Dopamine agonists antidepressants

Opioids, benzodiazepines, barbiturates, corticosteroids, dopamine agonists (e.g., amantadine, bromocriptine, levodopa, pergolide, pramipexole, ropinirole), H2-receptor antagonists, anticholinergics (e.g., diphenhydramine, trihexylphenidyl), P-adrenergic blockers, clonidine, methyldopa, carbamazepine, phenytoin, baclofen, cyclobenzaprine, lithium, antidepressants (e.g., tricyclic antidepressants, selective serotonin reuptake inhibitors), and interleukin-2... 

FIGURE 38-1. Primary assessment and initial treatment for complaint of excessive daytime sleepiness. RLS, restless-legs syndrome NPSG, nocturnal polysomnography OSA, obstructive sleep apnea DA, dopamine agonist MSLT, multiple sleep latency test BZDRA, benzodiazepine receptor agonist SNRI, serotonin and norepinephrine reuptake inhibitor TCA, tricyclic antidepressant CPAP, continuous positive airway pressure. 

The atypical tricyclic antidepressant amineptine (Survector) is an indirect dopamine agonist, which selectively inhibits dopamine uptake and induces its release, with additional stimulation of the adrenergic system. Its antidepressant effects are similar to those of other tricyclic antidepressant drugs. However, it acts more rapidly, is better... 

Bromocriptine is a dopamine agonist acting by direct stimulation of the dopamine receptors. In Parkinson s disease, it is reserved for use in patients who are intolerant to levodopa or in whom levodopa alone is not sufficient. Orphenadrine is an antimuscarinic indicated in Parkinson s disease. Antimuscarinics tend to be more effective than levodopa in targeting tremor rather than rigidity and bradykinesia. Moclobemide is an antidepressant referred to as a reversible monoamine oxidase inhibitor (RIAAA) type A. 

Antihypertensives, diuretics, antipsychotics, tricyclic antidepressants, levodopa, dopamine agonists, a-blockers Corticosteroids NSAIDs, anticoagulants -Blockers (non-selective)... 

Muscat R, Towell A, Willner P Changes in dopamine autoreceptor sensitivity in an animal model of depression. Psychopharmacology 94 545-550, 1988 Muscat R, Papp M, Willner P Antidepressant-hke effects of dopamine agonists in an animal model of depression. Biol Psychiatry 31 937-946, 1992... 

Papadimitriou GN, Kerkhofs M, Kempenaers C, et al EEG sleep in patients with generalized anxiety disorder. Psychiatry Res 26 183-190, 1988 Papadimitriou GN, Christodoulou GN, Katsouyanni K, et al Therapy and prevention of affective illness by total sleep deprivation. J Affect Disord 27 107-116, 1993 Papp M, Muscat R, Willner P Additive effects of chronic treatment with antidepressant drugs and intermittent treatment with a dopamine agonist. Eur Neuropsy-chopharmacol 2 121-125, 1992... 

Serra G, Forgioni A, D Aquila PS, et al Possible mechanism of antidepressant effect of L-sulpiride. Chn Neuropharmacol 13 (suppl l 576-583, 1990a Serra G, CoUn M, D Aquila PS, et al Possible role of dopamine D1 receptor in the behavioral supersensitivity to dopamine agonists induced by chronic treatment with antidepressants. Brain Res 527 234-243, 1990b Sershen H, Hashim, A, Lajtha A Behavioral and biochemical effects of nicotine in an MPTP-induced mouse model of Parkinson s disease. Pharmacol Biochem Behav 28 299-303, 1987... 

Consistent with earlier studies, Muscat et al. ( 58) reported on chronic exposure to mild unpredictable stress in rats as a model to study the antidepressant-reversible decreases in the consumption of palatable sweets. Using this model, they found that certain dopamine agonists (i.e., quinpirole, bromocriptine) administered intermittently had the same positive effects as TCAs. They further postulated that the infrequent, intermittent administration of dopamine agonists (e.g., psychostimulants) may avoid problems with tolerance and abuse while providing a clinically relevant antidepressant strategy. A report by Kapur and Mann ( 59) comprehensively reviews the role of dopamine in depressive disorders. They discuss several lines of evidence, including the following ... 

Muscat R, Papp M, Willner P. Antidepressant-like effects of dopamine agonists in an animal model of depression. Bid Psychiatry 1992 31 937-946. 

Levodopa or dopamine agonists produce diverse dyskinesias as a dose-related phenomenon in patients with Parkinson s disease dose reduction reverses them. Chorea may also develop in patients receiving phenytoin, carbamazepine, amphetamines, lithium, and oral contraceptives, and it resolves with discontinuance of the offending medication. Dystonia has resulted from administration of dopaminergic agents, lithium, serotonin reuptake inhibitors, carbamazepine, and metoclopramide and postural tremor from theophylline, caffeine, lithium, valproic acid, thyroid hormone, tricyclic antidepressants, and isoproterenol. 

BETA-2 AGONISTS ANTIDEPRESSANTS -MAOIs t occurrence of headache and hypertensive episodes. Unlikely to occur with modobemide and selegiline Due to impaired metabolism of these sympathomimetic amines due to inhibition of MAO. Modobemide is involved in the breakdown of serotonin, while selegiline is mainly involved in the breakdown of dopamine Be aware. Monitor BP closely... 

Dopamine inhibits prolactin synthesis. Drugs that inhibit dopamine synthesis or activity (e.g. antihypertensives, antidepressants, estrogen, phenothiazines, opiates), are the most common cause of hyperprolactinemia. Prolactin-secreting pituitary tumors sometimes are treated with bromocriptine, a dopamine agonist. 

Since many borderline patients are at risk for transient psychosis, the antidepressant bupropion (a dopamine agonist) should be used with caution. This drug, which is an effective antidepressant, may precipitate psychosis in prepsychotic individuals. 

The hypotensive adverse effects of apomorphine may possibly be increased by alcohol. The concurrent use of other drugs used for erectile dysfunction or dopamine agonists or antagonists is not recommended. However, domperidone, and prochlorperazine are said not to interact when apomorphine is used for erectile dysfunction, and domperidone is the recommended antiemetic when apomorphine is used for Parkinson s disease. There is evidence that antidepressants, antiepileptics, and ondansetron do not interact adversely. 

Future Outlook for Antidepressants. Third-generation antidepressants are expected to combine superior efficacy and improved safety, but are unlikely to reduce the onset of therapeutic action in depressed patients (179). Many dmgs in clinical development as antidepressive agents focus on estabhshed properties such as inhibition of serotonin, dopamine, and/or noradrenaline reuptake, agonistic or antagonistic action at various serotonin receptor subtypes, presynaptic tt2-adrenoceptor antagonism, or specific monoamine—oxidase type A inhibition. Examples include buspirone (3) (only... 

Listing of antidepressants grouped by principal mechanism of action in the synapse. Abbreviations MAOI—irreversible = irreversible monoamine oxidase inhibitor MAOI—reversible = reversible monoamine oxidase inhibitor NDRl = norepinephrine/ dopamine reuptake inhibitor NRI = norepinephrine reuptake inhibitor NSRl = norepinephrine/serotonin reuptake inhibitor NSSA = norepinephrine/specific serotonin agonist SRI = serotonin reuptake inhibitor SRl/serotonin-2 blocker = serotonin reuptake inhibitor and serotonin-2 receptor antagonist. 

Bupropion and also varenicline are mentioned in Chapter 21, Section I.c.4. Bupropion is a norepinephrine and dopamine reuptake inhibitor de-veoped as an antidepressant. It is now used on a large scale as a smoking cessation aid. Varenicline is the first nicotinic receptor partial agonist approved to treat smoking addiction. 

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