Drugs used to elevate mood and alleviate other symptoms associated with moderate to severe depression.
l . Tricyclics : e.g. Imipramine, Desipramine, Amitriptyline
2. Tetracyclics : Amoxapine
3. Monoamine Oxidase Inhibitors : e.g. Tranylcypramine, Phenelzine
4. Selective Serotonin Reuptake Inhibitors(SSRIs) : e.g. Fluvoxamine.
5. Novel Antidepressants- e.g. Bupropion, Trazadone,Venlafaxine
· Increase the catecholamine levels in the brain
· TCAs blocking the reuptake of NE and 5-HT at the nerve terminals, thus increasing the NE and 5-HT levels at the receptor site
· Mono amines are responsible for the degradation of catecholamines after reuptake; so MAOIs increase the NE and 5-HT levels at the receptor site
· SSRIs inhibits the reuptake of serotonin
· Absorption -from GIT
· Distribution -bound to plasma protein and tissue protein
· Metabolism -liver
· Excretion -kidney
2)Childhood Psychiatric Disorders: Enuresis, Separation anxiety disorder, Somnambulism, School phobia, Night terrors
3)Other Psychiatric Disorders: Panic attack, Generalized anxiety disorder, Agora phobia, Social phobia, OCD, Eating disorder, Borderline personality disorder, PTSD, Depersonalization syndrome
4) Medical disorders: Chronic pain, Migraine, Peptic ulcer disease
· Recovery phase from myocardial infarction
· Elderly or debilitated with hepatic, renal, cardiac insufficiency
· History of seizure disorder
· Pregnancy and lactation
Autonomic side effects-
Dry mouth, blurred vision, dry eyes, constipation, urinary retention, cycloplegia, mydriasis, delirium, orthostatic hypotension
tachycardia, arrhythmias and hypotension. Amitriptyline is considered most cardiotoxic drug
sedation, confusion, disorientation, anxiety, insomnia, ataxia, tremors, seizures
Hypertensive crisis with MAOIs-
palpitation, tightness in chest, stiff neck, throbbing and radiating head ache. High blood pressure with the elevation of heart rate is common.
Sexual side effects:
impotence, impaired ejaculation, anorgasmia
agranulocytosis, jaunuice, Skin rashes, systemic vasculitis
· Clients on MAOI should be warned against danger of tyramine rich foods which results in hypertensive crisis. They are beef liver, chicken liver, dried fish, over ripped fruits, chocolates, wine, beer, coffee etc.
· Report for unusual symptoms like occipital headache, nausea, vomiting, chest pain.
· Instruct not to take medication without prescription
· Caution the patient to change his position slowly to minimize orthostatic hypotension
· Strictly monitor of vital signs, especially blood pressure