ANTIDEPRESSANTS (antidepressiva; Greek anti-against + lat. depressus which are pressed down, suppressed) — group of the drugs improving a condition of patients at various mental disorders which are followed by a depression.
K A. belong various on chemical constitution and the mechanism of effect of substance. Among them hydrazine derivatives are inhibitors of a monaminoksidaza (MAO): Iprazidum (see), Nialamidum (see), fenelzin (nardit), an isocarboxazid (marplan); not hydrazine derivatives — MAO inhibitors: Indopanum (see); tricyclic connections: imipramine (see), amitriptyline (see), desmetilimipramin, protriptilin, surmontit (trimipramin), ftoratsizin (see), Opipramolum (Insidanum), Azaphenum (see); different And.: Haemophyrinum (see), Pyrazidolum (see).
Main property of all And. irrespective of their chemical constitution antidepressive activity, i.e. property to improve a condition of the patients having a depression is.
Nature of action different And. it is various: hydrazine and the MAO not hydrazine inhibitors along with antidepressive action increase motor and mental performance at patients; some tricyclic And. exert also stimulating impact on c. N of page (Imipraminum) or sedative action (amitriptyline, Azaphenum, etc.).
One of pathogenetic mechanisms of depressions is weakening of adrenergic processes in ts.n.s. The strengthening of noradrenaline in a brain happening under influence And., can therefore to be considered as an important link in the mechanism of their antidepressive action. Considerable value has, apparently, and increase in contents in a brain of serotonin.
It is supposed that strengthening of the central adrenergic processes under influence And. leads at a depression to decrease in motive and mental block, and strengthening of serotonergic processes — to improvement of mood (timoleptichesky effect), removal of alarm and tension.
Hydrazine and the MAO not hydrazine inhibitors cause increase in contents in a brain of an adrenergic mediator (noradrenaline), and also 5-oksitriptamin (serotonin) by braking of oxidizing deamination of monamin.
Tricyclic And. too stimulate adrenergic processes in a brain, but by blocking of the most important process of an inactivation of noradrenaline — its of «the return capture» — granules of presynaptic (adrenergic) nerve terminations. It leads to strengthening of active noradrenaline in the field of adrenergic synapses. According to modern data, MAO inhibitors also have property to block «the return capture» of noradrenaline. Tricyclic And. increase contents in a brain of serotonin. Some And. (amitriptyline and other tricyclic connections) influence cholinergic processes — render expressed central and peripheral m - cholinolytic action. MAO inhibitors have Ganglioblokiruyushchiye effect. The question of a role of cholinergic processes in the mechanism of antidepressive action is insufficiently clear because a number of the drugs which do not have cholinolytic effect has the expressed antidepressive activity.
Features of action And. define the main indications to their use. And., the timoleptichesky and stimulating properties combining, apply preferential at astheno-depressive states, causing sedation — at alarming depressions. However according to a variety of an etiology and complexity of a clinical picture of depressions And. different groups apply jointly or in combination with other psychotropic drugs.
By-effects, observed at use And., are partially caused by their pharmacological properties. E.g., owing to cholinolytic activity amitriptyline and an imipramine arises dryness of a mucous membrane of an oral cavity, disturbance of accommodation, increase in intraocular pressure, a delay of an urination, locks, tachycardia; MAO inhibitors cause hypotension, a sleep disorder, concern. Iprazidum has toxic effect on a liver.
MAO inhibitors exponentiate effect of narcotic, somnolent, analgesic substances, pressor amines and other medicines. At use of MAO inhibitors together with tricyclic And. heavy complications are possible. In case of need uses of tricyclic connections after treatment by MAO inhibitors do a break not less than on 2 weeks. MAO inhibitors are incompatible also with the adrenaline, ephedrine and other sympathomimetic amines, alcohol, drugs influencing functions of a thyroid gland. At use of MAO inhibitors it is necessary to exclude from a diet the products containing biogenic amines (cheese, beans, bananas, smoked products).
Bibliography: Antidepressants and treatment of depressions, under the editorship of I. P. Wingnut and T. Ya. Hvilivitsky, L., 1966, bibliogr.; Mashkovsky M. D. Adrenergic mechanisms of effect of antidepressants, Zhurn. neuropath, and psikhiat., t. 70, century 5, page 750, 1970, bibliogr.; Psychotropic drugs in medical practice, under the editorship of G. Ya. Avrutsky, M., 1971; Pharmacological bases of antidepressive effect, under the editorship of I. P. Wingnut, L., 1970; Biel J. N of Chemopharmacologic approaches to the treatment of mental depression, in book: Drugs affecting centr. nerv. system, ed. by A. Burger, p. 61, N. Y., 1968, bibliogr.
M. D. Mashkovsky.