CENTRAL NERVOUS SYSTEM
Dr. Nadeem akhtar MBBS.M.Phil
Asst. Professor PharmacologyAmna Inayat Medical College
Shaikhupura
ANTI-DEPRESSANTS
Drugs which are prescribed to relieve depression
Depression
• Low mood• Depressed feelings• Lonely living• Lack of energy• Other physical problems
• 17 % world wide prevalence
• 4 th number in the list of 10 world wide common diseases ,noted by WHO
• This will be on second number in 2020
Typical pic of depressed individual
Pathophysilogy
• 1. Amines hypothesis
• 2.Neurotrophic hypothesis
Physical or Pharmacological treatment
• A)Trycyclic antidepressants (TCAs)
• Imipramine• Clomipramine• Amitriptyline
Mode of action
• They inhibit re-uptake mechanisms
• Terminate synaptic actions of NE & 5-HT in the brain
Effects
• A.N.S• produce anticholinergic actions• C.V.S• Ventricular dysrythmias• Hypertension (rarely)
Drug interactions
• Antagonize the centrally acting drug antihypertensive agents e.g Clonidine
• If given with MAOS, patient develop severe hypertension
Indications
• Major depressive disorder (MDD)• Panic disorder (PD)• Obsessive compulsive disorder (OCD)• Enuresis• Chronic fatigue • Diabetic neuropathy• Eating disorders
Adverse effects
• Dryness of mouth• Constipation• Tachycardia• Blurring of the vision• Retention of urine• Postural hypotension• Sedation• Weight gain• Tremors• Sexual problems
Contra-indications
• Glaucoma
• Pregnancy
• Benign prostate hypertrophy (BPH)
Selective serotonin reuptake inhibitors (SSRIs)
• Fluxetine
• Citalopram
• Escitalopram
• Paroxitine
Mode of action
• Highly selective on 5-HT receptors
• Minimal inhibitory effect on NE transporters or blocking actions on adrenergic or cholinergic receptors
Adverse effects
• Minimal anticholinergic action and mild constipation
• Suicidal ideation with long term use
• Erectile dysfunction
Monoamine oxidase inhibitors
• Phenalzine
• tranylcypromine
Mode of action
• Increase amine level by interfering their • metabolism at nerve endings and • increasing storage of NE & 5-HT
usage
• Indicated when other treatment fail
• Dangerous drug-drug or drug & food interactions can develop
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
• Venlafaxine
• Duloxetine
• Milancipran
5-HT2 Antagonists
• Trazodone
• Nefazodone
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