Anti Depression Drugs

Depression: Depression occurs due to decreased activity of Noradrenaline (NA) and 5-HydroxyTryptamine
(5-HT).
Antidepressants drugs
Typical antidepressants Atypical antidepressants
Tricyclic antidepressants: Selective serotonin MAO inhibitors: Trazodone
a. Nor adrenaline and 5-HT reuptake inhibitors: Non selective MAO
reuptake inhibitors: Fluoxetine inhibitors: SNRI
 Imipramine Paroxetine Phenelzine Venlafaxine
 Amitriptyline Sertraline Isocarboxazid Duloxetine
 Clomipramine Fluvoxamine tranylcypromine Mianserin
 Dothiepin Citalopram Tianeptin
 Trimipramine Escitalopram Selective MAO-B inhibitors: Amineptin
 Doxepin Dapoxetine Selegeline Milnacipran
Reversible MAO-A Mirtazapine
b. Predominantly Nor inhibitors: Nafazodone
adrenaline reuptake Clorgyline Atomoxetine
inhibitors: Moclobemide Bupropion
 Desipramine
 Amoxapine
 Nortriptyline
 Reboxetine
Mechanism of action:
Typical antidepressants: They increase NA and 5-HT level by inhibiting metabolism or reuptake of NA or 5-HT.
Atypical antidepressants: They may or may not increase NA or 5-HT level or have different mechanism of action.
1st generation antidepressant: Inhibit reuptake of NA and 5-HT by inhibiting NET and SERT. But also have
anticholinergic, antiadrenergic and antihistaminergic effect. e.g. TCA, MAOI
2nd generation antidepressant: Inhibit reuptake of NA or 5-HT by inhibiting NET or SERT. But have no
anticholinergic, antiadrenergic and antihistaminergic effect. E.g. SSRI AND SNRI.
TCA:They inhibit reuptake of NA and 5-HT by inhibiting NET and SERT. But also have anticholinergic,
antiadrenergic and antihistaminergic effect.
SSRI: They inhibit reuptake of 5-HT by inhibiting SERT but not NET (NA). No anticholinergic and antiadrenergic
effect
SNRI: They inhibit reuptake of 5-HT and NA by inhibiting SERT and NET but no anticholinergic, antiadrenergic
and antihistaminergic effect.
Tricyclic antidepressants v/s SSRI
Tricyclic antidepressants: SSRI:
Cause sedation No sedation
Cause weight gain No weight gain
Anticholinergic action like blurred vision, constipation No anticholinergic action
Induce seizures No seizure induction
Hypotension No Hypotension
They inhibit reuptake of NA as well as 5-HT They inhibit reuptake of 5-HT only
st
1 generation antidepressant 2nd generation antidepressant
Low safety margin Good safety margin
 TCA: SSRI: MAO INHIBITORS: ATYPICAL ANTIDEPRESSANTS:
 Low safety Good safety margin Non selective MAO Venlafaxine and Duloxetine inhibit reuptake
margin Cause anxiety inhibitors show cheese of NA and 5-HT but not have anticholinergic
 Amoxapine Inhibit ejaculation reactions. activity. They are also known as SNRI
(inhibit Fluvoxamine: shortest actingSerotonin syndrome Amineptin and Tianeptin increase serotonin
D2 receptor SSRI develop if SSRI are reuptake.(Challenge 5-HT hypothesis of
also) is Fluoxetine: longest acting given with or after MAO depression)
metabolite of SSRI as well as longest inhibitors For smoking cessation Bupropion also used.
Loxapine acting antidepressant (for They increase risk of Bupropion inhibit uptake of dopamine and
 Also used for juvenile depression-only seizures NA.
nocturnal effective antidepressant) Reversible MAO Mianserin: It blocks alpha 2 receptor, 5-
enuresis. SSRI are 1st choice of drug inhibitors not show HT2 and H1 receptor but not inhibiting uptake
 TCA AND in depression, OCD, cheese reactions. of NA or 5-HT.
MAOI also Phobias. Moclobemide is good Trazodone:inhibit alpha receptor but weakly
known as Paroxetine highly choice for elder patient. inhibit 5-HT2. Weakly inhibit uptake of 5-HT.
1st generation teratogenic SSRI. Mirtazapine: inhibit alpha-2 receptor and
antidepressant. SSRI and SNRI also known increase release of NA and 5-HT.
as 2ndgeneration Nefazodone shortest acting antideprerssant
antidepressant. Duloxetine used for chronic neuropathic pain.