Depression

The study of psychoneurophysiology indicates that there is a relationship between the levels of biogenic amines and the development of depression. The major amines that have been implicated are: 1) the catecholamine norepinephrine and 2) 5 hydroxytriptamine or serotonin. Based on this theory, dopamine has also been studies. Additional research has examined the relationship between the noradrenergic system and the cholinergic system. It is theorized that an increase in cholinergic activity as compare to central norepinephrine activity may play a role in the development of depression. Alterations in cholinergic activity appears to be related to the sleep pattern disturbances associated with depression.

This theory partially explains the association between the long term use of certain medications, such as beta adrenergic antagonists and the development of depression. It also supports the use of tricyclic antidepressants and selective serotonin re-uptake inhibitors.

The following medications alter levels of biogenic amines. Clinical evidence has demonstrated either an increased occurrence of depression or effectiveness in the treatment of depression.

Medication	Clinical Effect	Biogenic Amines	Mechanism of Action
Reserpine	Depression	Decrease	Depletes Norepinephrine
Aldomet	Depression	Decrease	False Neurotransmitter
Propranolol	Depression	Decrease	Blocks NE activity
Amphetamine	Temporary relief of depression	Increase	Increased release of NE
Tricyclics	Relief of depression	Increase	Re-uptake inhibition
MAOIs	Relief of depression	Increase	Inhibits NE metabolism
SSRIs	Relief of depression	Increase	Re -uptake inhibition

Patient Care Issues

Ó JPFrizzell 2000

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