Antidepressants

1. ANTIDEPRESSANTS
DR.FOUZIA

2. DEPRESSION
Definition :
“Depression is characterized by sadness, hopelessness,
changes in sleep patterns and appetite, loss of energy,
and suicidal thoughts.”
Etiology:
Monoamine hypothesis:
Deficiency of serotonin (5-HT), NE, Dopamine

3. CLASSIFICATION OF ANTIDEPRESSANTS
Selective serotonin reuptake inhibitors (SSRIs)
Fluoxetine
Paroxetine
Sertraline
Citalopram
Escitalopram
Fluvoxamine

4. CLASSIFICATION OF ANTIDEPRESSANTS
Serotonin-NE reuptake inhibitors (SNRIs ) :
Venlafaxine
Desvenlafaxine
Duloxetine
Tricyclic-antidepressants (TCA):
Amitriptyline
Nortriptyline
Clomipramine
Imipramine
Doxepin

5. CLASSIFICATION OF ANTIDEPRESSANTS
Monoamine oxidase inhibitors: (MAOIs)
Phenelzine
Selegiline
Atypical antidepressants:
Bupropion
Mirtazapine
Amoxapine
Maprotiline

7. SSRIs
Therapeutic indications:
Generalized anxiety disorders
Post traumatic stress disorders
Obsessive- compulsive disorders
Panic disorders
Premenstrual dysphoric disorders
Bulimia
Alcohol dependence treatment

8. SSRIs
Adverse effects:
1-Headache
2-Sweating
3-Anxiety and agitation
4- GIT effects (nausea, vomiting, diarrhea)
5-Weakness
6-Fatigue
7-Sexual dysfunction
8-Changes in weight
9-Sleep disturbances
(insomnia and somnolence)

9. SNRIs
Inhibit
Serotonin
NE
reuptake

10. SNRIs
Therapeutic indications:
Depression
Fibromyalgia
Neuropathic pain
Pain of diabetic neuropathy
Post herpetic neuralgia
GAD
Stress urinary incontinence
Vasomotor symptoms of menopause

11. SNRIs
Adverse effects:
GIT upset(Nausea, diarrhea)
Headache
Insomnia or hypersomnia
Loss of libido
↑ BP
Insomnia
Anxiety
Agitation

12. TCAs
Inhibit
5-HT
NE
Reuptake

13. TCAs
Therapeutic indications:
Bipolar affective disorders
Acute panic attacks
Phobic disorders
Attention deficit hyperkinetic disorder (ADHD)
Depression unresponsive to SSRIs or SNRIs
Chronic painful conditions
Enuresis
Insomnia
Used as Antihistamine (Doxepin for pruritus)

14. TCAs
Adverse effects:
Anticholinergic
Dry mouth constipation, urinary retention , blurred
vision and confusion
α blocking effects :
Orthostatic hypotension
HI antagonism :
Weight gain and sedation
Arrhythmogenic at higher doses
Sexual dysfunction

15. MAOI
Inhibit
Metabolism:
NE
Dopamine
Serotonin
by MAO

16. MAOI
Therapeutic indications:
Depression unresponsive or intolerant of other
antidepressants
Adverse effects:
Drowsiness
Orthostatic hypotension
Blurred vision
Dry mouth
Constipation

17. BIPOLAR DISORDERS
It is a disorder characterized by depression and mania
Depression:
Sadness, hopelessness, changes in sleep patterns and
appetite, loss of energy, and suicidal thoughts
Mania:
Enthusiasm, anger, rapid thought and speech patterns,
extreme self-confidence, and impaired judgment

18. BIPOLAR DISORDERS
Lithium:
Acute phase and prophylaxis
Other drugs:
Carbamazepine
Valproic acid
Lamotrigine
Atypical anti- psychotics
Risperidone, Olanzapine, Ziprasidone,
Aripiprazole, Quetiapine