Cytochrome P450 system antidepressants

Nemeroff CB, DeVane CL, Pollack BG. Newer antidepressants and the cytochrome P450 system. Am J Psychiatry 1996 153 311-320. 

The cytochrome P450 system is actually a family of related liver enzymes. Each specific enzyme within this family is called an isoenzyme. New isoenzymes within the cytochrome P450 system are constantly being discovered. The 1A2, 2C9/2C19, 2D6, and 3A4 isoenzymes are the best understood. Table 3.10 shows the impact of the newer antidepressants on particular cytochrome P450 isoenzymes and the drugs that may be affected. 

Owen, J.R. and Nemeroff, C.B. (1998) New antidepressants and the cytochrome P450 system focus on venlafaxine, nefazodone, and mirtazapine. Depress Anxiety 7 Suppl l) 24-32. 

Tanaka E, Hisawa S. Clinically significant pharmacokinetic drug interactions with psychoactive drugs antidepressants and antipsychotics and the cytochrome P450 system. J Clin Pharm Ther 1999 24 7-16. 

Riesenman C Antidepressant drug interactions and the cytochrome P450 system A critical appraisal. Pharmacotherapy 1995 15(6 Pt 2) 84S. 

Ereshefsky L, Riesenman C, Lam YW. Antidepressant drug interactions and the cytochrome P450 system—the role of cytochrome P4502D6. Clin Pharmacokinet 1995 29(suppl 1) 10-19. 

In this chapter, we have discussed the mechanisms of action of the major antidepressant drugs. The acute pharmacological actions of these agents on receptors and enzymes have been described, as well as the major hypothesis that attempts to explain how all current antidepressants ultimately work. That hypothesis is known as the neurotransmitter receptor hypothesis of antidepressant action. We have also introduced pharmacokinetic concepts relating to the metabolism of antidepressants and mood stabilizers by the cytochrome P450 enzyme system. 

Ramaekers JG, Ansseau M, MuntjewerfT ND, Sweens JP, O Hanlon JF. Considering the P450 cytochrome system as determining combined effects of antidepressants and benzodiazepines on actual driving performance of depressed ou atients. Int Clin Psychopharmacol (1997) 12, 159-69. 

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