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Depression and Newer Antidepressants Ashraf B. Abdel-Naim Professor of Pharmacology and Toxicology Faculty of Pharmacy King Abdul Aziz University Jeddah,

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Presentation on theme: "Depression and Newer Antidepressants Ashraf B. Abdel-Naim Professor of Pharmacology and Toxicology Faculty of Pharmacy King Abdul Aziz University Jeddah,"— Presentation transcript:

1 Depression and Newer Antidepressants Ashraf B. Abdel-Naim Professor of Pharmacology and Toxicology Faculty of Pharmacy King Abdul Aziz University Jeddah, KSA

2 إِنَّا كُلَّ شَيْءٍ خَلَقْنَاهُ بِقَدَرٍ بسم الله الرحمن الرحيم سورة القمر – آية 49

3 What is a depressive disorder? A depressive disorder is a syndrome that reflects a sad mood exceeding normal sadness or grief. Depression symptoms are also characterized by neurovegetative signs (irregular eating, sleeping, crying spells, and decreased libido).

4 Depressive disorders are a huge public health problem Direct and indirect costs Depression causes significant problems more often than do arthritis, hypertension, chronic lung disease, and diabetes. Depression increases the risks for developing HIV, coronary artery disease, and asthma. Depression is frequently under-diagnosed. Depression is often under-treated.

5 Women and depression Women are twice as likely to become depressed as men. Postpartum depression

6 Types of depression Major Depression It is characterized by sad mood that interferes with the ability to work, sleep, eat, and enjoy once-pleasurable activities. Dysthymia Dysthymia is a less severe type of depression. Chronic symptoms that do not disable, but prevent the affected person from functioning at "full steam". Bipolar Disorder (Manic Depression) It involves cycles of depression and mania. The mood switches are sometimes dramatic and rapid, but most often they are gradual.

7 Symptoms of Depression Persistently sad mood Feelings of hopelessness, pessimism Feelings of guilt, worthlessness, helplessness Loss of interest in hobbies and activities that were once enjoyed, including sex Insomnia, or oversleeping Decreased appetite or overeating Fatigue, decreased energy Persistent physical symptoms such as headache, digestive disorders, and chronic pain Thoughts of death or suicide

8 Symptoms of Mania Inappropriate elation Inappropriate irritability Severe insomnia Grandiose notions Increased talking speed and/or volume Disconnected and racing thoughts Markedly increased energy Poor judgment Inappropriate social behavior

9 What are the causes of depression? Genetic (especially with bipolar disorder) Stressful environment

10 Biochemical Basis of Depression The depressive disorders appear to be associated with low brain serotonin and norepinephrine.

11 Drug Treatment of Depression

12 I. Monoamine oxidase inhibitors (MAOIs) Phenelzine, Tanylcypromine (non-selective) Clorgyline, Moclobemide (MAO-A-selective) Cheese Reaction

13 II. Tricyclic Antidepressants Imipramine, desipramine, amitriptyline, nortroptyline, amoxapine, doxipin Anticholinergic activity Sexual dysfunction Cardiac toxicity Orthostatic hypotension

14 III. Selective serotonin reuptake inhibitors (SSRIs) Fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), citalopram (Cipram) Little or no anticholinergic, alpha or histamine blocking activity. Decreased sexual desire (decreased libido), delayed orgasm Serotonergic syndrome

15 IV. Serotonin/norepinephrine reuptake inhibitors Venlafaxine (Effexor), duloxetine (Ariclaim) Venlafaxine is considered an SNRI, a serotonin and norepinephrine reuptake inhibitor. It has particularly robust effects. These drugs (SNRI) seem to be very promising, especially for the more severe and chronic cases of depression.

16 V. Atypical antidepressants Bupropion Mirtazapine Nefazodone & Trazodone Tianeptine (Stablon)

17 Bupropion It acts as norepinephrine and dopamine reuptake inhibitor Bupropion has been found to be effective as a smoking cessation aid.

18 Mirtazapine (Remeron) It is a tetracyclic compound. It enhances serotonin and norepinephrine. It is devoid of anticholinerigic, antiadrenergic or serotonin-related side effects Mirtazapine is given at bedtime and is often prescribed for people who have trouble falling asleep.

19 Nefazodone and Trazodone These drugs are weak inhibitors of serotonin re- uptake. Their therapeutic benefit is related to their ability to block 5-HT1 presynaptic auto receptors and, thereby, increase serotonin release. Both agents are sedating, probably because of their potent H1-blocking activity.

20 Tianeptine (Stablon) Selective serotonin reuptake enhancer! Tianeptine acts to prevent and even reverse stress-induced neural damage, promoting both neuronal survival and synaptic plasticity.

21 VI. Mood Stabillizers Lithium Other Mood-Stabilizing Drugs Anticonvulsants: Valproate, Carbamazepine, Gabapentin, and Lamotrigine Antipsychotics: Quetiapine, Risperidone

22 Non-Pharmacological Treatment of Depression (Psychotherapy) Talking therapies Interpersonal and cognitive/behavioral therapies Psychodynamic therapies Electroconvulsive therapy

23 Natural Products as Antidepressant Saint John's wort (Hypericum pefforatum) Most probably, it acts as a SSRI.

24 Self-help Do not set difficult goals for yourself. Break large tasks into small ones. Do not expect too much from yourself too soon. Try to be with other people, which is usually better than being alone. Participate in activities that may make you feel better. Do not make major life decisions, such as changing jobs or getting married without consulting others who know you well. Do not accept your negative thinking.

25 Guidelines In severe recurrent depressive illnesses, an antidepressant (or ECT) along with psychotherapy are required for the best outcome. If a person suffers one major depressive episode, he or she has a 50% chance of a second episode. If the individual suffers two major depressive episodes, the chance of a third episode is 75 to 80%. If the person suffers three episodes, the likelihood of a fourth episode is 90 to 95%.

26 After a second and certainly after a third episode, a patient should remain on a maintenance dosage of the medication. SSRIs are usually used initially because of their lower severity of side effects. Side effects of SSRI s can be minimized by starting tat low doses and gradually increasing the doses till full therapeutic effects.

27 If SSRIs fail, antidepressants with dual action are to be tried. Other options include bupropion, which has action on dopamine. Sometimes a combination of antidepressants from different classes may be used. For MAOIs, take care of the cheese reaction.

28 Alcoholic liquors reduce the effectiveness of antidepressants and should be avoided. Benzodiazepines are not antidepressants but they are occasionally prescribed with antidepressants for a brief period of anxiety. However, they should not be taken alone for depressive disorder.

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