Effects of antidepressant drugs

Proven or alleged lack of negative effects upon cognitive function, especially memory performance, is occasionally used as an argument to support the use 

This study, notwithstanding its imperfect design, is often quoted as evidence to show that improvement of depression and normalization of cognitive performance are likely to go together, and that antidepressants with strong anticholinergic action are not really harmful for the cognitive function of depressed patients. 

With regard to its effects on cognitive performance in the target population, the SSRI sertraline appears to be the most thoroughly studied newer antidepressant. Lane and O Hanlon (1999) listed three controlled clinical studies with fluoxetine and three with sertraline however, all three trials with fluoxetine and one of the trials with sertraline were not sufficiently powered to demonstrate reliable differences between treatments. One of the two adequately powered studies, a comparison between nortriptyline and sertraline in elderly depressed patients (Bondareff et al., 2000 see Box 7.3), supports the notion that antidepressants with anticholinergic action (such as nortriptyline) are similarly 

3 Effects of Two Antidepressants on Cognitive Function in Older Depressed Patients 

In a double-blind, parallel-group study, Bondareff et id. (2000) compared the SSRI sertraline and the tricyclic compound nortriptyline with regard to their efficacy and safety in a group of 210 outpatients 60 years and older. The patients met the DSM-DI-R criteria for major depressive episode and had a minimum score of 18 on the Hamilton Rating Scale for Depression. Their mean age was about 68 years, most patients were white and about 60% were female the severity of depression was rated as moderate in more than 70% and as severe in more than 20% of the cases. The daily doses of sertraline were between 50 and 150 mg, and those of nortriptyline were 25 100 mg the treatment lasted 12 weeks. In addition to clinical rating scales and self-assessment instruments, patients took the following tests of cognitive performance  

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The chemical effect of antidepressant drugs may be small or even non-existent, but these medications do produce a powerful placebo effect. In Chapters 5 and 6 1 examine the placebo effect itself. 1 look at the myriad of effects that placebos have been shown to have and explore the theories of how these effects are produced. 1 explain how placebos are able to produce substantial relief from depression, almost as much as that produced by medication, and the implications that this has for the treatment of depression. 

Staner, L., Luthringer, R. Macher, J. P. (1999). Effects of antidepressant drugs on sleep EEG in patients with major depression. Central Nerv. Syst. Drugs 11,... 

These are uncommon side effects of antidepressant drugs, particularly when used at normal therapeutic doses. 

As stated above, the ultimate mechanism of action of the antidepressant and anxiolytic effects of antidepressant drugs have not been fully elucidated yet. It is therefore necessary to identify novel candidate genes using unbiased genome-wide strategies. 

Blackwell, B. (1981) Adverse effects of antidepressant drugs. Part 1 monoamine oxidase inhibitors and tricyclics. Drags 21 201-219. 

Postnatal effect of antidepressant drugs administered during gestation. Exp Neurol 3 542-555. 

Reproduced from Taupin P. Neurogenesis and the Effects of Antidepressants. Drug Target Insights (2006) 1 13-7, with permission from Libertas Academia. 

FIGURE 7-2 T Effects of antidepressant drugs on amine synapses. All three types of drugs... 

Lucid I, O Leary OF. Distinguishing roles for norepinephrine and serotonin in the behavioral effects of antidepressant drugs. J Clin Psychiatry. 2004 65(suppl 4) 11-24. 

Lopezmunoz F, Alamo C, Cuenca E, et al. Effect of antidepressant drugs on cytochrome-P-450 isoenzymes and its clinical relevance-differential profile. Actas Luso Esp Neurol Psiquiatr Cienc Afines 1997 25 397 409. 

Early formulations of the monoamine theory of depression cited two strands of evidence. One was the effects of antidepressant drugs and the other was the effects of reserpine. Skildkraut believed that studies have shown a fairly consistent relationship between drug effects on catechloamines, especially norepinephrine, and affective or behavioural states (Schildkraut 1965, p. 509). He went on to describe how drugs that cause depletion and inactivation of norepinephrine centrally produce sedation or depression, while drugs which increase or potentiate brain norepinephrine are associated with behavioural stimulation or excitement and generally exert an antidepressant effect in man (p. 509). 

Smith, A., Traganza, E., Harrison, G. 1969, Studies on the effectiveness of antidepressant drugs, Psychopharmacol.Bull., p. Suppl-53. 

Roos JC. Cardiac effects of antidepressant drugs. A comparison of the tricyclic antidepressants and fluvoxamine. Br J Chn Pharmacol 1983 15(Suppl. 3) 439S-45S. 

Bipolar depression affects 1% of the general population, and treatment resistance is a significant problem. The addition of pindolol can lead to significant improvement in depressed patients who are resistant to antidepressant drugs, such as selective serotonin reuptake inhibitors or phenelzine. Of 17 patients with refractory bipolar depression, in whom pindolol was added to augment the effect of antidepressant drugs, eight responded favorably (95). However, two developed transient hypo-mania, and one of these became psychotic after the resolution of hypomanic symptoms. In both cases transient hypomanic symptoms resolved without any other intervention, while psychosis required pindolol withdrawal. 

Side Effects of Antidepressant Drugs - Recent publications pertaining to the clinical side effects of antidepressant agents are by Hollister, Kahr et al. 5, Tschen et al. 6, Blair and Simpson and Simpson et al. 8. The toxicology of amitriptyline has been described by Myers et al. 9. 

Figure 2.1 Like nearly all antidepressant drugs, TCAs can have significant side effects. Some of those side effects for different TCAs are listed here, along with their frequency. Sexual dysfunction is a common side effect of antidepressant drugs and has a high probability of occurrence in patients who take the drugs listed here. The chances of agitation and insomnia, on the other hand, are quite low.

Valproic add A medication first used solely as an anticonvulsant drug that has become commonly used for the treatment of bipolar disorder and sometimes to increase the effectiveness of antidepressant drugs. 

What are the major adverse effects of antidepressant drugs ... 

Effects of antidepressant drugs on various sieep parameters... 

Hall H, Ogren SO. Effects of antidepressant drugs on different receptors in the brain. Eur J Pharmacol 1981 70(3) 393-407. 

Placebo-controlled trial T3 has been used to enhance the effects of antidepressant drugs but results have been mixed (SEDA-32, 764 SEDA-33,882). Results of the largest prospective placebo-controlled trial to date indicate that T3 does not augment the effects of the SSRI, sertraline in the treatment of recent-onset major depressive disorder (MDD) [14 ]. 

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