Pharmacotherapy of Affective Disorders - Dr. Tasneem Attarwala.pptx

This detailed presentation provides an in-depth exploration of the pharmacotherapy used to manage affective disorders, including major depressive disorder (MDD), bipolar disorder, and anxiety disorders. Designed for medical professionals, students, and researchers, this presentation offers a thorough understanding of the various drug classes, their mechanisms of action, therapeutic uses, and potential side effects.
Key Topics Covered:

Introduction to Affective Disorders:
Definitions and classifications
Antidepressants:
Selective Serotonin Reuptake Inhibitors (SSRIs):
Mechanism of action
Common drugs (e.g., fluoxetine, sertraline)
Therapeutic uses and side effects
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):
Mechanism of action
Common drugs (e.g., venlafaxine, duloxetine)
Therapeutic uses and side effects
Tricyclic Antidepressants (TCAs):
Mechanism of action
Common drugs (e.g., amitriptyline, nortriptyline)
Therapeutic uses and side effects
Monoamine Oxidase Inhibitors (MAOIs):
Mechanism of action
Common drugs (e.g., phenelzine, tranylcypromine)
Therapeutic uses and dietary restrictions
Mood Stabilizers:
Lithium:
Mechanism of action
Therapeutic uses in bipolar disorder
Side effects and monitoring
Features:

Detailed explanations with diagrams and illustrations
Evidence-based data and clinical studies
Concise and clear points for easy understanding
Target Audience:

Medical students and professionals
Psychiatrists and psychologists
Researchers in pharmacology and psychiatry
Healthcare providers involved in mental health care

1. PHARMACOTHERAPY OF AFFECTIVE  DISORDERS PRESENTER :     Dr. TASNEEM ATTARWALA           1 st YEAR PG-RESIDENT           DEPARTMENT OF PHARMACOLOGY        M.G.M.M.C., INDORE

2. CONTENT INTRODUCTION TO AFFECTIVE DISORDERS  WHAT IS DEPRESSION? MECHANISM OF CAUSATION OF DEPRESSION ANTIDEPRESSANT DRUGS (CLASSIFICATION) MECHANISM OF ACTION AND ADR AND INTERACTIONS OF DRUGS THERAPEUTIC USES OF ANTIDEPRESSANTS WHAT IS MANIA? LITHIUM RECENT ADVANCES

3. INTRODUCTION What are Affective disorders? A particular mood of patient is grossly exaggerated. These disorders may manifest as:-  Mania Depression Manic-depressive psychoses

4. It is a disorder of mood. It is of 2 types : Unipolar depression Reactive depression Endogenous depression Bipolar depression WHAT IS DEPRESSION?

5. MECHANISM OF CAUSATION OF DEPRESSON Monoamine hypothesis of endogenous depression Downregulation of β 1 , β 2 and α 2 adrenoreceptors and 5-HT 2 receptors Neuroendocrine abnormalities Genetic transmission Decrease in BDNF and neuronal loss and volume of prefrontal cortex and hippocampus

6. TCAs :- Imipramine, Clomipramine, Amitriptyline, Doxepin SNRIs :- Duloxetine, Venlafaxine, Milnacipran Mainly block NE REUPTAKE :- Nortriptyline, Protriptyline, Maprotiline, Amoxapine, Reboxetine SSRI :- Sertraline, Fluoxetine, Fluvoxamine, Paroxatine , Vortioxetine, Citalopram, Escitalopram ATYPTCAL ANTIDEPRESSANTS :- Trazodone, Nefazodone, Bupropion, Mirtazapine, Mianserin ANTIDEPRESSANTS OF NATURAL ORIGIN MAO INHIBITORS :- a) Non-Selective :- Tranylcypromine b) Selective :- Moclobemide NMDA ANTAGONISTS :- Esketamine   GABA RECEPTOR MODULATOR :- Brexanolone ANTIDEPRESSANT DRUGS 

7. DRUGS THAT BLOCK NE AND 5-HT REUPTAKE

8. ADVERSE EFFECTS  WEIGHT GAIN CARDIOTOXIC SEXUAL DYSFYNCTION NARROW THERAPEUTIC INDEX

9. DRUG INTERACTIONS TCAs potentiate the effects of directly acting sympathomimetics. Anticholinergic drugs aggravate the toxicity of TCAs. T 3 and T 4 potentiate CNS stimulant effects of TCAs. MAOIs with TCAs show synergistic actions leading to serious toxicities.

10. SELECTIVE SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIs)

11. ADVERSE EFFECTS SNRIs

12. DRUGS WHICH PREDOMINANTLY BLOCK NE REUPTAKE

13. SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)

14. ADVERSE EFFECTS 

15. DRUG INTERACTIONS SSRI inhibit CYP2D6 & CYP3A4 and hence elevate plasma level and toxicity of TCAs, haloperidol, clozapine, warfarin, dextromethorphan, terfenadine. SSRIs + MAO Inhibitors = Serotonin Syndrome.

16. ATYPICAL ANTIDEPRESSANTS

17. ADVERSE EFFECTS ATYPICAL ANTIDEPRESSANTS Side Effects of Mirtazapine

18. NATURAL ANTIDEPRESSANTS 5-HT, NE and DA uptake inhibition (equipotent). GABA receptor binding MAO inhibition – very weak

19. MAO INHIBITORS

20. ADVERSE EFFECTS

21. DRUG INTERACTIONS OF MAO INHIBITORS

22. NMDA ANTAGONIST

23. GABA RECEPTOR MODULATOR

24. THERAPEUTIC USES OF ANTIDEPRESSANTS PSYCHIATRIC USES

25. THERAPEUTIC USES OF ANTIDEPRESSANTS NON-PSYCHIATRIC USES

26. WHAT IS MANIA? It is characterized by an excessive desire and too much euphoria. The mood swings between pathological excitement and profound depression is called bipolar manic depressive psychosis . 

27. MECHANISM OF ACTION OF LITHIUM

28. THERAPEUTIC USES Manic Depressive Bipolar Psychoses Cancer Chemotherapy induced Leukopenia and agranulocytosis Cluster headache in unipolar depression

29. ADVERSE EFFECTS

30. DRUG INTERACTIONS Lithium + Phenothiazine = Extrapyramidal side effects. Thiazide or loop diuretics increases lithium toxicity. NSAIDS reduce renal clearance of lithium.

31. RECENTS ADVANCES Psilocybin – For Resistant Depression – July 2023 (Psychedelic with serotonin receptor agonist receptor -5HT2A) Viloxazine ( Qelbree ) - For ADHD - April 2022 (Selective NE reuptake inhibitor) Lumateperone ( Caplyta ) - For Bipolar Depression - December 2021 (Multifunction modulator of  serotonin, glutamate and dopamine receptors) Esketamine  ( Spravato ) - For Resistant Depression - March 2019 ( NMDA receptor antagonist) Brexanolone  ( Zulresso ) - For PPD - March 2019 (GABA-A receptor modulator)

32. THANK YOU