Drugs used in Depression

Week-8
Contents
› The symptomatology of Depression
› The mechanism of action of antidepressant drugs
› The monoamine Theory of Depression
› Different Groups and types of antidepressant drugs used in
mental health settings
› The Adverse effects associated with antidepressants.
› Recommended monitoring and management of drug side
effects
Depression
› Is often used to describe a range of low feelings,
including sadness or low spirits, and more severe
mood problems.
› Symptoms:
› A mental illness characterized by pathological
changes in mood, loss of interest or pleasure,
feelings of guilt or low self-worth, disturbed sleep
or appetite, low energy, or poor concentration,
worthlessness, and guilt, hopelessness, morbid and
suicidal thoughts, irritability and weight loss/
weight gain.
› Aside from the emotional problems caused by
depression, individuals can also present with a
physical symptom such as chronic pain or digestive
issues. To be diagnosed with depression, symptoms
must be present for at least two weeks.
Types and Causes of Depression
› Major depression
› Chronic depression (Dysthymia)
› Atypical depression
› Bipolar disorder/Manic depression
› Seasonal depression (SAD)
DIAGNOSIS
› Extensive patient and family history
› Blood test for hypothyroidism
› Current medication
› DSM-V
CAUSES OF DEPRESSION
› A combination of Genetic vulnerability and interactive
environmental factors
– Stressful life events
– History of previous depressive episodes
– Chronic poor physical health
– Heritable personality traits
› Death/Abuse
› Medications
TREATMENT FOR DEPRESSION
› Psychotherapy
› Electroconvulsive therapy
› Natural alternatives
› Medication
› SSRIs (selective serotonin inhibitors)
› MAOIs (monoamine oxidase)
› TCAs (Tricyclic antidepressants)
› SNRIs (serotonin and norepinephrine reuptake inhibitors)
› NDRIs (Norepinephrine and dopamine reuptake inhibitors)
› TeCAs (Tetracyclic antidepressant)
Mechanism of Action
› Monoamine Theory of depression
– Neurodevelopmental and biochemical theories proposes that
depression is caused by an alteration in the level or function of
monoamine neurotransmitters, especially;
› Serotonin
› Dopamine and
› Noradrenaline
– The pathology of depression is strongly linked with functional
deficiency and alteration/depletion of catecholamines including
› Noradrenaline (NA), serotonin (5-HT), and dopamine (DA)
Antidepressants work by increasing levels of these chemicals in the areas of the
brain and influence mood, emotions, behavior.
 – Stahl (2013) suggests that symptoms of serotonin deficiency include:
Monoamine Theory of depression

› Anxiety, panic, phobia, obsessive compulsive disorders, food craving (Bulimia).

› Noradrenaline deficiency may result in depressed mood, with impaired cognitive
functioning and psychomotor retardation.

(a) In normal brain, monoamine molecules are released and bind to receptors on the neighbouring
neuron; (b) In depression, fewer monoamine molecules are available for binding to receptors,
leading to a mood disorder; (c) Treatment with a reuptake inhibitor (the red shape blocking the
reuptake transporter channel; here the SSRI Prozac) increases the number of monoamine
molecules in the synaptic gap, so more are available to bind to receptors on the neighbouring
neuron. This corrects the mood disorder.
MONOAMINE OXIDASE (MAO) AND DEPRESSION

› MAO is important because it breaks down monoamine neurotransmitters. As MAO

destroys monoamines, inhibiting MAO would have the net effect of increasing the
levels of monoamines available for neuron to neuron communication.

› Such monoamine oxidase inhibitors (or MAOIs) became the first generation of
antidepressants.
ANTIDEPRESSANTS
› Inhibit reuptake of neurotransmitters through selective
receptors.
› This mode of action enhances the concentration of specific
neurotransmitters in the synaptic space in the brain.
› It is theorized that the MOA and Catechol-O-methyl
transferase (COMT) enzymes situated in the presynaptic
neuron and the synapse breakdown monoamine
neurotransmitters (serotonin and dopamine).
Four Types of Antidepressants
› 1a: TCAs (Tricyclic antidepressant)
› 1b: SSRIs (selective serotonin inhibitors) first line drug
treatment
› 2: MAOIs (Monoamine Oxidase Inhibitor)
› 3: NaSSA (Noradrenaline and and Specific serotonergic Agents)
› 4: SARI (Serotonin 2 Antagonist/Reuptake Inhibitor)
Home Work
› Monoamine oxidase inhibitors (MAOIs) increase CNS synaptic
concentrations of these monoamines by inhibiting an enzyme
responsible for their degradation. Draw the reaction scheme
for the biological degradation of noradrenaline by monoamine
oxidase.
› ASSIGNED READING: chapter-7 page 284 Stahl’s Essential
Psychopharmacology
The Adverse effects associated with
antidepressants
Management of Drug Side Effects

› To Be continued…………