Compare and contrast the mechanism of action and side effects of tricyclic antidepressants, selective serotonin reuptake inhibitors and monoamine oxidase inhibitors.
Good answers were in tabular format.
The antidepressant action is similar for each agent. Initial increase in 5HT and NA, followed
in 2-3 weeks by a down regulation or change in efficiency of 5HT transmission. The agents
produce elevated neurotransmitters via different mechanisms, either reuptake blockade or
enzyme inhibition. MAOIs can be competitive or non-competitive. Mention of the different
neurotransmitters affected by each agent was required.
A description of significant side effects at therapeutic doses, and in overdose was expected
with explanations provided. These should have included - the anticholinergic effects and
cardiotoxicity of TCAs, postural hypotension, the catecholamine, pethidine and tyramine
related complications of MAOIs, and serotonin syndrome with SSRI/MAOI use and or
overdose. More marks were gained for mention that side effect profiles can be beneficial e.g.
analgesic properties of TCAs, sedation with TCAs/ SSRIs and energizing benefits of
SSRIs/SNRIs. SSRI’s safety and efficacy have markedly reduced the use of MAOIs and to a
lesser extent TCA’s..
Reference: Stoelting p 398-407
Katzung p 476-487.
|Specific mechanism of action||
TCAs act by at least five different mechanisms:
SSRIs inhibit SERT, the serotonin reuptake protein. This increases the availability of serotonin in the synapse. According to the monoamine hypothesis of mood regulation, the increase in serotonin
|MAOIs inhibit the activity of monoamine oxidase, which is responsible for the catabolism of monoamines like dopamine, noradrenaline and serotonin|
|Common mechanism of action||
|Common side effects||
||Agitation, diarrhoea, loss or gain of weight, vertigo, sexual dysfunction, risk of increased suicidality||Hypertensive crises, hepatotoxicity, seizures, hypoglycaemia, mania, psychosis. Dangerous pharmacodynamic interactions with other antidepressants and monoaminergic drugs, as well as foods that act as catecholamine precursors|
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