Transcript File
Drugs which can Elevate Mood (Mood Elevators)
Definitions
Affective disorders - mental illnesses characterized by
pathological changes in mood (not thought – compare
with schizophrenia)
1. Unipolar disorders
Depression – pathologically depressed mood.
Mania – excessive elation and accelerated
psychomotor activity (rare)
2. Bipolar disorder (manic-depressive illness) – „cycling
mood“
severe highs (mania) and lows (depressive
episodes)
It is common & normal emotion in which people
becoming depressed as a result of unfortunate
domestic and social conditions, sometimes the
depression is disproportionate to precipitating
factors or there may be no obvious cause at all.
Clinical presentation:
Emotional symptoms:
Sadness.
Hopelessness.
Loss of interest in usual activities.
Feeling of guilt.
Physical symptoms
Fatigue
Sleep disturbance
Pain (especially headache)
Appetite disturbance ↑or ↓
Intellectual or cognitive symptoms
Decreased ability to concentrate or slow thinking
Confusion
Poor memory for recent events.
Reduced self-esteem & self-confidence.
Ideas or acts of self harm or suicide.
What is the cause of depression?
Monoamine theory
Suggests that depression results from functionally
deficient monoamine neurotransmitters
(Norepinephrine (NE) &/or Serotonin (5-HT)) in
the CNS.
Therefore, in the treatment we try to ↑ the level of
these neurotransmitters
Major classes of anti-depressants:
1.Reuptake inhibitors
A. Selective serotonin(5-HT) reuptake inhibitors
(SSRIs)
e.g. Fluoxitine
B. Selective norepinephrine(NE) reuptake
inhibitors
e.g. Reboxitine
C. None Selective NE/5-HT reuptake
inhibitors(TCAs)
e.g. Imipramine ,Amitriptyline
2. Monoamine oxidase inhibitors
e.g. Phenelzine
3. Atypical antidepressants
e.g. Mirtazapine
Tricyclic antidepressants (TCAs)
MOA
Inhibit reuptake mechanism which is responsible for
termination of the synaptic action of NE & 5-HT in
the brain
Blocking of receptors:TCAs also block
muscarinic,serotonin,histamine,
α-adrenergic responsible of S/Es
Examples: Imipramine, Amitriptyline
Therapeutic uses
1.Major depression
2.Some panic disorder respond to TCAs
3.Imipramine has been used to control bed-wetting
in children (older than 6 years).
Advantages
Disadvantages / Side Effects
• Often effective in reducing
panic attacks and elevating
depressed mood.
•Usually a single daily dose
Anticholinergic : dry mouth, blurred
vision
constipation,
urinary retension
Antihistaminergic : Sedation
Alpha blockade : Postural hypotension
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S/Es
Antimuscarinic: constipation, blurred vision,
urinary retention, dry mouth
Sedation
Postural hypotension
Arrhythmias
Weight gain
Selective Serotonin Reuptake Inhibitors
(SSRIs)
MOA :Blocks serotonin reuptake only
Examples: Fluoxetine
SSRIs have little activity
to block muscarinic,
histamine H1,
α-adrenergic receptors
& relatively safe in
over dose
Therapeutic uses
1.Primary indication is depression
2.Obsessive compulsive disorders
3.Fluoxetine is effective in treating bulimia nervosa.
Unwanted effects:
In combination with MAOIs ,SSRIs can result in
“serotonin syndrome”
Monoamine Oxidase Inhibitors (MAOIs)
MOA: Inactivate monoamine oxidase A & B
enzymes, permitting neurotransmitter molecules
to escape degradation (↑ NE & 5-HT levels)
MAO is a mitochondrial enzymein the brain,
gut and liver.
Example: phenelzine
MOA of MAO inhibitors
Indicated for depressed patients who are
unresponsiveness or allergic to TCAs
Because of their risk for drug & drug food
interaction, MAOIs are considered
to be the last line agents.
S/Es:
Hypertensive reaction may occur in patients taking
MAO inhibitors and consume Tyramine
containing food (“cheese reaction”)
(as aged cheeses, beer, red wines)
Pharmacology of theTyramine Reaction
Tyramine
Non-Selective MAO Inhibitor
Tyramine
Hydroxyphenylacetic acid
(inactive)
MAO-A
X
MAO-A
Norepinephrine (NE)
displacement
NE
NE NE
(
NE
NE
NE
Sympathomimetic
Response
NE
NE NE
Blood Pressure)
A persistent headache is often a warning
of rising blood pressure in patients on
MAOIs..
Drug Choice
Comparisons of the antidepressants showed
that they are roughly equivalent in efficacy.
Individual patients may respond better to one
drug than to another.
SSRIs are not sedative, safe in overdose and
have mild adverse effects so they are widely
prescribed.
Finding the right drug and the right dose must
be accomplished empirically.
Bipolar Disorder - image
Bipolar Disorder - image
Drugs used in Mania – Mood Stabilizers
The main goal of pharmacological
treatment of bipolar disorder is to reduce
the frequency & severity of fluctuations in
mood.
Lithium Carbonate
Alternative Drugs:
Carbamazepine
Sodium Valproate
Mood stabilizing drugs
e.g Lithium salts
Therapeutic uses: used prophylactically for treating
manic-depressive disorder & in the treatment of
mania.
It is Teratogenic.
Has a narrow therapeutic index, frequency &
severity of adverse reactions is directly related to
the serum levels.
Monitoring plasma concentration is essential,
especially in presence of renal disease.
Main unwanted effects: tremor, hypothyroidism,
thirst & polyuria.
Different preparations of lithium vary in
their bioavailability and patients should
receive only one preparation. they should
maintain a reasonable fluid intake.
Record cards are available for patients
taking lithium.
Think Positive!
Thank You