Depression

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Depression

• Anh-Thu Phan
• Medicinal Chemistry
• Spring 2007- CSU

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What Is Depression?

• Clinical diagnosis of a depression at a low or
  sad state marked by significant levels of
  sadness, lack of energy, low self-worth, or guilt
  that being disruptive to an individual's social
  functioning or activities of daily living.
• Last more than 2 weeks

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Forms of Depression

• Major Depression or Unipolar Depression
• - Experience some episodes of physical problems,
  such as headaches, other aches and pains, or
  digestive upset, in addition to emotional
  difficulties.
• Bipolar Disorder
• - A.k.a. manic depressive illness, causes mood
  swings that soar to unusual elevation
• Dysthymia
• - Chronic and low-grade depression. It often
  begins in childhood or adolescence.
• Seasonal affective disorder (SAD)
• - Triggers by a decrease in exposure to
  sunlight, often occurs in Northern Hemisphere
• Postpartum Depression
• - Occurs sometimes after childbirth

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What Causes Depression?

• Imbalance of naturally-occurring chemicals,
  serotonin and norepinephrine, in the brain and
  the body.
• - lack of information flow between neurons

Courtesy of Cymbalta.com
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Possible Contributing Factors

• Environmental
• - Living with a depressed person, loss job,
  being victimized, got too much pressure on you
• Interpersonal
• - Relationship problems, death of love ones,
  unsolved anger or guilt
• Physical/ Medical/ Biological
• - Deformities, genetic predisposition, chronic
  anxiety, sleep deprivation, head trauma, obesity
• Diet/ Exercise
• - Non-nutritional foods, alcohol, tobacco, drugs
  use, lack of exercise
• Cognitive
• - Self criticism, pessimistic thinking

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Who Does Depression Hurts?

• EVERYONE
• - Men
• -Women
• -Adolescents
• - Elders
• Regardless of social economic status, gender, or
  race

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What Are The Symptoms?

• Miserable, sad, exhausted a lot of the time with
  no energy
• Feel like a failure and/or feel guilty a lot of
  the time.
• Sudden weight loss or gain
• Difficult to think clearly
• Seldom enjoy the things that you used to enjoy,
  ex sex, food, shopping.
• You feel irritable or angry more than usual.
• You feel you have no confidence
• Difficulty sleeping or wake up very early in the
  morning and can't sleep again
• Physical aches and pains
• - Head ache, constipation, back pain

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How Is It Diagnosed?

• You
• Your Physician
• Screening Test
• Hamilton Depression Rating Scale
• 21 multiple choice doctors use to rate the
  severity of a patient's depression
• Beck Depression Inventory
• 21 multiple choice self-report inventory
  questions

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What Are The Pharmaceutical Treatments ?
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How Do The Drugs Work?
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Drugs Focus

• MAOIS
• - Nardil (phenelzine sulfate )
• 15 mg tablet/ 0.50
• 60 mg - 90 mg per day
• ?Treat depression as well as anxiety or phobias
  mixed with depression
• SNRI
• - Cymbalta (duloxetine HCl)
• 20 mg, 30 mg, 60 mg capsules
• Brand 2.50- 3.50, Generic 0.65- 1.77
• 40 mg- 60 mg per day

Courtesy of Google images
?Major depressive disorder (MDD), Generalized
Anxiety Disorder (GAD), pain related to diabetic
peripheral neuropathy (DPN)
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Drugs History

• Nardil (phenelzine sulfate )
• - derivative of hydrazine which is
  phenylethylamine-like moiety
• Pfizer
• FDA approved in 1970
• Some formulations changed in 2003
• Cymbalta (duloxetine HCl)
• Duloxetine was discoverd by Eli Lily Company
• scientists in 1988, known as LY227942
• Co-promoting with Quintitles
• Got final FDA approval in 2004

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Pharmacology
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What Are The Common Side Effects?

• Nardil (phenelzine sulfate )
• Nervous system
• dizziness, fatigue, tremor, twitching, sleep
  disturbances, nausea
• Gastrointestinal
• constipation, dry mouth
• Metabolic
• weight gain
• Cardiovascular
• hypotension, anemia
• Genitourinary
• sexual disturbances

• Cymbalta (duloxetine HCl)
• - Dizziness
• - Nausea
• - Increase in sweating
• - Constipation
• - Dry mouth
• - Weight lost/ low appetite
• - Insomia
• - Vision blurry
• - Jaundice
• - Increase palpation in heart
• - Lesser sexual disturbances

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Precautions

• Nardil (phenelzine sulfate )
• Interact with tyramine-containing foods,
  serotogenic drugs, L-trypophan
• Hypotension
• Hypomania
• Epilepsy
• Pregnancy
• Lactation
• Spinal anesthesia

• Cymbalta (duloxetine HCl)
• Should not use with MAOIs
• May interact with alcohol to increase risk of
  liver injury
• Not for patients with renal or hepatic diseases
• Seizures with history of mania
• Possible direct toxicity and cause serotonin
  syndrome in neonates !!

INCREASE RISK OF SUICIDAL THINKING!!
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How Are The Side Effects Treated?

• Must weight the benefits with the side effects!
• Work with doctor to figure out the right balance
• Often worst at start but get better as the body
  adjust
• - upset stomach take with meal
• - sleepy during the day but awake at night, then
  change the time taking it
• - take with drugs that treat the side effects

Do not stop the medication SUDDENLY !!
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What Are The Non-pharmaceutical Treatments That
Available?

• Diet/ Exercise
• - folate, fish oil, vitamin D
• - eliminate alcohol, tobacco, marijuana
• Psychotherapy
• - counseling, spend more time with friends,
  cut down TV
• viewing and stressful situations
• Electroconvulsive Therapy (ECT)
• - last resource
• Magnetic Stimulation Treatment
• Saint-Johns Wort flower

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Things I shall look in details- Mechanism of
the drug- Contraindications- Long term side
effects- What else??
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DEPRESSION IS TREATABLE !!
Please dont be shy )
Thank You