‌‌in‌‌perimenopausal‌‌women‌‌who‌‌ 
don't‌‌want‌‌to‌‌have‌‌ERT.‌  ‌

‌ uloxetine‌  ‌
D SERTi‌+‌ ‌‌NETi‌  ‌ Relieves‌‌depression‌‌in‌‌absence‌‌of‌‌pain‌‌and‌‌ 
‌[60-120mg]‌  ‌ vice‌‌versa.‌  ‌
Fibromyalgia,Chronic‌‌Musculoskeletal‌‌pain‌  ‌
Diabetic‌‌peripheral‌‌neuropathic‌‌pain.‌  ‌

Milnacipran‌  ‌ SERTi‌+ ‌ ‌N
‌ ETi‌  ‌ More‌‌potent‌‌NET‌‌than‌‌SERT‌‌inhibitor‌‌and‌‌this‌ 
[100-200‌‌mg]‌  ‌ Day‌1‌ :‌1‌ 2.5‌m
‌ g‌o
‌ nce‌‌   ‌ activity‌‌leads‌‌to‌‌good‌‌cognitive‌‌improvement.‌  ‌
Days‌2
‌ -3:‌2
‌ 5‌m‌ g/day‌(‌ 12.5‌m
‌ g‌t‌ wice‌d‌ aily)‌‌  Side‌‌effects:‌‌Increased‌‌sweating‌‌and‌‌urinary‌‌ 
Days‌4
‌ -7:‌5
‌ 0‌m‌ g/day‌(‌ 25‌m
‌ g‌t‌ wice‌d‌ aily)‌‌   ‌ hesitancy.‌  ‌
After‌D
‌ ay‌7
‌ :‌1
‌ 00‌m
‌ g/day‌(‌ 50‌m‌ g‌t‌ wice‌d‌ aily)‌‌   ‌

Levo‌  ‌ SERTi‌+‌ ‌‌NETi‌  ‌  ‌

Milnacipran‌  ‌
[40-120‌‌mg]‌  ‌
 ‌
 ‌
‌NDRI‌  ‌ Norepinephrine‌‌Dopamine‌‌reuptake‌‌Inhibitor‌  ‌
   ‌ ‌ (Inhibition‌‌of‌‌monoamine‌‌receptors‌‌by‌‌blocking‌‌NET‌‌and‌‌DAT‌‌increase‌‌in‌‌NE‌‌and‌‌5HT‌‌ 
level‌‌in‌‌synaptic‌‌cleft.‌  ‌
Add‌‌on‌‌action‌‌NETi‌‌increases‌‌DA‌‌in‌‌the‌‌prefrontal‌‌cortex‌‌(not‌‌in‌‌any‌‌other‌‌areas‌‌of‌‌ 
the‌‌brain)‌‌DA+NE+5HT‌‌this‌‌is‌‌called‌‌as‌‌2.½‌‌Mechanism.)‌  ‌

‌ upropion‌  ‌
B DATi‌‌+‌‌NETi‌  ‌ ● Used‌‌to‌‌augment‌‌SSRI‌‌or‌‌SNRI‌‌in‌‌ 
‌[150-300‌‌mg]‌  ‌ Bupropion‌‌is‌‌a‌‌weak‌‌reuptake‌‌inhibitor‌‌  case‌‌when‌‌signs‌‌and‌‌symptoms‌‌of‌‌ 
property‌‌but‌‌is‌‌efficacious‌‌as‌‌its‌‌  residual‌‌Positive‌‌effects‌‌are‌‌seen.‌  ‌
inhibitory‌‌properties‌‌is‌‌made‌‌up‌‌by‌‌  ● Useful‌‌in‌‌treatment‌‌of‌‌reduced‌‌ 
6-HYDROXY‌‌metabolite‌‌of‌‌BUPROPION‌‌  positive‌‌effect‌‌and‌‌Dopamine‌‌ 
(Radafaxine)‌  ‌ deficiency‌‌syndrome.‌‌   ‌
 ‌ ● Bupropion‌‌does‌‌not‌‌cause‌‌sexual‌‌ 
Occupies‌‌DAT‌‌in‌‌Striatum‌‌and‌‌Nucleus‌‌  dysfunction‌‌as‌‌it‌‌lacks‌‌significant‌‌ 
Accumbens‌‌in‌‌a‌‌manner‌‌to‌‌mitigate‌‌ 
SERT‌‌inhibition.‌  ‌
craving‌‌but‌‌not‌‌sufficient‌‌to‌‌cause‌‌abuse.‌  ‌
● Non‌‌abusable‌‌and‌‌useful‌‌in‌‌ 
treatment‌‌of‌‌Nicotine‌‌De‌‌Addiction.‌  ‌

 ‌
‌NASSA‌  ‌ Nor-Adrenergic‌‌and‌‌Specific‌‌Serotonin‌‌Antidepressant.‌  ‌
‌Common‌   ‌ ‌ (Inhibition‌‌of‌‌monoamine‌‌receptors‌‌by‌‌blocking‌‌NET‌‌and‌‌DAT‌‌increase‌‌in‌‌NE‌‌and‌‌5HT‌‌ 
F‌ eatures‌  ‌
level‌‌in‌‌synaptic‌‌cleft.‌  ‌
Add‌‌on‌‌action‌‌NETi‌‌increases‌‌DA‌‌in‌‌the‌‌prefrontal‌‌cortex‌‌(not‌‌in‌‌any‌‌other‌‌areas‌‌of‌‌ 
the‌‌brain)‌‌DA+NE+5HT‌‌this‌‌is‌‌called‌‌as‌‌2.½‌‌Mechanism.)‌  ‌

‌ ianserin‌  ‌
M 5HT‌2A‌+5HT‌2C‌+5HT‌3 ‌‌ Same‌‌as‌‌above‌‌but‌‌additional‌‌effect‌‌on‌‌alpha‌‌ 
‌[30-‌‌90‌‌mg]‌  ‌ 1‌‌receptors.‌  ‌
Antagonist‌‌+‌‌α1‌+‌ ‌‌α2‌‌ 
antagonist‌‌+‌‌H1‌‌ 
Antagonist.‌  ‌
Mirtazapine‌  ‌ α2‌‌antagonist‌+‌ 5HT‌2A‌‌ ‌+ ‌‌ α2‌‌antagonist‌‌actions‌‌yield‌‌dual‌‌increase‌‌of‌‌ 
[15‌‌-‌‌45‌‌mg]‌  ‌ both‌‌5HT‌‌and‌‌NE‌‌release.‌‌(SNRI‌‌also‌‌ 
5HT‌2C‌+5HT‌3‌A
‌ ntagonist‌‌+ ‌‌ increases‌‌both‌‌5HT‌‌and‌‌NE‌‌release‌‌by‌‌the‌‌ 
H1‌‌Antagonist.‌  ‌ monoamine‌‌transporter‌‌blockage.)‌  ‌
These‌‌two‌‌mechanisms‌‌are‌‌synergistic‌‌so‌‌by‌‌ 
blocking‌‌both‌‌of‌‌them‌‌will‌‌lead‌‌to‌‌a‌‌greater‌‌ 
disinhibitory‌‌signal‌‌for‌‌these‌‌two‌‌ 
neurotransmitters.‌‌For‌‌this‌‌reason‌‌ 
Mirtazapine‌‌is‌‌often‌‌combined‌‌with‌‌SNRI‌‌for‌‌ 
cases‌‌who‌‌don't‌‌respond‌‌to‌‌SNRI‌‌alone.‌‌This‌‌ 
combination‌‌is‌‌often‌‌called‌‌as‌‌CALIFORNIA‌ 
ROCKET‌‌FUEL.‌  ‌
 ‌
‌NARI‌  ‌ Norepinephrine‌‌Reuptake‌‌Inhibitor‌  ‌
‌Common‌   ‌ ‌ (Inhibition‌‌of‌‌monoamine‌‌receptors‌‌by‌‌blocking‌‌NET‌‌and‌‌DAT‌‌increase‌‌in‌‌NE‌‌and‌‌5HT‌‌ 
F‌ eatures‌  ‌ level‌‌in‌‌synaptic‌‌cleft.‌  ‌

‌Reboxetine‌  ‌ NETi‌  ‌ Being‌s‌ elective‌i‌ncreases‌s‌ edation‌i‌n‌‌ 

‌[8-12mg]‌  ‌ (Increases‌N ‌ iffusively‌a‌ cross‌a‌ ll‌‌  some‌p
‌ E‌d ‌ atients‌d‌ ue‌t‌ o‌o
‌ verturning‌N
‌ A‌‌ 
 ‌ parts‌a‌ nd‌i‌ncreases‌D ‌ A‌i‌n‌‌  inputs‌t‌ o‌p
‌ yramidal‌n ‌ eurons.‌  ‌
‌Edivoxetine‌  ‌ prefrontal‌c‌ ortex.)‌  ‌
  ‌ ‌
 ‌ Serotonin‌‌antagonist/‌‌Reuptake‌‌Inhibitor‌  ‌
(Inhibition‌‌of‌‌monoamine‌‌reuptake‌‌by‌‌blocking‌‌SERT‌‌and‌‌it‌‌also‌‌has‌‌antagonistic‌‌ 
‌SARI‌  ‌ action‌‌on‌‌5HT‌2A‌‌ ‌5HT‌2C‌‌ ‌Receptor‌‌leading‌‌to‌‌more‌‌rapid‌‌increase‌‌in‌‌5HT‌‌level‌‌in‌‌ 
   ‌ ‌ synaptic‌‌cleft.).‌‌This‌‌feature‌‌makes‌‌it‌‌different‌‌from‌‌SSRi‌‌as‌‌both‌‌increase‌‌the‌‌level‌‌ 
‌ ommon‌   ‌ ‌ of‌‌5HT‌‌in‌‌synapse‌‌but‌‌SARi‌‌ensures‌‌that‌‌the‌‌raised‌‌5HT‌‌acts‌‌only‌‌via‌‌5HT1A‌‌ 
C
receptor‌‌as‌‌it‌‌blocks‌‌5HT‌2A‌‌ ‌5HT‌2C‌‌ ‌Receptors.‌  ‌
F‌ eatures‌  ‌

T‌ razodone‌  ‌ 5HT‌2A‌‌ ‌&‌‌5HT‌2C‌‌ ‌Receptor‌‌  At‌‌low‌‌dose‌‌only‌‌acts‌‌on‌‌5HT2A‌‌and‌‌causes‌‌ 

‌[150-300mg]‌  ‌ its‌‌antagonism‌‌along‌‌with‌‌this‌‌it‌‌also‌‌acts‌‌ 
Antagonism‌‌+‌‌SERTi‌‌   ‌ upon‌‌H1(antagonism)‌‌+‌‌α1‌‌adrenergic‌‌ 
 ‌
Hypnotic‌‌dose:‌‌   ‌ (antagonist)‌‌but‌‌acts‌‌weakly‌‌upon‌‌5HT2C‌‌ 
and‌‌on‌‌SERT.‌‌At‌‌low‌‌doses‌‌acts‌‌as‌‌hypnotic.‌  ‌
[25-150‌‌mg]‌  ‌  ‌
 ‌ SARi‌‌ensures‌‌that‌‌the‌‌raised‌‌5HT‌‌acts‌‌only‌‌ 
Antidepressant‌‌  via‌‌5HT1A‌‌receptor‌‌as‌‌it‌‌blocks‌‌5HT‌2A‌‌ ‌and‌‌ 
dose:‌  ‌ 5HT‌2C‌‌ ‌receptors‌‌thus‌‌it‌‌has‌‌no‌‌side‌‌effects‌‌ 
[150-300‌‌mg]‌  ‌ like‌‌sexual‌‌dysfunction,‌‌insomnia,‌‌anxiety‌‌ 
which‌‌is‌‌mediated‌‌by‌‌5HT‌2A‌‌ ‌and‌‌5HT‌2C‌ ‌
receptors.‌  ‌

 ‌
Nafazodone‌‌is‌‌also‌‌a‌‌SARI.‌  ‌
 ‌
New:‌‌   ‌
SARE‌‌(Serotonin‌‌antagonist‌‌and‌‌reuptake‌‌enhancer)‌  ‌
1. Tianeptine‌  ‌
2. Amineptine‌  ‌
 ‌
 ‌
‌TCA‌  ‌ Tricyclic‌‌Antidepressant.‌  ‌
   ‌ ‌ (Inhibition‌‌of‌‌receptors‌‌5HT2‌A‌‌,5HT‌2C‌,‌‌SERTi‌‌and‌‌NETi)‌  ‌

Common‌‌  Inhibition‌‌of‌‌receptors‌‌  By‌‌Inhibition‌‌of‌‌receptors‌‌‌5HT2‌A‌‌,5HT‌2C‌, ‌‌

Features‌  ‌ SERTi‌‌and‌‌NETi‌i‌t‌‌shows‌‌ANTIDEPRESSANT‌‌ 
5HT2A‌‌,5HT2C,‌‌SERTi‌‌and‌‌  EFFECTS.‌  ‌
NETi‌  ‌  ‌
SIDE‌‌EFFECTS:‌  ‌
H1‌‌blockage:‌W ‌ eight‌‌gain;‌‌drowsiness.‌  ‌
α1‌‌blockage:‌‌‌Hypotension;‌‌drowsiness‌‌and‌‌ 
dizziness.‌  ‌
M1‌‌blockage:‌C ‌ onstipation,‌‌blurred‌‌vision,‌‌ 
dry‌‌mouth,‌‌drowsiness.‌  ‌
Voltage‌‌sensitive‌‌Na+‌‌channels‌‌blockage:‌  ‌
IN‌‌BRAIN:‌S‌ EIZURES,‌‌COMA.‌  ‌
IN‌‌HEART:‌A ‌ RRHYTHMIA,‌‌DEATH.‌  ‌

 ‌ Amitriptyline‌‌[50-200]‌‌mg‌  ‌ Clomipramine‌‌[30-250mg]‌  ‌
DOSE‌  ‌
 ‌ Imipramine‌‌[50-200‌‌mg]‌  ‌ Nortriptyline‌‌[75-150‌‌mg]‌  ‌

Lofepramine‌‌[140-210‌‌mg]‌  ‌ Trimipramine‌‌[50-300‌‌mg]‌  ‌

 ‌ Dosulepin‌‌(Dothepin)[75-225‌‌mg]‌  ‌ Doxepin‌‌[30-300‌‌mg]‌  ‌

 ‌
TETRACYCLIC‌‌   ‌ Mianserin‌‌   ‌ Amoxapine‌  ‌
ANTIDEPRESSANT‌  ‌ Maprotiline‌  ‌

 ‌
BICYCLIC‌‌   ‌ Viloxazine‌  ‌  ‌
ANTIDEPRESSANT‌  ‌

  ‌
  ‌
  ‌
  ‌
  ‌
  ‌
  ‌
 MAOi‌  ‌ Monoamine‌‌oxidase‌‌inhibitor‌‌(‌ Brain‌‌MAO-A‌‌inhibition‌‌has‌‌to‌‌be‌‌done‌‌ 
to‌‌mediate‌‌antidepressant‌‌efficacy‌‌as‌‌MAO-A‌‌preferentially‌‌metabolizes‌‌serotonin‌‌ 
and‌‌norepinephrine.)‌  ‌

Common‌‌  By‌‌inhibition‌‌of‌‌MAO-A‌‌it‌‌causes‌‌an‌‌ 
Only‌‌MAO-A‌‌inhibition‌‌leads‌‌to‌‌robust‌‌ 
Features‌  ‌ increase‌‌in‌‌the‌‌level‌‌of‌‌Serotonin,‌‌ 
increase‌‌in‌‌the‌‌level‌‌of‌‌5Ht‌‌and‌‌NE‌‌and‌‌ 
Nor-epinephrine‌‌and‌‌Dopamine‌‌at‌‌ moderate‌‌increase‌‌in‌‌the‌‌levels‌‌of‌‌DA.‌‌As‌‌it‌‌ 
synaptic‌‌clefts.‌  ‌ increases‌‌these‌‌levels‌‌in‌‌a‌‌sufficient‌‌amount,‌‌ 
 ‌ is‌‌able‌‌to‌‌mediate‌‌the‌‌antidepressant‌‌action.‌  ‌
 ‌  ‌
Only‌‌MAO-B‌‌inhibition‌‌leads‌‌to‌‌moderate‌‌DA‌‌ 
MAO-A‌  ‌ MAO-B‌  ‌
level‌‌increase‌‌and‌‌its‌‌effect‌‌is‌‌irrelevant‌‌as‌‌ 
Substrates:‌  ‌ Substrates:‌  ‌ far‌‌as‌‌NE‌‌and‌‌5HT‌‌is‌‌concerned‌‌and‌‌it‌‌is‌‌thus‌‌ 
5HT,‌‌NE,‌‌DA,‌‌  DA,‌‌Tyramine,‌‌  not‌‌able‌‌to‌‌mediate‌‌its‌‌action‌‌as‌ 
Tyramine.‌  ‌ Phenylethylamine.‌  ‌ antidepressant‌‌action‌‌but‌‌is‌‌used‌‌in‌‌ 
treatment‌‌of‌‌Parkinson’s‌‌Disease.‌  ‌
Location:‌  ‌ Location:‌  ‌  ‌
Brain,‌S‌ kin,‌‌  Brain,‌‌  Both‌‌MAO-A‌‌and‌‌MAO-B‌‌inhibition‌‌leads‌‌to‌‌ 
Liver,‌‌  Lymphocytes,‌‌  very‌‌high‌‌rise‌‌in‌‌concentration‌‌of‌‌DA,5HT‌‌ 
Placenta.‌  ‌ platelets.‌  ‌ and‌‌NE‌‌at‌‌the‌‌synaptic‌‌cleft‌‌leading‌‌to‌‌robust‌‌ 
antidepressant‌‌action.‌  ‌
 ‌
 ‌
Thus,‌‌MAO-A‌‌and‌‌MAO-B‌‌inhibition‌‌is‌‌one‌‌of‌‌ 
the‌‌few‌‌therapeutic‌‌measures‌‌available‌‌to‌‌ 
increase‌‌dopamine‌‌in‌‌depression,‌‌and‌‌ 
therefore‌‌to‌‌treat‌‌refractory‌‌symptoms‌‌of‌‌ 
diminished‌‌positive‌‌effects.‌  ‌

Dose:‌  ‌ Isocarboxazid‌‌[30-60‌‌mg]‌  ‌ Phenelzine‌‌[45-‌‌90‌‌mg]‌  ‌

Tranylcypromine‌‌[20-30‌‌mg]‌  ‌ Moclobemide‌‌[150-300‌‌mg]‌  ‌
 ‌

Melatonin‌‌   ‌ Melatonin‌‌is‌‌associated‌‌with‌‌the‌‌Circadian‌‌rhythm.‌‌Light‌‌is‌‌the‌‌most‌‌powerful‌‌ 
synchronizer.‌‌When‌‌light‌‌enters‌‌through‌‌the‌‌eye‌‌it‌‌is‌‌translated‌‌via‌‌the‌‌ 
Agonists‌  ‌ Retinohypothalamic‌‌tract‌‌to‌‌the‌‌suprachiasmatic‌‌nucleus‌‌within‌‌hypothalamus.‌‌The‌‌ 
 ‌ Suprachiasmatic‌‌nucleus,‌‌in‌‌turn,‌‌signals‌‌the‌‌pineal‌‌gland‌‌to‌‌turn‌‌off‌‌Melatonin‌‌ 
‌ ommon‌   ‌ ‌
C Production.‌‌During‌‌the‌‌darkness‌‌there‌‌are‌‌signals‌‌to‌‌the‌‌pineal‌‌gland‌‌to‌‌produce‌‌ 
‌Features‌  ‌ melatonin.‌‌Melatonin,‌‌in‌‌turn,‌‌can‌‌act‌‌on‌‌the‌‌SCN‌‌to‌‌reset‌‌circadian‌‌rhythm.‌  ‌

AGOMELATINE‌  ‌ Agonist‌‌at‌‌Melatonin‌‌1‌‌(MT‌‌1)‌‌+ ‌‌ Very‌‌common‌‌side‌‌effects:‌‌headache‌‌   ‌

[25-50‌‌mg]‌  ‌ Melatonin‌‌2‌‌(MT‌‌2)+‌‌antagonist‌‌  Common‌‌side‌‌effects:‌‌dizziness,‌‌sleepiness‌‌ 
actions‌‌at‌‌5HT2C‌‌Receptors.‌  ‌ (somnolence),‌‌difficulty‌‌in‌‌sleeping‌‌(insomnia),‌‌ 
 ‌ feeling‌‌sick‌‌(nausea),‌‌diarrhoea,‌‌constipation.‌  ‌

 ‌
 ‌
Herbal‌‌Product:‌  ‌
● St.‌‌Johns‌‌Wort‌‌(Active‌‌Compound‌‌=‌‌Hyperphorin)‌  ‌
● Inhibits‌‌reuptake‌‌of‌‌NE,‌‌5HT‌  ‌
Newer‌‌agents‌‌for‌‌treatment‌‌of‌‌Depression‌  ‌
 ‌
VORTIOXETINE‌  ‌ SERTi‌‌+‌‌[5HT‌1A‌,‌‌5HT‌1B/1D‌] ‌‌ The‌‌clinical‌‌properties‌‌of‌‌vortioxetine‌‌suggest‌‌ 
[5-‌‌20‌ ‌mg]‌  ‌ partial‌‌agonist‌‌+‌‌5HT‌3 ‌ ‌ antidepressant‌‌properties‌‌without‌‌sexual‌‌ 
Antagonist‌‌+‌‌5HT‌7‌A ‌ ntagonists‌  ‌ dysfunction,‌‌pro-cognitive‌‌effects.‌  ‌
 ‌
It‌‌increases‌‌the‌‌level‌‌of‌‌5HT,‌‌NE,‌‌ 
DA,‌‌Histamine,‌‌Acetylcholine.‌  ‌
 ‌
KETAMINE‌  ‌ Binds‌‌to‌‌open‌‌channel‌‌  Also‌‌has‌‌action‌‌on‌‌α‌‌receptor,‌‌NET,‌‌SERT‌‌ 
[0.5‌‌-‌‌1‌‌mg/kg‌‌  configuration‌‌of‌‌NMDA‌‌  (Serotonin‌‌transporter),‌‌μ-opioid‌‌receptor.‌  ‌
i.v.]‌  ‌ receptor.‌‌In‌‌this‌‌receptor‌‌there‌‌    ‌
is‌‌a‌‌calcium‌‌channel‌‌and‌‌in‌‌that‌‌ 
channel‌‌there‌‌is‌‌a‌‌site‌‌called‌‌as‌‌ 
PCP‌‌(where‌‌phencyclidine‌‌ 
binds).‌‌This‌‌is‌‌the‌‌site‌‌of‌‌ 
binding.‌‌Ketamine‌‌blocks‌‌this‌‌ 
Receptor.‌  ‌
 ‌
 ‌
DEXTROMETHORPHAN‌  ‌ Has‌‌the‌‌same‌‌actions‌‌like‌‌  It‌‌is‌‌a‌‌weak‌‌NMDA‌‌receptor‌‌antagonist,‌‌with‌‌ 
ketamine‌‌and‌‌acts‌‌on‌‌all‌‌  stronger‌‌SERT,‌ ‌α‌‌receptor,‌‌NET,‌‌SERT,‌  ‌
the‌‌receptors‌‌as‌‌ketamine.‌  ‌ μ-opioid‌‌receptor.‌  ‌
 ‌
It‌‌is‌‌being‌‌used‌‌in‌‌combination‌‌with‌‌ 
Quinidine‌‌(as‌‌it‌‌increases‌‌its‌‌bioavailability)‌‌ 
to‌‌treat‌‌pseudobulbar‌‌affect‌‌and‌‌may‌‌have‌‌ 
some‌‌therapeutic‌‌utility‌‌in‌‌depression‌‌as‌‌ 
well.‌  ‌

 ‌
Ref:‌  ‌
● S‌ tahl’s‌P
‌ sychopharmacology‌4 ‌ th‌E‌ dition‌  ‌
● M
‌ audsley‌P ‌ rescribing‌g‌ uidelines‌1‌ 2e‌a‌ nd‌1‌ 3‌e‌ .‌  ‌
‌By:‌‌   ‌
Manish‌‌Roshan‌‌and‌‌Rajvardhan‌‌   ‌
Junior‌‌Resident‌  ‌
Dept.‌‌of‌‌Psychiatry,‌‌AIIMS‌‌Delhi‌  ‌
 ‌