Drugs for Major Depressive Disorder

Tricyclic Antidepressant

• Amitryptiline

• Clomipramine

• Desipramine

• Doxepin

• Imipramine

• Nortriptyline

• Uses

  • For major depressive disorder, as an adjunct
  • An additional drug, not the first line of treatment
  • Not a primary therapy because of the following side effects
  • Excessive sedation
    • Blocks Histamine Receptor
  • Anticholinergic effects
    • Block DUMBELLSS Effects (Cholinergic)
  • 3Cs - (Coma, Convulsion, Cardiotoxicity)
  • Weight Gain

• Mechanism of Action:

  • Inhibit serotonin and norepinephrine reuptake

• Selective Serotonin Reuptake Inhibitor (SSRI)

  • Citalopram

  • Escitalopram

  • Fluoxetine

  • 1st line agent for Major Depressive Disorder

  • Fluvoxamine

  • Paroxetine

  • Sertraline

  • Uses

  • 1st line agent for Major Depressive Disorder

  • Also for Obsessive Compulsive Disorder (Perfectionist), generalized anxiety disorder

  • Eating disorder

    • Anorexia nervosa
    • Characterized by food restriction, inappropriate eating habits or rituals, obsession with having a thin figure, and an irrational fear of weight gain, as well as a distorted body self-perception.
    • Bulimia nervosa
    • Characterized by binge eating and purging by vomiting, taking a laxative, diuretic, excessive exercise, because of an extensive concern for body weight

  • Mechanism of Action

  • Blocking serotonin reuptake by inhibiting SERT (Serotonin transporter)

  • Side Effects

  • Increase suicidality

  • Erectile Dysfunction

  • QT Prolongation

    • ECG or in the Heart
    • Occurs when the heart muscle takes longer to contract and relax than usual.

• Serotonin Norepinephrine Reuptake Inhibitor (SNRI)

  • Venlafaxine

  • Desvenlafaxine

  • Duloxetine

  • Uses:

  • Major Depressive Disorder

  • Neuropathic pain

  • Mechanism of Action

  • Inhibit serotonin and norepinephrine reuptake

  • Side Effects

  • Hypertension (Particularly with venlafaxine since it causes severe hypertension)

  • Duloxetine causes liver damage

  • Venlafaxine causes cardiotoxicity

• Serotonin Antagonist (Serotonin Reuptake Inhibitor)

  • Trazodone

  • Mefazodone

  • Uses:

  • Major Depressive Disorder

  • Sleeping Aid

  • Side Effect

  • Priapism

    • Causing continuous erection

• Tetracyclics (Possible to Block Dopamine Receptor)

  • Amoxapine

  • Maprotiline

  • Uses:

  • Major Depressive Disorder

  • Mechanism of Action

  • Strong NE reuptake inhibitor, weak serotonin reuptake inhibitor

  • Side Effects

  • Dopamine 2 Inhibition: Parkinsonism

  • Seizure

  • Cardiotoxicity

• Monoamine Oxidase Inhibitor (MAOi)

  • MAO A

  • MAO A Selective Drug

    • Moclobemide

  • Metabolizes

    • Norepinephrine, Epinephrine, Serotonin, Amines (Histamine and Tyramine)

  • MAO B

  • MAO B Selective Drug

    • Selegiline
    • Rasagiline

  • Metabolizes Dopamine

  • Non Selective MAO Inhibitors

  • Phenelzine

  • Isocarboxazid

  • Tranylcypromine

  • Uses

  • Major Depressive Disorder (Adjunct) (Additional Drug Therapy)

  • Anxiety disorders

  • Depressed patients with anxiety, phobic features, and hypochondriasis

    • Hypochodriasis causing a person to feel like he/she is sick although he/she is currently not experiencing any disease
    • Phobia causes uncontrollable anxiety or fearful on something

  • Side Effect

  • Seizures

  • Arrhythmia

  • Hyperthermia

  • Drug Interaction

  • MAO Inhibitor is never given with tyramine-rich food (cheese, wine, fish)

    • Causes hypertensive crisis

• Miscellaneous Agent

  • Noradrenergic Selective Serotonergic Antidepressant (NSSA)

  • Mirtazapine

  • Uses

    • MDD
    • Appetite stimulant
    • Sleeping Aid

  • Side Effects

    • Weight gain
    • Blurring of vision
    • Sedation

  • Norepinephrine-Dopamine Reuptake Inhibitor (NDRI)

  • Bupropion

  • Mechanism of Action

    • Inhibit dopamine and norepinephrine reuptake

  • Uses

    • MDD
    • Smoking cessation
    • Alcohol dependence

  • Side Effects

    • Weight loss
    • Psychotic events