Antidepressant An antidepressant is a type of medication

Antidepressant: An antidepressant is a type of medication used primarily to treat depression ; some of these medications have been useful in treating headaches , even when headaches aren’t associated with depression. Depression: It is a common and serious illness that negatively affects how one feels the way he thinks and how he acts. Depression causes feelings of sadness and a loss of interest in activities once enjoyed.

Classification: Antidepressant drugs are classified into five major categories ANTIDEPRESSANTS SSRIs SNRIs TCAs MAO Atypical

Classification(continued) ►Selective serotonin reuptake inhibitors (SSRIs): The most commonly prescribed antidepressants. They are highly effective and generally cause fewer side effects than the other antidepressants. SSRIs help to alleviate symptoms of depression by blocking the reabsorption or reuptake of serotonin in the brain. e. g: Citalopram, Vilazodone. ►(SNRIs): Serotonin-norepinephrine reuptake inhibitors work by blocking the reabsorption of the neurotransmitters serotonin and norepinephrine in the brain. e. g: Duloxetine, Venlafaxine ►Tricyclic antidepressants (TCAs): They were one of the first approved antidepressants. Although they are effective, they have been replaced by newer antidepressants that generally cause fewer side effects. They block muscarinic M 1, histamine H 1, and alpha-adrenergic receptors. e. g: Doxepine, Amoxapine.

Classification (continued) ►Monoamine oxidase inhibitors (MAOIs): They block the activity of monoamine oxidase, an enzyme that breaks down norepinephrine, serotonin, and dopamine in the brain and other parts of the body. e. g: Moclobemide, Phenelzine ►Atypical agents: Each medicine in this category has a unique mechanism of action in the body. However, like other antidepressants, atypical antidepressants affect the levels of dopamine, serotonin, and norepinephrine in the brain. eg: Trazodone, Mianserin.

Sources: There are some natural sources of antidepressant drugs. sources Natural Watercress Spinach Mustard, turnip, or beet greens Lettuces (red, green, romaine) Swiss chard Fresh herbs (cilantro, basil, or parsley) Chicory greens Peppers (bell, serrano, or jalapeno) Kale or collards Pumpkin Dandelion greens Cauliflower Kohlrabi Red cabbage

Sources(continued) Natural sources Pumpkin Broccoli Brussels sprouts Acerola Butternut squash Papaya Lemon Strawberry Oyster Poultry giblets Clam Mussels Octopus Crab Goat Tuna

Pharmacology : Mechanism of action of antidepressant drug Inhibition of nerve terminal NE neuronal uptake system Increase in synaptic concentrat ion of NE Desensitiz ation of nerve terminal α 2 adrenocep tors Increase in neuronal NE release Further increase in synaptic concentrat ion of NE Desensitiz ation of postsynap t ic βadrenocep tors with no change in postsynap t ic α 1 adrenocep tors sensitivity

Therapeutic Uses: The primary, or approved, uses of antidepressants are to treat: -Agitation -Obsessive-compulsive disorders (OCD) -Childhood enuresis, or bedwetting -Depression and major depressive disorder -Generalized anxiety disorder -Bipolar disorder -Posttraumatic stress disorder (PTSD) -Social anxiety disorder

Therapeutic Uses(Continued): Off-label uses of antidepressants include: -Insomnia -Pain -Migraine Studies suggest that 29 percent of antidepressant use is for an off-label purpose.

Adverse effects & Toxicity Adverse effects of drugs are related to toxicity. Some adverse effects of antidepressant drugs are, -Nausea -Weight gain -Lower sex drive -Tiredness -Trouble sleeping -Dry mouth -Blurred vision -Constipation -Dizziness -Anxiety

Toxicities of antidepressant drugs -Delirium -Hallucinations -Tremors -Involuntary eye movement -Increasingly worsening heart pace (dysrhythmia) -Respiratory distress -Seizures -Unconsciousness -Coma

Drug-drug Interaction : Antidepressant drug Interacting drug Possible effect(s) Fluoxetine & Paroxetine SSRIs Metoprolol and Propranolol Increased beta-blocking effects, bradycardia Benzodiazepines SSRIs Warfarin Increased sedation possible. Fluoxetine and paroxetine may reduce metabolism of some benzodiazepines Increased INR and increased bleeding risk due to antiplatelet effect TCAs SSRIs Monoamaine oxidase inhibitors (MAOIs) SSRIs Increased plasma concentrations of TCA causing increased adverse effects. Serotonin syndrome possible, especially with clomipramine Hypertensive crisis

Drug-drug Interaction (continued): Antidepressa nt drug Interacting drug Possible effect(s) TCAs Ritonavir Plasma concentrations of TCAs may be increased. TCAs Antiarrhythmic drugs, e. g. amiodarone, flecainide, quinidine Increased risk of ventricular arrhythmias TCAs Antipsychotics Fluoxetine Antiepileptics, carbamazepine and phenytoin Increased sedation, additive anticholinergic effects Plasma concentrations of phenothiazines and/or the TCA may be increased Increased plasma concentrations of carbamazepine and phenytoin with fluoxetine