Week 4 notes 10 - T reatment of Mood Disorders Mood...

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Treatment of Mood Disorders Mood disorders are very common; frequently the affected patient requires pharmacotherapy in order to remain as functional as possible. While this section is not exhaustive of all the available options, it covers the major categories of drugs used to treat depression, psychosis, bipolar disorder and anxiety disorders. Antidepressant Drugs Tricyclic Antidepressant Drugs (TCAs) Monoamine Oxidase Inhibitors (MAOIs) Selective Serotonin Re-Uptake Inhibitors (SSRIs) Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) List of the Tricyclic Antidepressant Drugs (Nonselective Norepinephrine-Serotonin Reuptake Inhibitors) amitriptyline (Elavil) amoxapine (Asendin) clomipramine (Anafanil) desipramine (Norpramin) doxepin (Sinequan) (Adapin) imipramine (Tofranil) nortriptyline (Aventyl) protriptyline (Vivactil) trimipramine (Surmontil) Pharmacodynamics of the Tricyclic Antidepressants The mechanisms by which the tricyclic antidepressants (TCAs) work is only partially understood and appears to be quite complex. These drugs block the re-uptake of norepinephrine and serotonin back into the nerve endings from which they are released. In doing so, they prolong the presence of these neurotransmitters in the synapse and also prolong the contact between them and their respective receptors. It is presumed that prolonged contact between norepinephrine and its receptors eventually produces a down-regulation of norepinephrine receptors that creates a disproportionally greater effect of serotonin on its receptors. Serotonin receptors apparently do not undergo any down-regulation. One way of looking at this is to think of depression as a relative ineffectiveness of serotonin in the emotion center of the brain. The TCAs allow serotonin to once again become the predominant neurotransmitter in those areas of the brain associated with mood. Pharmacokinetics of the Tricyclic Antidepressants 1
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Treatment of Mood Disorders All of the tricyclic anti-depressants are well absorbed when administered orally. Some (amitriptyline, imipramine) are also administered I.M. They are all metabolized in the liver, some to active metabolites. Some are excreted in the bile and undergo enterohepatic recirculation. All are excreted in the urine. Advantages of the Tricyclic Antidepressants in the Treatment of Depression - Available orally - Generally once-a-day dosing; clearly an inducement to compliance - They have a long duration of action (weeks); this is in part due to enterohepatic recirculation and in part due to active metabolites - Most are relatively inexpensive; generally the most cost-effective of the anti- depressants - Multiple uses; can be used for depression, insomnia, as adjuncts to analgesia, for migraine therapy, in the treatment of attention deficit disorder, enuresis, etc - Wide variability of acceptable doses; allows better individualization for patients - Can be used for chronic therapy; i.e., the long-term, indefinite treatment of depression Disadvantages of the Tricyclic Antidepressants in the Treatment of Depression
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Week 4 notes 10 - T reatment of Mood Disorders Mood...

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