Using your textbooks, compile a classification of the drugs used as antidepressants.

Classification	Subclass / middle
Selective Serotonin Reuptake Inhibitors (SSRIs)	Fluoxetine Citalopram Escitalopram Paroxetine Sertraline
Serotonin - Norepinephrine Reuptake Inhibitors (SNRIs)	Duloxetine Venlafaxine Levomilnacipran
Tricyclic Antidepressants (TCAs)	Imipramine Many others
5 - HT Receptor Modulators	Nefazodone Trazodone Vortioxetine
Tetracyclic, Unicyclic	Bupropion Amoxapine Maprotiline Mirtazapine
Monoamine Oxidase Inhibitors (MAOIs)	Phenelzine Tranylcypromine Selegiline

2. With regard to the mechanisms of action of the existing drugs, what do they all have in common?

These drugs have a multiple multipotent action on many monoamine energy receptors and this is due to the nonspecific increase in serotonin or noradrenaline.

3. How long does it take for the antidepressant effects of these drugs to appear? What is the reason for this?

These drugs have a slow onset of action and take 14 - 21 days or even more before they start working effectively.

4. How do the TADs and the selective serotonin reuptake inhibitors (SSRIs) differ from each other in terms of:

• Effectiveness:TAD requires titration to minimum effective dose while SSRIs can usually start at full dose immediately (NB anxiety).

• Side effects:
  • TAD:
    • Sedation due to H1 receptor blockade
    • Sympathomimetic: tremor, insomnia (decreases NA readmission)
    • Anticholinergics: vision disorders, dry mouth, constipation, urinary retention, confusion (M-block)
    • Cardiovascular: orthostatic hypotension, dysrhythmias
    • Psychoses, precipitate mania
    • Convulsions
  • SSRI:
    • Insomnia, tremor, GIT - disorders, headache, decreased libido, sexual dysfunction, anxiety (acute), EPS (needles, pins, itching, restless legs) withdrawal syndrome
    • The drugs can reduce appetite and overweight patients can thus lose weight.
    • Drugs are not sedative - do not frequent
    • How acute anxiety as toxicity as SSRIs are usually used for it.
    • Initially, there is a sudden increase in the 5-HT levels in the brain that aggravates anxiety, however, it gets better again later.
• Safety
  • TAD overdose:
    • Very dangerous
    • 10 x daily dose can be fatal
    • Agitation, delirium, neuromuscular irritability, convulsions, coma, respiratory depression, circulatory collapse, hyperpirection, dysrhythmias
    • Coma, convulsions, cardiotoxicity
  • SSRI:
    • The drug has a better side effects profile than many other drugs and is safer in acute overdose.
    • May lower appetite and result in weight loss.

5. How does mirtazepine work?

A NaSSA - Noradrenaline and specific serotonin antidepressant.

Blockα2 (blockade of this inhibitory receptor promotes both NA (autoreceptor) and 5 - HT release (heteroreceptor), 5 - HT2A and 5 - HT3. Also blocks H1 and α1. Also indirect stimulation of 5 - HT1A.

6. How does venlafaxine work?

Blocks both 5 - HT and NA readmission, more potent for 5 - HT than for NA.

7. How does agomelatine work?

Restores the body's biorhythms. Primary agonist at melatonin 1 + 2 receptors and an antagonist at 5 - HT2C receptors.