Depression - Pharmacology

About 20% of Americans are depressed; however, one-third receives medical or psychiatric help for their depression. Depression is characterized by mood changes and loss of interest in normal activities. Patients who are depressed might have insomnia, fatigue, a feeling of despair, and an inability to concentrate. Some may have suicidal thoughts. Depression is associated with two-third of all suicides.

Depression is caused by a number of factors including genetic predisposition, social and environmental factors, and biologic conditions such as insufficient monoamine neurotransmitter (norepinephrine and serotonin).

There are three types of depression:

REACTIVE (EXOGENOUS)

Reactive depression has a sudden onset and lasts for months and is usually caused by an event such as the loss of a loved one. Benzodiazepine is used to treat reactive depression.

MAJOR (UNIPOLAR)

Major depression is characterized by losing interest in work and home. The patient is unable to complete tasks and falls into a deep depression. Causes of major depression can include genetic predisposition, social and environmental factors, and biologic conditions. Benzodiazepines are the drugs of choice to treat major depressions.

BIPOLAR AFFECTIVE (MANIC-DEPRESSIVE)

Bipolar affective is when the patient undergoes moods swings from manic (euphoric) to depressive (dysphoric). Lithium is prescribed for bipolar affective disorders. Antidepressants are used to treat depressions, however they also can mask suicidal tendencies (Side effects of antidepressants). There are four groups of antidepressants. These are tricyclics, second-generation antidepressants (Serontonin Reuptake Inhibitors or SSRIs), atypical antidepressants, and Monoamine oxidase (MAO) inhibitors.

Tricyclics are the most commonly prescribed drug to treat major depression. Tricyclics include clomipramine HCl (Anafranil), desipramineHCl (Norpramin, Pertofrane), doxepin HCl (Sinequan), imipramine HCl (Tofranil), NortriptylineHCl (Aventyl), ProtriptylineHCl (Vivactil), and trimipramine maleate (Surmontil).

Second-generation antidepressants have fewer side effects than tricyclics. They do not cause hypotension, sedation, anticholinergic effects, or cardiotoxi-city. Second-generation antidepressants include

  • SSRI:fluoxetine HCl (Prozac), paroxetine HCl (Paxil), sertraline HCl (Zoloft), fluvoxamine (Luvox)
  • Atypical: amoxapine (Asendin), bupropion HCl (Wellbutrin), maprotilineHCl (Ludiomil), nefazodoneHCl (Serzone), trazodoneHCl (Desyrel)

Side effects of antidepressants.

TABLE : Side effects of antidepressants.

Monamine Oxidase Inhibitors (MAOI). The enzyme monoamine oxidase inactivates norepinephrine, dopamine, epinephrine, and serotonin. By inhibiting monoamine oxidase, the levels of these neurotransmitters rise. Examples of these drugs includes isocarboxazid (Marplan), phenelzine sulfate (Nardil), and tranycypromine sulfate (Parnate).


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