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40a.Depression Wrap Up.docx

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University of Toronto St. George
Mac Burnham

Depression 5. Wrap Up How good are the drugs? - Successful for about 2/3 of patients. - Unsuccessful are about a third. (3+% of the population?)  Epilepsy and schizophrenia are fairly rare in comparison to depression Newer drugs – SSRIs and SNRIs – have more tolerable side effects.  Looking at the drugs we have to treat depression, newer ones are ssris and snris. They have more tolerable side effects. Not to say they don’t have side effect but just better. Older drugs – tricyclics, etc. are stronger.  The older ones are probably stronger (tricyclics and maois). So if it doesn’t work eventually they will try you on tricyclics. ECT – fall back; DBS experimental  Fall back is ECT. And DBS is experimental still but a coming therapy. Mechanism of Action - All the drugs commonly used have a therapeutic delay (indirect effect).  Therepeutic delay of about 2 weeks.  There looks like theres at least 2 ways of relieving depression (5ht and ne)  - Some mainly elevate 5HT, others mainly elevate NE (maprotoline)  There looks like theres at least 2 ways of relieving depression (5ht and ne) - MAOAI are safe and should be tried.  The inhibitors of maoa, which are not quite widely used, some authors say they should be. If you use inhibitors of either maoa or maob, you will not get this cheese effect. Maob inhibitors are used mainly in parkinsons. Maoa could be used for depression but ppl are afraid because old maois were more dangerous. But these new ones should prob be used more. - What works fast? Stimulants. Opioids. (direct effect?) EC
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