Psychopharmacology

ANTIDEPRESSANTS

PROF.DR. ARAFAT AL DUJAILI

 ANTIDEPRESSANTS

Common uses
a. Depression
b. Anxiety
c. Chronic pain, with and without depression
 Cyclic antidepressants
a. Action: blocking of re-uptake of serotonin and
norepinephrine, blocking of alpha- I adrenergic
receptors, and muscarinic receptors.
b. Pharmacokinetics
1. Fat soluble
2. Metabolized by the liver and excreted by the
kidneys
3. Requires reaching plasma levels for imipramine,
nortriptyline, desipramine, and amitriptyline for
efficacy
 Adverse effects
1. Anticholinergic effects
2. CNS effects • Drowsiness • Insomnia and agitation •
Disorientation and confusion • Headache • Fine tremor
3. Cardiovascular:
• Tachycardia
• Orthostatic hypotension
4. Sexual • Men: impotence, testicular swelling
• Women: anorgasmia and breast enlargement
5. Metabolic: changes in blood sugar levels
 Selective serotonin re-uptake
inhibitors (SSRI)
a. Most widely used antidepressants
b. No effect on NE or dopamine, very selective
blockage of re-uptake of serotonin
c. Fewest adverse effects of any antidepressants
currently available.
 Adverse effects

1. Anorgasmia and delayed orgasm in 15 to 20% of

patients
2. Serotonin syndrome
• Associated with: high doses, MAOI and SSRI,
• Symptoms: general restlessness, sweating, insomnia,
nausea, diarrhea, cramps, delirium
• Treatment: remove causative agent, stop SSRIS, give
cyproheptadine
 SSRI
1. Fluoxetine: longest half-life
2. Sertraline
3. Paroxetine
4. Fluvoxamine: approved for OCD
5. Citalopram
6. Escitalopram
 Monoamine oxidase inhibitors
(MAOls)
Mechanism of action
Inhibits MAO, an enzyme that metabolizes serotonin,
epinephrine, and NE
 Adverse effects
MAOI + TYRAMINE = HYPERTENSIVE CRISIS
• Problem foods: cheese, dried fish, sausage, chocolate,
avocados

• Signs: occipital headache, stiff neck, nausea and

vomiting, chest pain, dilated pupils, nosebleed, elevated
blood pressure

• Treatment: stop medication, give phentolamine (alpha

blockage) or chlorpromazine (antipsychotic with
hypotensive effects)
The End
Thank You