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Living Healthfully - September 2009

A Type of Drug-Food Interaction 2

September 30th 2009 06:39
Brief Discussion on Depression
“Major depressive disorder (also known as clinical depression, major depression, unipolar depression, or unipolar disorder) is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and loss of interest or pleasure in normally enjoyable activities. The diagnosis of major depressive disorder is based on the patient's self-reported experiences, behavior reported by relatives or friends, and a mental status exam. There is no laboratory test for major depression, although physicians generally request tests for physical conditions that may cause similar symptoms. The most common time of onset is between the ages of 30 and 40 years, with a later peak between 50 and 60 years. Major depression is reported about twice as frequently in women as in men, although men are at higher risk for committing suicide (Wikipedia.org)”.

The theories on what causes depression are numerous and variable. Scientists attribute depression to biological alterations, psychosocial impairment, or alcohol-drug abuse. Nevertheless, an explanation under biological causes has provided the major experimental models for the discovery of potential management for patients suffering from the condition (Potter and Hollister, 2007). Such explanation claims that depression arises due to low levels of monoamine neurotransmitters in the body. These neurotransmitters include serotonin, norepinephrine, and dopamine. Naturally, these chemicals are involved in alertness, energy, attention, motivation, pleasure, and reward. Disrupting their production and release, or promoting their reuptake and degradation causes these chemicals to become depleted, therefore leading to the signs of depression.
Management of the condition includes psychotherapy and anti-depressant drugs. Anti-depressants can be grouped into tricyclic antidepressants (imipramine and amitryptyline), second generation and subsequent antidepressants (amoxapine and maprotiline), selective serotonin reuptake inhibitors (flouxetine), monoamine oxidase inhibitors (phenelzine and in our case iproniazid, which is already withdrawn from the market). For our purpose, we shall be discussing the mechanism of monoamine oxidase inhibitors (MAO inhibitors) at the later part of the discourse.

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A Type of Drug-Food Interaction

September 28th 2009 06:38
A patient comes in with the following details:

•Has been suffering from depression
•Tried several anti-depressants but nothing worked for her, except for Iproniazid
oIproniazid is a MAO inhibitor, can be considered as a last line for depression management
oIproniazid then was a new drug and side effects are yet to be discovered.
oHer doctor asked her to notify him in case of any unusual effects
•Condition improved and was able to return to usual life
•Hosted a wine and cheese party during which she had severe headache
•In the hospital BP is at 230/160 mmHg
•MD administered phentolamine ( non-selective Alpha receptor antagonist) to address HPN

Then we ask the following:
Why Did the Patient Had Headache and Hypertension Crisis Upon Intake of Wine and Cheese?
Patient was given Phentolamine. How does it act? Why was it useful in this case?
Why didn’t the physician use a Beta-adrenoceptor antagonist to treat the condition?

to be continued...
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