Antidepressant: Difference between revisions
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'''Antidepressant''' medications are "mood-stimulating drugs used primarily in the treatment of affective disorders and related conditions. Several [[monoamine oxidase inhibitor]]s are useful as antidepressants apparently as a long-term consequence of their modulation of catecholamine levels. The tricyclic compounds useful as antidepressive agents ([[tricyclic antidepressant]]) also appear to act through brain catecholamine systems. A third group ([[second-generation antidepressant]] agents) is a diverse group of drugs including some that act specifically on serotonergic systems."<ref>{{MeSH}}</ref> | '''Antidepressant''' medications, also called '''antidepressive agents''', are "mood-stimulating drugs used primarily in the treatment of affective disorders and related conditions. Several [[monoamine oxidase inhibitor]]s are useful as antidepressants apparently as a long-term consequence of their modulation of catecholamine levels. The tricyclic compounds useful as antidepressive agents ([[tricyclic antidepressant]]) also appear to act through brain catecholamine systems. A third group ([[second-generation antidepressant]] agents) is a diverse group of drugs including some that act specifically on serotonergic systems."<ref>{{MeSH}}</ref> | ||
==Mechanism of action== | |||
Depression may be due to the monoamine-deficiency hypothesis, which is a "deficiency in serotonin or norepinephrine neurotransmission in the brain."<ref name="pmid18172175">{{cite journal |author=Belmaker RH, Agam G |title=Major depressive disorder |journal=N. Engl. J. Med. |volume=358 |issue=1 |pages=55–68 |year=2008 |pmid=18172175 |doi=10.1056/NEJMra073096|url=http://content.nejm.org/cgi/content/full/358/1/55}}</ref> | |||
==Classification== | ==Classification== | ||
===Tricyclic antidepressants=== | |||
{{main|Tricyclic antidepressant}} | |||
Tricyclic antidepressants are "substances that contain a fused three-ring moiety and are used in the treatment of [[depression]]. These drugs block the uptake of norepinephrine and serotonin into axon terminals and may block some subtypes of serotonin, adrenergic, and histamine receptors. However the mechanism of their antidepressant effects is not clear because the therapeutic effects usually take weeks to develop and may reflect compensatory changes in the central nervous system."<ref>{{MeSH|Tricyclic Antidepressive Agents}}</ref> | |||
===Heterocyclic antidepressants=== | |||
Heterocyclic antidepressants include trazadone and bupropion, and more recently, mirtazapine and nefazadone which are based on trazadone<ref name="isbn0-07-145153-6">{{cite book |author=Katzung, Bertram G. |authorlink= |editor= |others= |title=Basic and Clinical Pharmacology |edition=10th |chapter=Antidepressant Agents |chapterurl= |language= |publisher=McGraw-Hill Medical Publishing Division |location=New York |year=2006 |origyear= |pages= |quote= |isbn=0-07-145153-6 |oclc= |doi= |url=http://www.accessmedicine.com/resourceTOC.aspx?resourceID=16 |accessdate=}}</ref> | |||
===Second-generation antidepressants=== | ===Second-generation antidepressants=== | ||
{{main|Second-generation antidepressant}} | {{main|Second-generation antidepressant}} | ||
Second-generation antidepressants are a "structurally and mechanistically diverse group of drugs that are not [[tricyclic antidepressant|tricyclics]] or [[monoamine oxidase inhibitor]]s. The most clinically important appear to act selectively on serotonergic systems, especially by inhibiting serotonin reuptake."<ref>{{MeSH|Second-generation antidepressants}}</ref> | Second-generation antidepressants are a "structurally and mechanistically diverse group of drugs that are not [[tricyclic antidepressant|tricyclics]] or [[monoamine oxidase inhibitor]]s. The most clinically important appear to act selectively on serotonergic systems, especially by inhibiting serotonin reuptake."<ref>{{MeSH|Second-generation antidepressants}}</ref> | ||
===Monoamine oxidase inhibitors=== | ===Monoamine oxidase inhibitors=== | ||
[[Monoamine oxidase inhibitor]]s are a "chemically heterogeneous group of drugs that have in common the ability to block oxidative deamination of naturally occurring monoamines".<ref>{{MeSH|Monoamine Oxidase Inhibitors}}</ref> | [[Monoamine oxidase inhibitor]]s are a "chemically heterogeneous group of drugs that have in common the ability to block oxidative deamination of naturally occurring monoamines".<ref>{{MeSH|Monoamine Oxidase Inhibitors}}</ref> | ||
==Effectiveness== | |||
The effectiveness is antidepressants depends on the severity of a patient's depression. This relationship may be due to thedeclining effect of placebo among more severely depressed patients.<ref name="pmid20042812">{{cite journal| author=Lo B| title=Commentary: Conflict of interest policies: an opportunity for the medical profession to take the lead. | journal=Acad Med | year= 2010 | volume= 85 | issue= 1 | pages= 9-11 | pmid=20042812 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=20042812 | doi=10.1097/ACM.0b013e3181c46e96 }}</ref> | |||
{| class="wikitable" align="right" | |||
|+ The effectiveness of antidepressants depending on severity of depression<ref name="pmid20042812" /> | |||
!American Psychiatric Association classification of severity<ref name="isbn1-58562-218-4">{{cite book |author=First, Michael B. |title=Handbook of Psychiatric Measures, Second Edition |publisher=American Psychiatric Publishing, Inc |location= |year=2007 |pages= |isbn=1-58562-218-4 |oclc= |doi= |accessdate=}}</ref>!! [http://healthnet.umassmed.edu/mhealth/HAMD.pdf Hamilton Depression Rating Scale] (HDRS)!![[Number needed to treat]]!!Clinical significance (NICE)<ref>National Institute for Clinical Excellence. [http://guidance.nice.org.uk/CG90 Depression: Management of Depression in Primary and Secondary Care]. London, England: National Institute for Clinical Excellence; 2004.</ref> | |||
|- | |||
| Mild to moderate|| < 19|| 16|| No | |||
|- | |||
| Severe|| 19 - 22|| 11|| No | |||
|- | |||
| Very severe|| > 22|| 4|| Yes | |||
|} | |||
"The clinical response of our patients underscores the usefulness of mirtazapine in the treatment of the comorbid symptoms of weight loss, insomnia, and anxiety". <ref name="pmid11573849">{{cite journal| author=Raji MA, Brady SR| title=Mirtazapine for treatment of depression and comorbidities in Alzheimer disease. | journal=Ann Pharmacother | year= 2001 | volume= 35 | issue= 9 | pages= 1024-7 | pmid=11573849 | doi= | pmc= | url= }} </ref> | |||
[[Amitriptyline]], mirtazapine, and [[paroxetine]] may case more weight gain than other [[antidepressent]]s according to a [[meta-analysis]].<ref name="pmid21062615">{{cite journal| author=Serretti A, Mandelli L| title=Antidepressants and body weight: a comprehensive review and meta-analysis. | journal=J Clin Psychiatry | year= 2010 | volume= 71 | issue= 10 | pages= 1259-72 | pmid=21062615 | doi=10.4088/JCP.09r05346blu | pmc= | url= }} </ref> | |||
==Drug toxicity== | |||
[[Second-generation antidepressant]]s are not clearly safer than [[tricyclic antidepressant]]s.<ref name="pmid21810375">{{cite journal| author=Coupland CA, Dhiman P, Barton G, Morriss R, Arthur A, Sach T et al.| title=A study of the safety and harms of antidepressant drugs for older people: a cohort study using a large primary care database. | journal=Health Technol Assess | year= 2011 | volume= 15 | issue= 28 | pages= 1-202, iii-iv | pmid=21810375 | doi=10.3310/hta15280 | pmc= | url= }} </ref> | |||
===Neuroleptic malignant syndrome=== | |||
{{main|Neuroleptic malignant syndrome}} | |||
===Serotonin syndrome=== | |||
{{main|serotonin syndrome}} | |||
===Recurrence of illness after discontinuation=== | |||
The recurrence risk for depression or panic was shorter if antidepressants were discontinued over 7 days or less.<ref name="pmid20478876">{{cite journal| author=Baldessarini RJ, Tondo L, Ghiani C, Lepri B| title=Illness risk following rapid versus gradual discontinuation of antidepressants. | journal=Am J Psychiatry | year= 2010 | volume= 167 | issue= 8 | pages= 934-41 | pmid=20478876 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20478876 | doi=10.1176/appi.ajp.2010.09060880 }} </ref> | |||
==References== | ==References== | ||
| Line 18: | Line 52: | ||
==See also== | ==See also== | ||
* [[Depression]] | * [[Depression]][[Category:Suggestion Bot Tag]] | ||
Latest revision as of 11:00, 11 July 2024
Antidepressant medications, also called antidepressive agents, are "mood-stimulating drugs used primarily in the treatment of affective disorders and related conditions. Several monoamine oxidase inhibitors are useful as antidepressants apparently as a long-term consequence of their modulation of catecholamine levels. The tricyclic compounds useful as antidepressive agents (tricyclic antidepressant) also appear to act through brain catecholamine systems. A third group (second-generation antidepressant agents) is a diverse group of drugs including some that act specifically on serotonergic systems."[1]
Mechanism of action
Depression may be due to the monoamine-deficiency hypothesis, which is a "deficiency in serotonin or norepinephrine neurotransmission in the brain."[2]
Classification
Tricyclic antidepressants
Tricyclic antidepressants are "substances that contain a fused three-ring moiety and are used in the treatment of depression. These drugs block the uptake of norepinephrine and serotonin into axon terminals and may block some subtypes of serotonin, adrenergic, and histamine receptors. However the mechanism of their antidepressant effects is not clear because the therapeutic effects usually take weeks to develop and may reflect compensatory changes in the central nervous system."[3]
Heterocyclic antidepressants
Heterocyclic antidepressants include trazadone and bupropion, and more recently, mirtazapine and nefazadone which are based on trazadone[4]
Second-generation antidepressants
Second-generation antidepressants are a "structurally and mechanistically diverse group of drugs that are not tricyclics or monoamine oxidase inhibitors. The most clinically important appear to act selectively on serotonergic systems, especially by inhibiting serotonin reuptake."[5]
Monoamine oxidase inhibitors
Monoamine oxidase inhibitors are a "chemically heterogeneous group of drugs that have in common the ability to block oxidative deamination of naturally occurring monoamines".[6]
Effectiveness
The effectiveness is antidepressants depends on the severity of a patient's depression. This relationship may be due to thedeclining effect of placebo among more severely depressed patients.[7]
| American Psychiatric Association classification of severity[8] | Hamilton Depression Rating Scale (HDRS) | Number needed to treat | Clinical significance (NICE)[9] |
|---|---|---|---|
| Mild to moderate | < 19 | 16 | No |
| Severe | 19 - 22 | 11 | No |
| Very severe | > 22 | 4 | Yes |
"The clinical response of our patients underscores the usefulness of mirtazapine in the treatment of the comorbid symptoms of weight loss, insomnia, and anxiety". [10]
Amitriptyline, mirtazapine, and paroxetine may case more weight gain than other antidepressents according to a meta-analysis.[11]
Drug toxicity
Second-generation antidepressants are not clearly safer than tricyclic antidepressants.[12]
Neuroleptic malignant syndrome
Serotonin syndrome
Recurrence of illness after discontinuation
The recurrence risk for depression or panic was shorter if antidepressants were discontinued over 7 days or less.[13]
References
- ↑ Anonymous (2024), Antidepressant (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Belmaker RH, Agam G (2008). "Major depressive disorder". N. Engl. J. Med. 358 (1): 55–68. DOI:10.1056/NEJMra073096. PMID 18172175. Research Blogging.
- ↑ Anonymous (2024), Tricyclic Antidepressive Agents (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Katzung, Bertram G. (2006). “Antidepressant Agents”, Basic and Clinical Pharmacology, 10th. New York: McGraw-Hill Medical Publishing Division. ISBN 0-07-145153-6.
- ↑ Anonymous (2024), Second-generation antidepressants (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Anonymous (2024), Monoamine Oxidase Inhibitors (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ 7.0 7.1 Lo B (2010). "Commentary: Conflict of interest policies: an opportunity for the medical profession to take the lead.". Acad Med 85 (1): 9-11. DOI:10.1097/ACM.0b013e3181c46e96. PMID 20042812. Research Blogging.
- ↑ First, Michael B. (2007). Handbook of Psychiatric Measures, Second Edition. American Psychiatric Publishing, Inc. ISBN 1-58562-218-4.
- ↑ National Institute for Clinical Excellence. Depression: Management of Depression in Primary and Secondary Care. London, England: National Institute for Clinical Excellence; 2004.
- ↑ Raji MA, Brady SR (2001). "Mirtazapine for treatment of depression and comorbidities in Alzheimer disease.". Ann Pharmacother 35 (9): 1024-7. PMID 11573849. [e]
- ↑ Serretti A, Mandelli L (2010). "Antidepressants and body weight: a comprehensive review and meta-analysis.". J Clin Psychiatry 71 (10): 1259-72. DOI:10.4088/JCP.09r05346blu. PMID 21062615. Research Blogging.
- ↑ Coupland CA, Dhiman P, Barton G, Morriss R, Arthur A, Sach T et al. (2011). "A study of the safety and harms of antidepressant drugs for older people: a cohort study using a large primary care database.". Health Technol Assess 15 (28): 1-202, iii-iv. DOI:10.3310/hta15280. PMID 21810375. Research Blogging.
- ↑ Baldessarini RJ, Tondo L, Ghiani C, Lepri B (2010). "Illness risk following rapid versus gradual discontinuation of antidepressants.". Am J Psychiatry 167 (8): 934-41. DOI:10.1176/appi.ajp.2010.09060880. PMID 20478876. Research Blogging.