antidepressants powerpoint presentations

It is a short presentation for antidepressants

1. antidepressants Nalmas sanjana Intern

2. Classification

3. MAO INHIBITORS Non selective - block both MAO A/B Irreversible drugs (hit and run drugs) Tranylcypromine, isocarboxazide , phenelzine Selective – block MAO A RIMA Moclobemide, clorgyline Uses : second line drug of atypical depression

4. Mechanism of action– Inhibits monoamine oxidase enzyme Inhibits catabolism of serotonin, norepinephrine, dopamine Side effects : Cheese reaction : Tyramine + MAO I  increase in norepinephrine  hypertensive emergency DOC- IV Phentolamine

5. 2. Serotonin syndrome Combining 2 ADs / adding of any seroternergic drug (tramadol) Features– sympathetic activation ( sweating, increased BP,HR ) Eye– mydriasis Rigid muscles Brisk DTR Ocular clonus Raised temperature Treatment : symptomatic Rx + BZD If no response  cyproheptadine (5HT2 Blocker)

6. TCA Clomipramine- max inhibition of 5HT reuptake Amitryptiline – max M1 blockade Amoxapine- D2 blocker (psychotic depression)

7. Side effects of TCA Anticholinergic- dry mouth, bad taste, constipation, urinary retention, palpitations, blurred vision Sedation, mental confusion Increased appetite and weight gain,diabetes,metabolic syndrome(avoid TCA,MAOI ) Postural hypotension Sweating and fine tremors Seizure threshold is lowered ( clomipramine, amoxapine) CNS and CVS side effects ( toxic doses ) Lethal effect even with 5-10 tab Ionised form of TCA  Blocks Na channel DOC: sodium bicarbonate Suicidal ideation ( amitriptyline )

8. SSRIs

9. Fluoxetine – Longer half life ( 50 hrs) No withdrawal symptoms Metabolite (200 hrs)

10. Max withdrawal symptoms Max erectile dysfunction Most teratogenic Max enzyme inhibition (CYP2D6) Rx depression with insomnia Withdrawal symptoms of SSRI – irritability,anger,insomnia,agitation,headache,nausea,vomiting,sensory symptoms

11. Side effects – Others – weight gain,akathisia , bone resorption ,teratogenic Hyperprolactinemia,galactorrhea reported with fluoxetine,paroxetine,sertraline Benzodiazepine for 2-6 weeks (to relieve anxiogenic effect)

12. SEXUAL DYSFUNCTION Can be due to disease itself/ drugs Dose dependant effect Fully reversible High among SSRIs Management – Rule out other possible causes Switch to lower risk ADs Non pharmacological strategies- waiting for spontaneous remission, drug holidays, dose reduction Pharmacological strategies- PDE inhibitors , bupropion, mirtazapine, transdermal testosterone

13. SSRI and bleeding Depletion of platelet serotonin ( SERT inhibitor) Manifestations- GI bleeding ICH Gynaecological and obstetrical hemorrhage AUB , PPH Surgical and post op bleeding Management - lower risk AD( bupropion,nortriptyline,mirtazapine ) If SSRI cant be avoided– close monitoring required, PPI

14. Hyponatremia Within 30 days of starting therapy SIADH Dose unrelated High with SSRI and SNRI Close monitoring- symptoms like lethargy, nausea,confusion,cramps,seizures Management- fluid restriction, discontinuation of drug,other alternatives- nortriptyline,mirtazapine

15. SNRIs Dual acting antidepressants Low dose- inhibition of 5HT reuptake High dose- inhibition of NE reuptake Drugs – venlafaxine,desvenlafaxine,duloxetine , milnacipran Used when patients drive, motivation, energy is low Venlafaxine –max withdrawal symptoms Long term use- HYPERTENSION

16. ATYPICAL ADs Bupropion Increases NE and dopamine levels Decreases depression and improves attention Also used in smoking cessation , ADHD Anxiogenic Side effect- decreses seizure threshold , worsens psychosis , anxiety, weight loss Advantage- no erectile dysfunction 2. Vilazodone SPARI 5HT1A partial agonist and reuptake inhibitor

17. 3. Vortioxetine Multimodal serotonergic agent 5HT1A agonist 5 HT1B Partial agonist Antagonist at 5HT1D,5HT3,5HT7 receptors 4. Mirtazapine Noradrenargic and specific serotonin antagonist Alpha 2 antagonist H1 antagonist 5HT receptor antagonist Side effects- sedation,weight gain, Agranulocytosis

18. 5. Trazodone SARI- serotonin receptor antagonist and reuptake inhibitor Side effects – sedation, priapism

19. Sedative antidepressants- TCA Mirtazapine Trazodone ADs causing weight gain Mirtazapine SSRI SNRI TCA Lesser weight gain- bupropion , fluoxetine ADs which don’t affect sexual functioning Bupropion Mirtazapine Vilazodone Vortioxetine

20. References Stahl’s essential psychopharmacology- 5 th edition Essentials of medical pharmacology – KD Tripathi The Maudsley Prescribing guidelines in psychiatry https://www.ncbi.nlm.nih.gov/books/NBK538182/ https://www.ncbi.nlm.nih.gov/books/NBK538182/# article-17687.s1

21. Thank you..