1. 1 ANTI DEPRESSANT DRUGS

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3. 3 DEPRESSION INTENSE FEELINGS OF SADNESS INTENSE FEELINGS OF SADNESS HOPELESSNESS HOPELESSNESS DESPAIR DESPAIR INABILITY TO EXPERIENCE PLEASURE IN USUAL ACTIVITIES.. INABILITY TO EXPERIENCE PLEASURE IN USUAL ACTIVITIES.. Weight loss/weight gain Weight loss/weight gain Changes in sleep pattern Changes in sleep pattern Recurrent thoughts of death Recurrent thoughts of death Suicidal tendencies Suicidal tendencies

4. 4 MANIA OPPOSITE BEHAVIOR OPPOSITE BEHAVIOR ENTHUSIASM ENTHUSIASM RAPID THOUGHT AND SPEECH. RAPID THOUGHT AND SPEECH. IMPAIRED JUDGEMENT. IMPAIRED JUDGEMENT.

5. 5 Causes of depression Heredity – upto 40% Heredity – upto 40% Psychological-low self esteem Psychological-low self esteem Life experiences-poverty, unemployment, death of parent Life experiences-poverty, unemployment, death of parent Medical conditions- hepatitis, hypothyroidism, parkinsons Medical conditions- hepatitis, hypothyroidism, parkinsons In women –ante/post natal, post menopausal In women –ante/post natal, post menopausal

6. 6 Antidepressant Drugs BLOCKADE OF BLOCKADE OF NEUROTRANSMITTER REUPTAKE NEUROTRANSMITTER REUPTAKE DOPAMINE DOPAMINE SEROTONIN SEROTONIN NOREPINEPHRINE NOREPINEPHRINE

7. 7 Tricyclic antidepressants (TCAs) Amitriptyline Amitriptyline Imipramine - NOREPINEPHRINE Imipramine - NOREPINEPHRINE Desipramine Desipramine Doxepin Doxepin Clomipramine - SEROTONIN Clomipramine - SEROTONIN Nortriptyline Nortriptyline Protriptyline Protriptyline Maprotiline – Second generation Maprotiline – Second generation Amoxapine -- Second generation Amoxapine -- Second generation

8. 8 MODE OF ACTION INHIBITION OF NUEROTRANSMITTER REUPTAKE INHIBITION OF NUEROTRANSMITTER REUPTAKE BLOCKING OF RECEPTORS (Serotonergic, adrenergic, histamine, muscarinic) BLOCKING OF RECEPTORS (Serotonergic, adrenergic, histamine, muscarinic)

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10. 10 Actions Elevate mood Elevate mood Improve mental alertness Improve mental alertness ↑ physical activity ↑ physical activity More than 2 weeks need.. More than 2 weeks need..

11. 11 Tricyclic Antidepressants Most Common Adverse Effects Urinary retention Urinary retention Constipation Constipation Weight Gain Weight Gain Sexual Dysfunction Sexual Dysfunction Confusion/Delirium Confusion/Delirium Orthostatic Hypotension Orthostatic Hypotension

12. 12 Drug-Drug Interactions MAO Inhibitors: MAO Inhibitors: Hypertensive Crisis, Tachycardia, Seizures Hypertensive Crisis, Tachycardia, Seizures Antihypertensive Medications: Antihypertensive Medications: Potentiation of Orthostatic Hypotension, Potentiation of Orthostatic Hypotension,

13. 13 Drug-Drug Interactions Sympathomimetics: Increased Cardiotoxicity, Increased Cardiotoxicity, Cimetidine : Cimetidine : Decreased liver metabolism resulting in higher Imipramine levels Decreased liver metabolism resulting in higher Imipramine levels

14. 14 Over dosage restlessness/excitement restlessness/excitement tonic-clonic seizures or dystonia tonic-clonic seizures or dystonia Hypoxia, hypotension Hypoxia, hypotension coma coma

15. 15 Amitriptyline anticholinergic properties greater than Imipramine anticholinergic properties greater than Imipramine sedation: > Imipramine sedation: > Imipramine antihistaminic properties antihistaminic properties orthostatic hypotension ??? orthostatic hypotension ??? mild analgesic mild analgesic

16. 16 Clinical uses endogenous depression endogenous depression prophylaxis for migraine prophylaxis for migraine eating disorder associated with depression eating disorder associated with depression sedative for non-depressed patients sedative for non-depressed patients

17. 17 Imipramine - Clinical uses endogenous depression endogenous depression reactive depression reactive depression enuresis enuresis alcoholism alcoholism cocaine withdrawal cocaine withdrawal attention deficit disorders attention deficit disorders with amphetamine or methyphenidate for narcolepsy with amphetamine or methyphenidate for narcolepsy

18. 18 Clomipramine - Clinical Uses: Obsessive-compulsive disorder Obsessive-compulsive disorder panic disorder panic disorder agoraphobia agoraphobia

19. 19 Monoamine oxidase inhibitors (MAO-I’s) Phenelzine Phenelzine Tranylcypromine Tranylcypromine Clorgyline (specific for MAO type A ) Clorgyline (specific for MAO type A ) Isocarboxazid Isocarboxazid

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21. 21 Clinical Uses endogenous depression endogenous depression depressive phase of bipolar disorder depressive phase of bipolar disorder severe reactive depression not responsive to other drugs severe reactive depression not responsive to other drugs

22. 22 Most Common Adverse Effects Sleep disturbances Sleep disturbances Orthostatic Hypotension Orthostatic Hypotension Weight Gain Weight Gain Sexual Dysfunction Sexual Dysfunction Drug/Food Interactions ** Drug/Food Interactions ** Food – Tyramine (cheese, chicken liver, beer, red wine) Food – Tyramine (cheese, chicken liver, beer, red wine) With SSRIS : SEROTONIN SYNDROME. With SSRIS : SEROTONIN SYNDROME. TOXICITY : SUPPORTIVE THERAPY TOXICITY : SUPPORTIVE THERAPY

23. 23 Drug-Drug Interactions TCAS TCAS SSRIS SSRIS BUSPIRONE BUSPIRONE SYMPATHOMIMETICS SYMPATHOMIMETICS CNS DEPRESSANTS CNS DEPRESSANTS OPIOD ANALGESICS OPIOD ANALGESICS GENERAL ANAESTHESIA GENERAL ANAESTHESIA

24. 24 Selective Serotonin - Reuptake Inhibitors - (SSRIs) Fluoxetine Fluoxetine Sertraline Sertraline Paroxetine Paroxetine Nefazodone Nefazodone Trazodone Trazodone

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26. 26 Action New group New group Selectively inhibit serotonin reuptake. Selectively inhibit serotonin reuptake. Fewer anticholinergic and lower cardiac toxicity. Fewer anticholinergic and lower cardiac toxicity.

27. 27 Clinical Uses: endogenous depression endogenous depression obsessive-compulsive disorder obsessive-compulsive disorder obesity obesity bulimia nervosa – (Fluoxetine) bulimia nervosa – (Fluoxetine)

28. 28 Most Common Adverse Effects: Nausea Nausea Headache Headache Insomnia Insomnia Nervousness Nervousness Fatigue Fatigue Sexual Dysfunction Sexual Dysfunction Inappropriate ADH secretion Inappropriate ADH secretion Extrapyramidal effects Extrapyramidal effects

29. 29 Drug-Drug Interactions Tryptophan Tryptophan TCAS TCAS MAO – I ‘s MAO – I ‘s

30. 30 Lithium Pharmacology Absorption : oral Absorption : oral Excretion : urine Excretion : urine Very toxic Very toxic

31. 31 Mech ???? Neurotransmitter release modulation Neurotransmitter release modulation Li – Na exchange Li – Na exchange Second messenger effect Second messenger effect PIP2 (Phoshphadityl Inositol biphosphate) ↓ PIP2 (Phoshphadityl Inositol biphosphate) ↓

32. 32 Rx Manic depressive patients Manic depressive patients Acute manic episodes Acute manic episodes Prevent recurrence of mania Prevent recurrence of mania

33. 33 Adverse Effects Tremor-- common side effect Tremor-- common side effect choreoathetosis choreoathetosis motor hyperactivity motor hyperactivity ataxia ataxia dysarthria dysarthria aphasia aphasia Psychiatric manifestations Psychiatric manifestations

34. 34 Others Thyroid function effects Thyroid function effects Renal Effects: Renal Effects: Polydipsia; polyuria Polydipsia; polyuria Edema Edema Cardiac Effects - arrhythmias Cardiac Effects - arrhythmias Contraindicated in pregnancy Contraindicated in pregnancy

35. 35 Lithium Overdosage peritoneal dialysis -- effective peritoneal dialysis -- effective hemodialysis -- effective; preferred hemodialysis -- effective; preferred Other mood stabilizers: Carbamazepine Carbamazepine Valproic acid Valproic acid

36. 36 PSYCHIATRIC COUNSELLING PSYCHIATRIC COUNSELLING MEDITATION ( yoga) MEDITATION ( yoga)

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40. 40 Don’t worry Don’t worry be be Happy Happy