Depression

Patients with depression most commonly don’t complain about it directly

We must watch for the clues of depression
• Vague somatic complaints
• Anxiety
•  Sleep or Insomnia
•  Energy or Fatigue
•  Appetite
•  Concentration
• Psychomotor retardation
•  Pleasure (Anhedonia)

Treatment
• Treatment of choice : Antidepressant + Psychotherapy
• 1st line drugs : Serotonin specific reuptake inhibitor (SSRI)
• 2nd line drugs : Serotonin norepinephrine reuptake inhibitor (SNRI), Tricyclic antidepressant
• Bupropion, Mitrazapine

Watch out when prescribe antidepressant to bipolar patient, as it can trigger mania or hypomania,
especially in Bipolar patients

More common in female

Dysrhythmia
• Definition : Depressed mood on most day > 2 years without episodes of major depression,
mania/hypomania or psychosis

All drugs
MOA
•

Tricyclic SSRI SNRI Monoamine

antidepressants oxidase (MAO)
inhibitor
Example nortriptyline, fluoxetine, venlafaxine,
amitriptyline citalopram, duloxetine,
paroxetine, sertraline, desvenlafaxine
fluvoxamine,
escitalopram
MOA Prevent reuptake Prevent reuptake of Prevent reuptake of
of norepinephrine serotonin norepinephrine &
& serotonin serotonin
Adverse Block alpha • Insomnia • Same as SSRI
effect adrenergic • Anxiety
receptor • Jitteriness Block alpha
• Headache adrenergic receptor
 • Orthostatic • Sexual dysfunction • Sweating
hypotension • Dizziness
• Dizziness
• Syncope
Block muscarinic
receptor (Cause
anti-cholinergic
effect)
• Dry mouth
• Blurred vision
• Constipation
• Urinary
retention
Anti-histamine
effect
• Sedation
Notes • Danger if More preferred • Good for
overdose as it can compare to tricyclic atypical
cause Cardiac antidepressant depression –
arrythmia because Atypical
» Antidote – • Less serious side presentation of
Bicarbonate effects hypersomnia,
• Not danger if hyperphagia
overdose • Danger ! Don’t
give MAO
inhibitor at same
time with SSRI or
meperidine, as
can cause danger
reaction that can
cause death