CNS by Dr. Nadeem Korai

CENTRAL NERVOUS SYSTEM

Dr. Nadeem akhtar MBBS.M.Phil

Asst. Professor PharmacologyAmna Inayat Medical College

Shaikhupura

ANTI-DEPRESSANTS

Drugs which are prescribed to relieve depression

Depression

• Low mood• Depressed feelings• Lonely living• Lack of energy• Other physical problems

• 17 % world wide prevalence

• 4 th number in the list of 10 world wide common diseases ,noted by WHO

• This will be on second number in 2020

Typical pic of depressed individual

Pathophysilogy

• 1. Amines hypothesis

• 2.Neurotrophic hypothesis

Physical or Pharmacological treatment

• A)Trycyclic antidepressants (TCAs)

• Imipramine• Clomipramine• Amitriptyline

Mode of action

• They inhibit re-uptake mechanisms

• Terminate synaptic actions of NE & 5-HT in the brain

Effects

• A.N.S• produce anticholinergic actions• C.V.S• Ventricular dysrythmias• Hypertension (rarely)

Drug interactions

• Antagonize the centrally acting drug antihypertensive agents e.g Clonidine

• If given with MAOS, patient develop severe hypertension

Indications

• Major depressive disorder (MDD)• Panic disorder (PD)• Obsessive compulsive disorder (OCD)• Enuresis• Chronic fatigue • Diabetic neuropathy• Eating disorders

Adverse effects

• Dryness of mouth• Constipation• Tachycardia• Blurring of the vision• Retention of urine• Postural hypotension• Sedation• Weight gain• Tremors• Sexual problems

Contra-indications

• Glaucoma

• Pregnancy

• Benign prostate hypertrophy (BPH)

Selective serotonin reuptake inhibitors (SSRIs)

• Fluxetine

• Citalopram

• Escitalopram

• Paroxitine

Mode of action

• Highly selective on 5-HT receptors

• Minimal inhibitory effect on NE transporters or blocking actions on adrenergic or cholinergic receptors

Adverse effects

• Minimal anticholinergic action and mild constipation

• Suicidal ideation with long term use

• Erectile dysfunction

Monoamine oxidase inhibitors

• Phenalzine

• tranylcypromine

Mode of action

• Increase amine level by interfering their • metabolism at nerve endings and • increasing storage of NE & 5-HT

usage

• Indicated when other treatment fail

• Dangerous drug-drug or drug & food interactions can develop

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

• Venlafaxine

• Duloxetine

• Milancipran

5-HT2 Antagonists

• Trazodone

• Nefazodone