UNIPOLAR

DEPRESSION
SUBMITTED BY:
CHAD AXEROL, CRISTINA PARMANAND, MATTHEW POPPE, ELLIE TURNER

First Generation Antidepressants

Tricyclic Antidepressants

Block presynaptic reuptake

transporter for norepinephrine
and serotonin

Metabolizes dopamine,
norepinephrine, serotonin, tyramine

Causes transmitter molecules to build

up in terminal causing more
transmitters to be released in synaptic
cleft

Block postsynaptic receptors for

histamine, acetylcholine, and
norepinephrine

Common Side Effects:

Monoamine Oxidase Inhibitors

Drowsiness, dizziness, confusion,

memory and cognitive
impairments, dry mouth, blurred
vision and increased heart rate

Limitations

Slow onset of action

Long half-lives + cardiotoxic =

fatal overdose

Side Effects

Increased blood pressure

Potentially fatal interactions with some

medications and foods (strict diet)

Advantages

Work in patients who respond poorly

to other antidepressive drug therapies

Effective for treating atypical and

masked depression, eating disorders,
anxiety disorders

Second Generation (Atypical) Antidepressants

Developed to reduce limitations and side effects of first-generation antidepressants

First few had other adverse side effects or were more effective at treating other
neurological disorders

Effexor

Mixed serotoninnorepinephrine reuptake

inhibitor
No anticholinergic or
antihistaminic effects
Concern with Effexor and
increased blood pressure seen
in 2-13 percent of patients

Martinez et al. (2010) found

no association with usage
and increased cardiac risk
when compared with other
antidepressants

Bupropion

Dopamine-norepinephrine reuptake
inhibitor

Useful add-on with patients

partially responsive to SSRIs
(DeBattista et al.,2003)

Side Effects

Anxiety, restlessness, insomnia,

weight-loss. May trigger manic
episodes. Possible seizures with
high dosages

Advantages

Anti-craving properties

Selective Serotonin Reuptake Inhibitors (SSRIs)

Block the presynaptic transporter for serotonin

reuptake

Do not block postsynaptic serotonin receptors

Few anticholinergic or antihistaminic side

effects

Some are sedative

Long-term use may have some cognitive

impairment

Overdose is not fatal

Serotonin Syndrome:

SSRI Withdrawal Syndrome:

Seen in 60% of patients who stop
taking SSRIs
Flulike symptoms
Insomnia
Nausea
Sensory disturbances
Imbalance
Hyperarousal

Concerns

Serotonin Syndrome

SSRI Withdrawal Syndrome

Long term treatment problems

Possible teratogen

Accumulation of serotonin leading to

responses such as; cognitive
disturbances, behavioural agitation,
ANS dysfunctions and neuromuscular
impairment

Onset within a few days and last

3-4 weeks

References:

Caron, J., & Liu, A. Public Health Agency of Canada, (2010).A descriptive study of the prevalence of psychological distress
and mental disorders in the canadian population: comparison between low-income and non-low-income populations .
Retrieved from website: http://www.phac-aspc.gc.ca/publicat/cdic-mcbc/30-3/ar_03-eng.php

Singh , A., & Misra, N. (2009). Loneliness, depression and sociability in old age. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016701 /

Mental- Depression. (2009, February 1). Retrieved from http://

www.hc-sc.gc.ca/hl-vs/iyh-vsv/diseases-maladies/depression-eng.php

What is depression? (2014, December 22). Retrieved from http://www.phac-aspc.gc.ca/cd-mc/mi-mm/depression-eng.php

Current Understandings of Major Depression. (2005, January 1). Retrieved from http://
www.sevencounties.org/poc/view_doc.php?type=doc&id=12998&cn=5

Ross, J. E. & Ashton-Shaeffer, C. (2009). Theraeputic recreation practice models. In Stumbo, N. J. (ed.), Professional Issues in
Therapeutic Recreation. Champaign, IL: Sagamore Publishing

Martinez, C., T. L. Assimes, D. Mines, S. Dell'aniello, and S. Suissa. (2010)"Use of Venlafaxine Compared with Other
Antidepressants and the Risk of Sudden Cardiac Death or near Death: A Nested Case-control Study." BMJ 340.Feb05 1 C249.

DeBattista, Charles, H. Brent Solvason, Jennifer Poirier, Ellen Kendrick, and Alan F. Schatzberg. (2003) "A Prospective Trial of
Bupropion SR Augmentation of Partial and Non-Responders to Serotonergic Antidepressants." J Clin Psychopharmacol 23.1:
27-30.

Advokat, Claire D., and Joseph E. Comaty. "Antidepressant Drugs." A Primer of Drug Action: A Comprehensive Guide to the
Actions, Uses, and Side Effects of Psychoactive Drugs. By Robert M. Julien. 12th ed. New York, NY: Worth, 2011. 141-86.