DEPRESSION 3. Therapy
THERAPY FOR MOOD DISORDERS: CHAPTER 25 IN DEPT TEXT,
CHAPTER 16 IN CARLSON
AN OVERVIEW OF THERAPIES
o work in about 70% of people and takes about a month
o Prolonged temporal-lobe epilepsy schizophrenia and tonic-clonic seizures leading
to forced normalization was the motivation for this. Treatment of choice for drug-
o Transcranial magnetic stimulation
Sleep, REM-sleep deprivation
Light therapy (SAD)
Counselling: CBT to improve thinking etc.
OTC/Street Drugs: alcohol, THC, stimulants, etc. Self-medication
A HISTORICAL OVERVIEW OF THE DRUGS
It all started with anti-histamines. Found it blocked H1 receptor in brain and made you sleepy.
Playing with the anti-histamines enabled the advent of chlorpromazine (first antipsychotic).
1) Tricyclic antidepressants (TCAs– Block 5HT and NE reuptake
Came out in the late 1950s.
Work on a lot of people with a 3-4 week delay
2) Monoamine oxidase inhibitors (MAOIs)
Came out in the late 1950s (a tiny bit before the tricyclics)
Probably as effective or more effect than TCAs, but can be very dangerous
3) Second generation antidepressants, etc. (1980s)
4) SSRI’s (1990s)
5) SNRI’s recent (1990s-2000+) Raise 5HT and noradrenaline together. Don’t know if added NE has benefit
MANIA: MOOD STABILIZERS (Antidepressants AS
Use antidepressants with care because it can exacerbate mania (which is the more severe)
1) Lithium carbonate (1950s)
This is the mainstay, majority of people respond to it. If they don’t, go onto
second line drugs. Not antidepressant or mania. It’s anti-cyclic. Stops the cyclic
progression from one mood to the next.
2) Anticonvulsants (recent)
Several anticonvulsants used for atypical (resists lithium) bipolar.
Use valproate, carbamazepine. Don’t know why they work.
3) Atypical antipsychotics (recent)
Strong drugs that calm you down. They’re essentially being used as tranquilizers
for the manic phase as opposed to antipsychotics. Don’t have the terrible motor
side-effects of the typical antipsychotics. Lessen arousal levels.
DRUGS FOR DEPRESSION (Detail)
TRICYCLIC ANTIDEPRESSANTS (LATE 1950’S)
Mechanism:Block reuptake of 5HT (especially tertiary) and NE (especially
secondary). However, a lot of cross-conversion occurs in the body ( e.g., 2 3 )
Time to act: 2 weeks plus
NORMALS: drowsiness, fatigue. Do not make normal people happy
DEPRESSED PEOPLE: Improvement of mood along with side effects:
o Anticholinergic antimuscarinic-cholinergic in brain (dry mouth, etc.)
Essentially parasympathetic (smooth muscle) loss of function
o Sedation because they tend to block H1 receptors)
o Cardiotoxic – muscarinic system slows heart whereas NE speeds heart; confused o Orthostatic hypotension – block NE in periphery, giving you hypotension
o Mania – can switch depression into mania in a bipolar person
Dangers of the tricyclics:
You’re blocking the reuptake of NE. This also occurs in the body. NE
receptors are part of the sympathetic nervous system and raise blood
pressure, so you have to be careful.
Drug interactions: potentiate pressor drugs (drugs that increase blood
pressure); don’t combine with MAOI’s.
o You have to be ESPECIALLY careful when taking tricyclics with MAOIs
because MAOIs are notorious for raising blood pressure
Note: Probably stronger than the SSRI’s, although with more side effects
So these are reserved for individuals who don’t respond to SSRIs or SNRIs
MAOI’S (monoamine oxidase A+B in