Notes: Y2 pharm - depression & bipolar disorder | NSB
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Neuropharm DepressionPharm
• Unipolar Depression
o reactive, non-familial: association with stressful life events/ anxiety/
agitation
o endogenous, familial: distinct symptomology unrelated to stress
• Bipolar Depression
o depression alternating with mania over a few weeks.
o strong hereditary tendency
o BP1- mania
o BP2- hypomania
Depression is a deficiency of monoamine transmission
• Unipolar depression- (need both)
o thymoleptics- drugs that re-elevate mood (monoamine reuptake – TCA
(tricyclic antidepressants))
o thymeretics- drugs that activate psychomotor drive (monoamine
metabolism – MAOIs (monoamine oxidase inhibitors))
N&B Pharmacology: Pharmacological
basis for the treatment of depression and
bipolar
Antidepressant Treatments:
• Tricyclic antidepressants (TCAs)- block reuptake (noradrenaline)
• Selective Serotonin Reuptake Inhibitors (SSRIs)- block serotonin reuptake
• Noradrenaline Reuptake Inhibitors (NRIs)- block NA reuptake
• Serotonin and Noradrenaline Reuptake inhibitors (SNRIs)- block 5HT and NA
reuptake
• drugs that target intracellular messengers (rolipram- phosphodiesterase
inhibitor)
• electro convulsion therapy
MAO-Inhibitors:
• in nerve terminals and control monoamines (iproniazid)
• in intestinal mucosa and liver (metabolises dietary amines to prevent passage
into systemic circulation) (Cheese reaction)
• Monoamine Reuptake Inhibitors for antidepression
o Serotonin transporter (SERT)
o noradrenaline transporter (NET)
TCAs:
• take 2-3 weeks to take effect
• lack of selectivity (alpha-1 antagonism, postural hypotension. H1 antagonist,
sedation. muscarinic antagonist, dry mouth, blurred vision, constipation)
• acute cardiotoxicity
SSRIs:
• citalopram, vortioxetine, sertraline
• side-effects: GI, rash, tremor, loss of libido
• safe in overdose
NRIs: (3rd Generation antidepressants)
• maprotiline
SNRIs: (3rd Generation antidepressants)
• venlafaxine (inhibits SERT and NET)
o low therapeutic dose: SERT>NET
o high therapeutic dose: SERT=NET
N&B Pharmacology: Pharmacological
basis for the treatment of depression and
bipolar
Multiple Useful Actions Drugs: (3rd Generation antidepressants)
• mirtazapine -(NRI and alpha-2 antagonist (decreases presynaptic feedback
inhibition of NA and 5HT release))
• mianserin -(weak monoamine (NA) uptake inhibitor, alpha-2 antagonist
• trazodone- (serotonin antagonist and reuptake inhibitor, 5HT2 antagonist)
Depression, Bipolar
