Biological Treatments Post

Biological Treatments Post - 6/17/2009 PSY 423: Mood...

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6/17/2009 1 PSY Md Di d PSY 423: Mood Disorders Summer 2009 Chrystal Vergara and Paula Yanes Pharmacotherapy for Depression Major Classes of Antidepressants Tricyclics Monoamine Oxidase Inhibitors 2 (MAOIs) Specific Serotonin Reuptake Inhibitors (SSRIs) Miscellaneous (catch all category) Efficacy of Antidepressants All are approximately equal Differ in terms of side effects 3 Individuals respond better to some drugs 50 60% have favorable responses in acute treatment Continuation reduces relapse rates (22% vs. 50%) Efficacy with children is *HIGHLY* debated
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6/17/2009 2 Pharmacological Treatment for Depression Based on the monoamine hypothesis of depression of depression Reductions in monoamines Alterations in monoamine receptor sensitivities Tricyclic Antidepressants Discovered over 40 years ago in the course of trying to improve anti psychotics 5 Patients remained psychotic but mood improved Imipramine was among the first developed Tricyclic Antidepressants Amitryptyline (Elavil) Desipramine (Norpramine) 6 Doxepin Imipramine (Tofranil) Nortriptyline (Pamelor, Aventil) Protriptyline Trimipramine
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6/17/2009 3 Tricyclic Antidepressants Mechanisms Bl k ti NE tk tt 7 Block presynaptic NE reuptake transporter Block presynaptic 5 HT reuptake transporter Block Histamine receptors Block Acetylcholine receptors Down regulation of presynaptic receptors Tricyclic Antidepressants (TCAs) 8 Tricyclic Antidepressants Benefits of Tricyclics 9 Do not induce euphoria and are therefore non addictive Withdrawal is not particularly unpleasant or problematic Available as generic so CHEAP!!
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6/17/2009 4 Tricyclic Antidepressants Side effects of Tricyclics Sedation (because of anti histamine effects) Dry mouth, tremors, weight gain, blurred vision, 10 constipation, decreased blood pressure Mental confusion, memory problems Sexual side effects (ejaculatory problems, reduced desire and response) Low therapeutic index Therapeutic Dose/ Toxic Dose Tricyclic Antidepressants Most dangerous side effect Tricyclics sometimes produce Cardiac 11 arrhythmias (not so dangerous) When taken in overdose, Tricyclics can cause significant arrhythmias and can be fatal!!! Suicide potential must be considered before prescribing tricyclics!!! Monoamine Oxidase Inhibitors (MAOI’s) Mechanism: Blocks MAO so more NT is released Recently enjoying a resurgence among 12 physicians Non lethal with proper diet Efficacious in many who don’t respond to TCAs and SSRIs May be more efficacious for certain depressions
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6/17/2009 5 MAO Inhibitors (MAOI’s) 13 MAO Inhibitors (MAOI’s) Include… 14 Phenelzine (Nardil) Tranylcypromine (Parnate) Isocarboxazide (Marplan) Moclobimide MAO Inhibitors (MAOI’s) Similar side effects as others (weight gain, sexual dysfunction, dry mouth, sleep disturbance, etc) 15 Lowers blood pressure Non
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Biological Treatments Post - 6/17/2009 PSY 423: Mood...

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