One liners about antidepressants

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Introduction:

  • According to the biological theory of depression, reduction of 3 monoamines in our brain (serotonin, norepinephrine and dopamine); also known as trimonoaminergic depletion is responsible for depression
  • Antidepressants works primarily by decreasing the sensitivity of the neuroreceptors of the any of the 3 monoamines specified, in a long term basis.

Family of the antidepressants:

  1. Tricyclic antidepressants (TCA): Inhibits reuptake of all 3 monoamines
  2. Selective serotonin reuptake inhibitor (SSRI)
  3. Serotonin and norepinephrine reuptake inhibitors (SNRI)
  4. Norepinephrine-dopamine reuptake inhibitor (NDRI).

Uses of TCA:

  1. Clomipramine: Gold standard drug for OCD
  2. Imipramine: Nocturnal enuresis (DOC: Desmopressin)
  3. Amitriptyline: Tension type headache
  4. Nortriptyline: Post-stroke depression.

SSRI:

  • Fluvoxamine has the shortest half life among all SSRIs; so, it has the highest risk of drug discontinuation syndrome
  • Fluoxetine has the longest half life among all SSRIs; so, it has no risk of drug discontinuation syndrome
  • SSRIs are the DOC in following conditions:
    1. Depression
    2. Atypical depression
    3. Premenstrual dysphoric disorder
    4. Panic disorder (Chronic anxiety)
    5. Phobia
    6. OCD
    7. Post-traumatic stress disorder (PTSD)
    8. Premature ejaculation.
  • MC side effect of SSRI is nausea and vomiting (due to increased amount of serotonin acting on CTZ area of brain)
  • Most characteristic┬áside effect of SSRI is delayed ejaculation; for this property, SSRIs are used in the treatment of premature ejaculation.

Miscellaneous uses of SNRI (other than depression):

  • Venlafaxine: MC-ly used SNRI
  • Duloxetine: Fibromyalgia, diabetic neuropathy & chronic pain syndrome
  • Atomoxetine: ADHD
  • Sibutramine: Marketted for treatment of obesity, withdrawn due to cardiovascular adverse events.

NDRI: Bupropion-

  • Bupropion is prescribed as an aid for smoking cessation. It reduces the severity of nicotine cravings and withdrawal symptoms.

Newer agents:

  • NaSSA: Mirtazapine
  • SARI: Trazodone
  • SSRE: Tianeptine
  • SPARI: Vilazodone.

*NaSSA: Noradrenergic specific serotonergic agent, SARI: Serotonergic antagonist & reuptake inhibitor, SSRE: Selective serotonin reuptake enhancer, SPARI: Serotonin partial agonist & reuptake inhibitor.

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