INCREASE DA transmission. INCREASE actions of sympathomimetic amines (cheese reaction)
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What is the cheese reaction?
Tyramine and other amines are normally metabolised by MAO. With MAOIs amine levels INCREASE. They act as indirect sympathomimetics provoke HYPERTENSIVE crisis
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What do monoamine reuptake inhibitors do?
Prevent removal of transmitter from synaptic cleft. Levels of transmitter in cleft INCREASE. Magnitude and duration of receptor activation INCREASE
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What are the properties of selective MAOIs?
Fewer side effects. Lower efficacy
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What are the properties of reversible MAOIs?
Lower interaction with other antidepressants. Lower efficacy
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What do tricyclic antidepressants do? What are the side effects?
Inhibit reuptake of 5-HT and NA. H1 antagonism - sedation. mAch antagonism - dry mouth. alpha1 antagonism - postural hypotension
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What is the serotonin syndrome?
Synergistic INCREASE in synaptic 5-HT provokes malignant hyperthermia.
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What are the 3 theories of delayed antidepressant action?
What happens during postsynaptic receptor adaptation?
Increase of synaptic levels of transmitter causes desensitisation of receptors. Desensitisation crucial in the therapeutic response.
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What happens during desensitisation of autoreceptors?
ADs inhibit firing and terminal release via auto receptors. Synaptic 5-HT levels NOT increased. Auto receptors desensitise firing and terminal release are restored --> synaptic 5-HT increases
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What happens during synaptic remodelling?
ADs cause increase in 5-HT. This increase causes synaptic remodelling (5-HT is a trophic factor) which takes time
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