nom deplume

I am aspiring to create such a thing, as much for my own purposes as
any other reason. Since this kind of list might be interesting to
people in this group, I am posting it here. This is the "first
edition," and covers only antidepressants. I intend to add other
categories over time, as time permits.

Please let me know what you think. Is this useful? If not, I won't
bother anyone with further posts; if yes, then I'll post future
revisions.

I would appreciate any suggestions on how to improve the document. One
area I think could use major work is a per-drug list of relevant
information, such as side effects. If you have any such information,
or can point me to any, that would be great.

One irritation is formatting; the original is in MS Word, and the
translation to ASCII doesn't produce the best-possible appearance. I
don't particularly want to edit in ASCII, though, so does anyone have
any suggestions as to how to get a nice ASCII rendition from Word?

--
Nom dePlume, Ph.D

Why, yes, in fact, I am a rocket scientist.

========================================

Summary of Psychotropic Medications
by Nom dePlume
(nomdeplume1000@yahoo.com)

Release Date: 30 December 2003
Copyright © 2003 by Nom dePlume

Table of Contents
SUMMARY OF PSYCHOTROPIC MEDICATIONS 1
1 INTRODUCTION 2
2 DEPRESSION 2
2.1 SOURCES 2
2.2 ABBREVIATIONS 2
2.3 MONOAMINE OXIDASE INHIBITORS (MAOI) 3
2.3.1 Mechanism 3
2.3.2 Benefits 3
2.3.3 Principal Drawbacks 3
2.3.4 Medications 3
2.4 REVERSIBLE MAO INHIBITORS (RIMA) 3
2.4.1 Mechanism 3
2.4.2 Benefits 4
2.4.3 Principal Drawbacks 4
2.4.4 Medications 4
2.5 TRYCYCLIC / TETRACYCLIC ANTIDEPRESSANTS (TCA) 4
2.5.1 Mechanism 4
2.5.2 Benefits 4
2.5.3 Principal Drawbacks 4
2.5.4 Medications 4
2.6 SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI) 5
2.6.1 Mechanism 5
2.6.2 Benefits 5
2.6.3 Principal Drawbacks 5
2.6.4 Medications 5
2.7 SEROTONIN ANTAGONIST / REUPTAKE INHIBITORS (SARI) 6
2.7.1 Mechanism 6
2.7.2 Benefits 6
2.7.3 Principal Drawbacks 6
2.7.4 Medications 6
2.8 SELECTIVE SEROTONIN / NOREPINEPHRINE REUPTAKE INHIBITORS (SNRI) 6
2.8.1 Mechanism 6
2.8.2 Benefits 7
2.8.3 Principal Drawbacks 7
2.8.4 Medications 7
2.9 NOREPINEPHRINE / DOPAMINE REUPTAKE INHIBITORS (NDRI) 7
2.9.1 Mechanism 7
2.9.2 Benefits 7
2.9.3 Principal Drawbacks 7
2.9.4 Medications 7
2.10 NORADRENERGIC / SPECIFIC SEROTONERGIC ANTIDEPRESSANTS (NASSA) 7
2.10.1 Mechanism 7
2.10.2 Benefits 8
2.10.3 Principal Drawbacks 8
2.10.4 Medications 8

1 Introduction
Psychotropic medications affect the functioning of the brain,
typically by changing neurotransmitter chemistry. They are prescribed
for a variety of mental illnesses, such as depression, bipolar
disorder, and psychosis.

The number of psychotropic medications is large and growing steadily,
and it is increasingly difficult for the layperson to keep up with


updated periodically with new information, as medical science and the
author's time allows.

What this document does not do is provide medical advice, or
comprehensive information about any medication. It is intended only to
be a convenient summary of publicly-available information about these
medications. No guarantee of accuracy or relevance is provided.

The document is organized by the illness for which the medications are
most often prescribed. Each section contains a list of categories of
medications and their acronyms. The general properties of each
category are described, and a list of individual medications follows.
Note that a particular medication, though listed as prescribed for one
illness, may be useful and prescribed for others as well.

1.1 Copyright Information
This document is copyrighted by Nom dePlume. However, it may be
distributed freely, in part or in whole, provided the distributed text
is not modified, and this note is provided as part of the
distribution.

2 Depression
The Web site for NAMI (an acronym without a name, although the\0
National Association for Mental Illness comes to mind as a likely
candidate), at http://www.nami.org, describes Major Depression as
follows:

The symptoms of depression include:
· persistently sad or irritable mood
· pronounced changes in sleep, appetite, and energy
· difficulty thinking, concentrating, and remembering
· physical slowing or agitation
· lack of interest in or pleasure from activities that were once
enjoyed
· feelings of guilt, worthlessness, hopelessness, and emptiness
· recurrent thoughts of death or suicide
· persistent physical symptoms that do not respond to treatment, such
as headaches, digestive disorders, and chronic pain

When several of these symptoms of depressive disorder occur at the
same time, last longer than two weeks, and interfere with ordinary
functioning, professional treatment is needed.

(It is the author's personal opinion that excessive anger, which does
not abate, should also be added to this list, especially in the case
of depression in men.)

Current medications for the treatment of depression, generally
referred to as "antidepressant medications," or "antidepressants,"
work by increasing the concentration, in the brain, of one or more of
these neurotransmitters: serotonin, norepinephrine, and dopamine.

2.1 Sources
Most of the information in this document is generally available from a
large number of sources, in which case no specific sources are given
listed. Specific sources are cited for quoted material. Some sources
of particular interest are also listed below.

http://www.dr-bob.org
http://www.driesen.com/index.html
http://www.psycom.net/depression.central.html
http://www.nami.org
http://www.blarg.net/~charlatn/depre...yclic.faq.html
http://www.psychopharminfo.com

2.2 Abbreviations
MAOI Monoamine Oxidase Inhibitor
NaSSA Noradrenergic / Specific Serotonergic Antidepressant
NDRI Norepinphrine / Dopamine Reuptake Inhibitor
RIMA Reversible Monoamine Oxidase Inhibitor
SARI Serotonin Agonist / Reuptake Inhibitor
SNRI Serotonin / Norepinephrine Reuptake Inhibitor
SSRI Selective Serotonin Reuptake Inhibitor
TCA Tricyclic or Tetracyclic Antidepressant

2.3 Monoamine Oxidase Inhibitors (MAOI)
The first antidepressant family discovered (1950s). These were
discovered in a quest for tuberculosis treatments. They failed in that
role, but markedly alleviated depression in many patients.

2.3.1 Mechanism
Irreversibly inhibits both types of monoamine oxidase, the enzymes
that metabolize (destroy) neurotransmitters in the synaptic gap after
signal transmission. Inhibition of neurotransmitter metabolization
increases the concentration of neurotransmitters serotonin,
norepinephrine, and dopamine. ("Irreversible" in this case means the
inhibition lasts about 10 days.)

There are two types of MAO: MAO-A and MAO-B. MAO-A preferentially
metabolizes serotonin and noradrenaline, and is found primarily in the
placenta, gut, and liver. MAO-B is found primarily in the brain,
liver, and platelets. Both MAO-A and MAO-B metabolize tyramine.

2.3.2 Benefits
Very effective. Some consider MAOIs the most effective
antidepressants, especially for treatment-resistant depression. Claims
of 50% benefiting in latter case. Anticipated transdermal (skin patch)
version of selegiline should eliminate food interactions and dietary
restrictions.

2.3.3 Principal Drawbacks
Has dietary restrictions due to suppression of MAO activity in the
digestive tract, where MAO destroys tyramine. High concentrations of
tyramine cause high blood pressure, leading to bad headaches and
possibly death. Thus avoid aged cheese, aged and preserved meats, and
some other foods containing tyramine. MAOIs also interact negatively
with numerous medications, including over-the-counter cold
medications, such as cough syrup. May cause orthostatic hypotension.
Known to be extremely dangerous, even lethal, when combined with any
medication that increases serotonin concentration. Believed to be
dangerous if used with any other antidepressant medication. May
suppress libido.

2.3.4 Medications

Brand Name Chemical Name
Nardil Phenelzine
Parnate Tranylcypromine
Deprenyl Selegiline
Marplan Isocarboxazid

2.4 Reversible MAO Inhibitors (RIMA)
This category was developed in the hope that medications would retain
the effectiveness of MAOIs without the drawbacks.

2.4.1 Mechanism
Similar to MAOIs, but inhibits only MAO-A, and is "reversible,"
meaning the inhibition ceases within 24 hours. Increases serotonin and
norepinephrine, since MAO-A preferentially metabolizes these. (Some
sources say dopamine also increases.) May work better when combined
with a tricyclic antidepressant or lithium.

2.4.2 Benefits
Typically effective. No dietary restrictions, unlike standard MAOIs.
Negligile drug interactions.

2.4.3 Principal Drawbacks
Nausea, insomnia and some increase in anxiety. May be less effective
than standard MAOIs.

2.4.4 Medications
Brand Name Chemical Name
Manerix, Aurorix Moclobemide

2.5 Tricyclic / Tetracyclic Antidepressants (TCA)
This category is named after the chemical structure of the
medications, not for their mechanism. Often referred to as the "second
generation" antidepressants, although their discovery was
contemporaneous with MAOIs. Also known as "non-selective cyclic
antidepressants."

2.5.1 Mechanism
Suppresses reuptake of serotonin and norepinephrine from synaptic gap
by neuron that emitted them, thus increasing their concentration. Not
called SNRIs because latter name is applied to much newer medications.

2.5.2 Benefits
Typically effective (i.e., as effective as any other category at
relieving depression).

2.5.3 Principal Drawbacks
Side-effect profile considered somewhat worse than later SSRI drugs.
Typical problems are anticholinergic effects (flushing, dry skin and
mucous membranes, altered mental status and fever) sedation (due to
antihistamine properties), weight gain, CNS toxicity, orthostatic
hypotension, cardiovascular toxicity, delirium. May suppress libido.

2.5.4 Medications
All but Ludiomil (Maprotiline) are tricyclics. Ludiomil is a
tetracyclic. Collectively, these are all referred to as
"hetero-cyclics."

Brand Name Chemical Name Structural Type
Elavil, Endep, Levate, Novotriptyn, Apo-Amitriptyline Amitriptyline
Tricyclic
Asendin, Amoxapine Dibenzoxazipine Tricyclic
Anafranil Clomipramine Tricyclic
Norpramin, Pertofrane Desipramine Tricyclic
Adapin, Sinequan, Novo-Doxepin, Triadapin Doxepin Tricyclic
Norfranil, Tipramine, Tofranil, Tofranil-PM, Apo-Imipramine, Impril,
Novopramine Imipramine Tricyclic
Aventyl, Pamelor Nortriptyline Tricyclic
Vivactil, Triptil Protriptyline Tricyclic
Surmontil, Apo-Trimip, Novo-Tripramine, Rhotrimine Trimipramine
Tricyclic

Ludiomil Maprotiline Tetracyclic

From "www.blarg.net/~charlatn/depression/tricyclic.faq.html":

There are two broad chemical classes of tricyclics. The tertiary
amines (amitriptyline, imipramine, trimipramine and doxepin), which
have proportionally more effect in boosting serotonin than
norepinephrine, produce more sedation, anticholinergic effects and
orthostatic hypotension. Amitriptyline an doxepin are especially
sedating. Secondary amines (nortriptyline, desipramine, and
protriptyline) tend more toward enhancement of norepinephrine levels
and hence toward irritability, overstimulation and disturbance of
sleep. The tertiary amines, thus, are more useful where depression is
accompanied by sleep disturbance, agitation and restlessness; whereas
the secondary amines may be preferable where the depressed patient is
fatigued, withdrawn, apathetic and inert. The psychiatrist's initial
evaluation, therefore, must go into extensive detail about the pattern
of depressive symptoms you have experienced, to tailor the agent to
the condition. An impression about which side effects you would best
tolerate (or even benefit from) will enter into the physician's choice
of tricyclic as well. Overall, desipramine and nortriptyline are
perhaps the most benign in terms of patient tolerance, and are often
the initial tricyclic of choice.

2.6 Selective Serotonin Reuptake Inhibitors (SSRI)
These were developed in the hope that inhibiting reuptake of just a
single neurotransmitter (serotonin) would avoid the unpleasant side
effects of the MAOI and TCA medications. Often called the "third
generation" family of antidepressants, although the first NDRI
(bupropion) was developed at about the same time.

2.6.1 Mechanism
Suppresses reuptake of serotonin from synaptic gap by neuron that
emitted them, thus increasing their concentration.

2.6.2 Benefits
Typically effective (i.e., as effective as any other category at
relieving depression). Relatively benign side-effect profile, compared
to earlier-generation medications.

2.6.3 Principal Drawbacks
Usually suppresses libido, often dramatically. May cause general
emotional "flatness" that some find unpleasant.

2.6.4 Medications

Brand Name Chemical Name Structural Type
Prozac Fluoxetine Bicyclic
Luvox Fluvoxamine Monocyclic
Paxil Paroxetine Phenylpiperidine
Zoloft Sertraline Tetrahydronaphthylmethylamine
Celexa Citalopram Phthalane derivative
Lexapro Phthalane derivative

2.7 Serotonin Antagonist / Reuptake Inhibitors (SARI)

2.7.1 Mechanism
Suppresses reuptake of serotonin from synaptic gap by neuron that
emitted them. Also promotes conversion of serotonin precursor 5HT to
serotonin. The result is to increase serotonin concentration.

2.7.2 Benefits
Typically effective (i.e., as effective as any other category at
relieving depression). Relatively benign side-effect profile, compared
to earlier-generation medications.

2.7.3 Principal Drawbacks
Usually suppresses libido, often dramatically. May cause general
emotional "flatness" that some find unpleasant.

2.7.4 Medications

Brand Name Chemical Name Structural Type
Dexyrel Trazodone cyclic
Serzone (discontinued) Nefazodone Monocyclic
Paxil Paroxetine Phenylpiperidine
Zoloft Sertraline Tetrahydronaphthylmethylamine
Celexa Citalopram Phthalane derivative
Lexapro Phthalane derivative

2.8 Selective Serotonin / Norepinephrine Reuptake Inhibitors (SNRI)
These were developed in the hope that inhibiting reuptake of two
neurotransmitters (serotonin and norepinephrine) would be more
effective than the SSRI medications. Some studies show that this
probability of medications in this category relieving depression is
slightly, if not dramatically, higher than for the SSRIs.

2.8.1 Mechanism
Suppresses reuptake of serotonin and norepinephrine from synaptic gap
by neuron that emitted them, thus increasing their concentration.

2.8.2 Benefits
Typically effective (i.e., as effective as any other category at
relieving depression). Relatively benign side-effect profile, compared
to earlier-generation medications.

2.8.3 Principal Drawbacks
Usually suppresses libido, often dramatically. Inhibits or suppresses
ability to have orgasm (anorgasmia) even if libido and erectile
function is present. Withdrawal effects can be particularly unpleasant
and lingering. Most unusual of latter are peculiar "brain shock"
feelings.

2.8.4 Medications
Brand Name Chemical Name Structural Type
Effexor Venlafaxine Bicyclic agent

2.9 Norepinephrine / Dopamine Reuptake Inhibitors (NDRI)
The only member in this category as of this writing, bupropion
(Wellbutrin), was developed at about the same time as the first SSRI
(Prozac). Unfortunately, earlier users of Wellbutrin were more prone
to seizures than the general population. Wellbutrin was reformulated
into a sustained-release version that reduced the seizure incidence to
roughly normal levels, but its history scared off physicians for many
years. As a result, SSRIs, and especially Prozac, dominated the market
for several years. At this time, Wellbutrin is commonly prescribed.

2.9.1 Mechanism
Inhibits the reuptake of dopamine and norepinephrine.

2.9.2 Benefits
Typically effective. Unlike SSRI and most other antidepressant
categories, does not normally suppress libido. It is often prescribed
along with SSRIs to alleviate the libido-suppression effects of SSRIs.
This category has become increasingly popular as the libido issues
have become better understood. (Bupropion is also prescribed as an aid
in smoking cessation, under the name Zyban.)

2.9.3 Principal Drawbacks
Anxiety, jitteriness, insomnia; increased possibility of seizures in
seizure-prone population (e.g. people with epilepsy).

2.9.4 Medications
Brand Name Chemical Name Structural Type
Wellbutrin, Zyban Bupropion Bicyclic

2.10 Noradrenergic / Specific Serotonergic Antidepressants (NaSSA)
2.10.1 Mechanism
Increases the release of norepinephrine and serotonin, and blocks two
specific serotonin receptors.

2.10.2 Benefits
Typically effective. Blockage of serotonin recepters results in fewer
serotonergic effects (e.g., loss of libido, nausea, nervousness,
diarrhea) compared to SSRIs. Also causes fewer anticholinergic
symptoms than tricyclics. Minimal drug interaction problems.

2.10.3 Principal Drawbacks
Drowsiness, increased appetite, weight gain, dizziness, dry mouth,
constipation. A very small number in clinical trials for Remeron (two
out of 2796) developed agranulocytosis (drop in white-blood cell
count, increasing vulnerability to infection), though it isn't clear
that there was any connection with the medication. However, if
symptoms of infection (sore throat, fever, mouth sores) develop while
on this medication, they should be reported to physician immediately.

2.10.4 Medications
Brand Name Chemical Name Structural Type
Remeron Mirtazapine Tetracyclic