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Antidepressant Drugs Journal of Pain and Symptom Management

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1 Antidepressant Drugs Journal of Pain and Symptom Management
Paul Howard, BMedSci, MRCP, Robert Twycross, DM, FRCP, John Shuster, MD, Mary Mihalyo, BS, PharmD, RPh, Andrew Wilcock, DM, FRCP  Journal of Pain and Symptom Management  Volume 44, Issue 5, Pages (November 2012) DOI: /j.jpainsymman Copyright © Terms and Conditions

2 Fig. 1 Predominant mechanism of action of antidepressants. aMonoamine oxidase type A breaks down serotonin, norepinephrine (noradrenaline) and dopamine. Type B breaks down dopamine. Antidepressant-MAOIs are either non-selective (e.g., phenelzine) or type A selective (e.g., moclobemide). Antiparkinsonian MAOIs (e.g., selegiline) are Type B selective. bBlockade of pre-synaptic α-adrenergic receptors removes inhibition of serotonin and norepinephrine release. cBlockade of post-synaptic 5HT2A and 5HT2C-receptors removes inhibition of dopamine and norepinephrine release from the post-synaptic neuron. Journal of Pain and Symptom Management  , DOI: ( /j.jpainsymman ) Copyright © Terms and Conditions

3 Fig. 2 Overview of the management of depression.30,99 aSub-threshold symptoms=patients with <5 DSM IV symptoms required for a diagnosis of depression. bCBT=cognitive behavioral therapy. cSee below, managing an inadequate initial response. Journal of Pain and Symptom Management  , DOI: ( /j.jpainsymman ) Copyright © Terms and Conditions


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