Drugs Used to

Treat Affective
Disorders
Dr.Mehwish Waseem
DPT,MS-CPPT
• Form of mental illness characterized by intense feelings of
sadness and despair increased in both intensity and duration
to an incapacitating extent.
– General dysphoric mood (sadness, irritability)
– general lack of interest in previously pleasurable activities.
– anorexia, sleep disorders (either too much or too little),
– fatigue, lack of self-esteem,
– somatic complaints, and irrational guilt.
– Recurrent thoughts of death and suicide may also help lead to a
diagnosis of depression.

DEPRESSION
• Depression is caused by the complex interaction of a number of
genetic, environmental, and biochemical factors

• disturbance in CNS neurotransmission of amine neurotransmitters. ..

5-hydroxytryptamine (serotonin), norepinephrine, and dopamine…
control many aspects of mood and behavior.

• may be caused by an increased sensitivity of the presynaptic or

postsynaptic receptors

• This theory is based primarily on the finding that Antidepressant

drugs …prolong the activity of amine neurotransmission in the brain,
thereby causing a compensatory decrease in the sensitivity of the
amine receptors.

Pathophysiology of
Depression
• Tricyclics,
• Monoamine oxidase (MAO) inhibitors,
• Second-Generation drugs

Antidepressant Drugs
 Tricyclics
• three-ring chemical structure (hence the name “tricyclic”).

• blocking the reuptake of amine neurotransmitters into the

presynaptic terminal…allow the released amines to remain in the
cleft and continue to exert their effects.(especially norepinephrine)
leads to the compensatory decrease in receptor sensitivity, which
ultimately leads to a decrease in depression.

• In the past, tricyclic drugs such as amitriptyline and nortriptyline

were the most commonly used antidepressants and were the
standard against which other antidepressants were measured
• AMITRYPTYLIN
• NORTRYPTALINE
• AMOXAPINE
• CLOMIPRAMINE
• DESIPRAMINE
• DOXEPIN
• IMIPRAMINE

Tricyclics
• ISOCARBOXAZID
• PHENELZINE
• TRANYLCYPROMINE
• MONOAMINE OXIDASE (MAO) is an enzyme located at
amines synapses that metabolizes amines>remove released
transmitters through enzymatic destruction. Drugs that inhibit
this enzyme allow more of the transmitter to remain in the
synaptic cleft and continue to exert an effect
• Not drug of choice but helpful if other agents do not respond.

MAO INHIBATORS
• Flouxetine
• Citalopram
• Fluvoxamine
• Paraxetine
• Sertraline
THESE DRUGS BLOCK SELECTIVE RE UPTAKE OF
SEROTONINE.
• Less side effects.

SSRIs
• Reboxetine.nor-epi
• VENALFEXINE: serotonin & nor-epi(SNRIs)

OTHER SELECTIVE DRUGS

• Sedation
• Anticholinergic :
• Central: confusion
• Peripheral: dry mouth, constipation, urinary retention,
tachcardia.
• Arrythmia
• Orthostatic hypotension

Tricyclics Adverse effects

• CNS excitation…restlessness, irritability, agitation, sleep loss.
• Central & peripheral anticholinergic effects.
• MAO …breakdown catecholamine…Increased blood
pressure…excess activity at peripheral sympathetic adrenergic
terminals.
• Fermented food: cheese & wine…releaes Catecholamine…
MAO inhibitors…do not degrade it…HTN crisis.

MAO Inhibitors side

effects
• GI problems
• Insomnia
• Serotonin syndrome: sweating, shivering, movement
disorders…typically disapear when drug discontinued.

SSRIs side effects

Manic episodes are characterized by euphoria, hyperactivity, and
talkativeness and depressive episodes.
•Increase NT release…for the manic episodes of this disorder. The
subsequent depression may simply be a rebound from the general
excitement of the manic episode

Treatment of Bipolar
Disorder: Antimanic
Drugs
• Lithium (Li) is a monovalent cation…competing with
other cations including sodium, potassium, and calcium.
• lithium may stabilize neuronal excitability by decreasing
the sensitivity of certain postsynaptic receptors

Lithium
• Mild (Below 1.5
mEq/L) • Moderate (1.5–3.0
mEq/L)
• Fine hand tremor
(resting) • Confusion&Lethargy
• Gastrointestinal upset • Ataxia
• Muscle weakness • Dysarthria
• Fatigue • Emesis
• Problems with memory • Increased deep tendon
and concentration reflexes
• Increased tremor
• Muscle fasciculations

Lithium toxicity
• Severe (Above 3.0
mEq/L)
• Choreoathetoid Other drugs used in
movements bipolar syndrome
• Seizures • antiseizure medications
• Respiratory • Antipsychotic
complications medications
• Coma
• Death

Lithium toxicity
 THANK
YOU