Drugs used in affective disorders: antidepressants Sarah & Clara.
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Transcript of Drugs used in affective disorders: antidepressants Sarah & Clara.
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Drugs used in affective disorders: antidepressants
Sarah & Clara
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• Depression: Most common mental health issue. ICD-10: Mood [affective] disorders (F30-F39).
• Key symptoms:• 1) Persistent low mood/sadness and/or• 2) marked loss of interest or pleasure
• If have those, check for these: – disturbed sleep (decreased or increased compared to usual)– decreased or increased appetite and/or weight– fatigue or loss of energy– agitation or slowing of movements– poor concentration or indecisiveness– feelings of worthlessness or excessive or inappropriate guilt– suicidal thoughts or acts
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Pharmacological treatments for depression – 4 main classes:
• Selective Serotonin Reuptake Inhibitors (SSRIs)• Monoamine Oxidase Inhibitors (MAOI-As)• Tricyclic Antidepressants (TCAs)• Atypical Antidepressants (e.g. NRIs, SNRIs)
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SSRIs MAOI-As TCAs Atypical
Fluoxetine Moclobermide Amitryptiline Buspirone
Paroxetine Phenelzine Nortripyline Bupropion
Citalopram Isocarboxadize Cocaine Reboxetine
Setraline Venlafaxine
Citalopram
Venlafaxine
Nortriptyline
Moclobermide
Sertraline
Fluoxetine
Buspirone
Amitryptiline
Reboxetine Phenelzine
Paroxetine
Bupropion Isocarboxadize Cocaine
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Explain the MoA of SSRIs:
• Serotonin is released into the synaptic cleft.• Under normal circumstances, some of this serotonin is taken back
up into the pre-synaptic nerve ending by a re-uptake pump.• SSRIs inhibit this re-uptake pump.• Therefore serotonin levels in the cleft are increased…• …and more serotonin is available to bind to receptors• = HAPPY (NB: Serotonin often referred to as 5HT)
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Side effects of SSRIs/5HT modulation (5):
• Slow onset (2-3 weeks earliest)• Sleep disorders• Sickness• Sexual dysfunction• ‘Serotonin Syndrome’ (hyperthermia, cardiovascular
problems, aggression, tremor and rigidity)
• REMEMBER THE 5 S’s!
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Explain the MoA of MAOI-A’s:• Increase levels of
NA/5HT by inhibiting their enzymatic breakdown by monoamine oxidase.
• =HAPPY
• Some are selective/non-selective and reversible/irreversible.
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Side effects of MAOI-A’s (5):• Postural hypotension• Convulsions• Restlessness• Sleep disorders• CHEESE REACTION• + not to be used with either SSRIs or TCAs = bad mix
• Cheese reaction: • Cheese, red wine etc contain tyramine – another substance
usually broken down by monoamine oxidase. A build up of tyramine can cause a hypertensive crisis.
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The 5 main actions of TCA’s:• 5HT reuptake blocker• NA reuptake blocker• α1 adrenoreceptor antagonist
• H1 receptor antagonist
• M1 receptor antagonist
• Biggest effect is the increase in NA levels. Bit iffy with the effect on 5HT…
• And they have side effects to match!• H1: Sedation and weight gain• A1: Vasodilation and tachycardia• M1: Constipation, dry mouth, glaucoma
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Atypicals (don’t worry too much)
• NRIs (e.g. Ruboxetine) work in exactly the same way as SSRIs to up 5HT levels.
• SNRIs (e.g. Venlafaxine) are multitaskers and up levels of NA and 5HT by reuptake inhibition
• 5HT partial agonists reduce neuronal impulse firing to allow serotonin levels to replete:
• Buspirone• Trazodone• Tandospirone
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A final few others…• Agomelatine
• Melatonin agonist• Increases slow-wave sleep
• Lithium• Historical general mood stabilizer, CNS mechanisms not well understood.
• Non-pharmacological:• CBT• Counselling• Electro convulsive therapy (ECT)• Trans-cranial magnetic stimulation (TMS)
NICE recommendation: a combined treatment programme of CBT + AD.
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Any questions?https://www.cnsforum.com/educationalresources/imagebank/antidepressants
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Exam style questions• List: the two main symptoms & additional symptoms required
for the diagnosis of depression• List the types of pharmocological treatment used for
depression. Name two drugs for each class of drugs. • Name some non-pharmacological treatments for depression• What is the MOA for SSRIs?• Name some side effects of SSRIs• What is the “Serotonin Syndrome”?• Describe the MOA of Monoamine Oxidase Inhibitors. • What are the side effects of MOA-I?• Which receptors do Tricyclic Antidepressants work on? Name
the effects for each receptors, and therefore the side effects for this type of drug (actual exam question!)