Depression

 Depression, also known as major depressive disorder (MDD), is a mental health condition characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in activities. It can also manifest in physical symptoms like fatigue, changes in appetite, sleep disturbances, and difficulty concentrating. It’s caused by a combination of genetic, biological, environmental, and psychological factors.

Medicines Used in the Treatment of Depression (India)

The primary medications used for treating depression are antidepressants. These medications work by balancing neurotransmitters in the brain that affect mood and emotional responses. Below is a list of commonly used antidepressants, their mechanism of action, and brand names available in India.

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1. Selective Serotonin Reuptake Inhibitors (SSRIs)

• Mechanism of Action: SSRIs increase serotonin levels by inhibiting its reuptake into presynaptic neurons, making more serotonin available to improve mood regulation.
• Common Drugs:
  • Escitalopram
  • Sertraline
  • Fluoxetine
  • Paroxetine
  • Citalopram
• Brand Names in India:
  • Cipralex (Escitalopram)
  • Lustral (Sertraline)
  • Fludac (Fluoxetine)
  • Paxil (Paroxetine)
  • Citalopram is less commonly available in India.

2. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

• Mechanism of Action: SNRIs inhibit the reuptake of both serotonin and norepinephrine, increasing the levels of these neurotransmitters in the brain to help improve mood and reduce anxiety.
• Common Drugs:
  • Venlafaxine
  • Duloxetine
  • Desvenlafaxine
• Brand Names in India:
  • Veniz (Venlafaxine)
  • Duzela (Duloxetine)
  • Desval ER (Desvenlafaxine)

3. Tricyclic Antidepressants (TCAs)

• Mechanism of Action: TCAs inhibit the reuptake of serotonin and norepinephrine but also affect other neurotransmitter systems like acetylcholine, leading to their therapeutic effects as well as side effects. These are generally used when newer antidepressants fail to work.
• Common Drugs:
  • Amitriptyline
  • Imipramine
  • Nortriptyline
• Brand Names in India:
  • Amitone (Amitriptyline)
  • Tofranil (Imipramine)
  • Nortrip (Nortriptyline)

4. Atypical Antidepressants

• Mechanism of Action: These drugs work in unique ways, often affecting multiple neurotransmitter systems, and are used when SSRIs and SNRIs are ineffective or not well-tolerated.
• Common Drugs:
  • Bupropion (Norepinephrine-dopamine reuptake inhibitor)
  • Mirtazapine (Increases serotonin and norepinephrine by acting as an antagonist at central presynaptic alpha-2 receptors)
  • Trazodone (Primarily a serotonin receptor antagonist and weak reuptake inhibitor)
• Brand Names in India:
  • Wellbutrin (Bupropion)
  • Mirtaz (Mirtazapine)
  • Trazonil (Trazodone)

5. Monoamine Oxidase Inhibitors (MAOIs)

• Mechanism of Action: MAOIs inhibit the enzyme monoamine oxidase, which breaks down serotonin, norepinephrine, and dopamine. These are rarely used today because of dietary restrictions and potential for severe interactions with other medications.
• Common Drugs:
  • Phenelzine
  • Tranylcypromine
• Brand Names in India:
  • Nardil (Phenelzine)
  • Parnate (Tranylcypromine)

6. Serotonin Modulators

• Mechanism of Action: These drugs modulate serotonin receptors or inhibit serotonin reuptake in different ways compared to SSRIs.
• Common Drugs:
  • Vortioxetine (a serotonin modulator and stimulator)
• Brand Names in India:
  • Brintellix (Vortioxetine)

7. Benzodiazepines (Adjunctive Use)

• Mechanism of Action: Benzodiazepines enhance the activity of GABA, a neurotransmitter that inhibits overactivity in the brain. These are primarily used for short-term relief of anxiety associated with depression but are not used as a primary treatment for depression.
• Common Drugs:
  • Alprazolam
  • Lorazepam
• Brand Names in India:
  • Alprax (Alprazolam)
  • Ativan (Lorazepam)

8. Antipsychotic Medications (Adjunctive Use)

• Mechanism of Action: Atypical antipsychotics are sometimes used in combination with antidepressants for treatment-resistant depression. They affect serotonin and dopamine receptors in the brain.
• Common Drugs:
  • Quetiapine
  • Aripiprazole
  • Olanzapine
• Brand Names in India:
  • Seroquel (Quetiapine)
  • Arpizol (Aripiprazole)
  • Oleanz (Olanzapine)

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Combination Therapies

For some patients, combination therapies may be necessary. For example, combining an SSRI with an atypical antidepressant or adding an antipsychotic to an antidepressant regimen can be helpful in treatment-resistant cases.

Common Combination Therapies:

• SSRI + Atypical Antipsychotic (e.g., Escitalopram + Quetiapine)
• SSRI + Bupropion

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Conclusion

Depression is managed with a range of medications, primarily antidepressants like SSRIs, SNRIs, and TCAs. The choice of medication depends on the individual’s symptoms, severity of depression, side effects, and their response to previous treatments. Medications may take several weeks to show full effects, and treatment is often accompanied by psychotherapy. Various brand names of these medications are widely available in India.