Question

Some pharmaceuticals were much more commonly prescribed at one time but today are prescribed much less frequently. Pick two such substances and explain the dramatic decline in psychiatric use. Be as specific and as detailed as you can.

use Goode's book and tell page number

Answer 1

1-->>MAOI(monoamine oxidase inhibitor) were once commonly prescribed between 1950-1970 as treatment of majordepressive disorder,particularly treatment resistant depression and atypical depression.They are powerful anti-depressantsas well as effective therapeutic agents for panic disorder and social phobia.They are also used in the treatment of Parkinson's disease and several other disorders. But they have numerous side effects in relation to dietary limitations and drug interactions some of which can be fatal.

People taking MAOIs generally need to change their diets to limit or avoid foods and beverages containing
tyramine. If large amounts of tyramine are consumed, they may suffer hypertensive crisis, which can be fatal.
Examples of foods and beverages with potentially high levels of tyramine include animal liver and fermented substances,
such as alcoholic beverages and aged cheeses.Excessive concentrations of tyramine in blood plasma can lead to hypertensive crisis
by increasing the release of norepinephrine (NE), which causes blood vessels to constrict by activating alpha-1 adrenergic receptors.
Ordinarily, MAO-A would destroy the excess NE; when MAO-A is inhibited, however, NE levels get too high, leading to dangerous increases in blood pressure.

MAOIs should not be combined with other psychoactive substances (antidepressants, painkillers, stimulants, including prescribed, OTC and ‘controlled drugs’ etc.)
except under expert care. Certain combinations can cause lethal reactions, common examples including SSRIs, tricyclics, MDMA, meperidine, tramadol, and dextromethorphan.
Drugs that affect the release or reuptake of epinephrine, norepinephrine, or dopamine typically need to be administered at lower doses due to the resulting potentiated and
prolonged effect. MAOIs also interact with tobacco-containing products (e.g., cigarettes) and may potentiate the effects of certain compounds in tobacco.
This may be reflected in the difficulty of smoking cessation, as tobacco contains naturally occurring MAOI compounds in addition to the nicotine.

Reversible inhibitors of monoamine oxidase A (RIMAs) are a subclass of MAOIs that selectively and reversibly inhibit the MAO-A enzyme.
RIMAs are used clinically in the treatment of depression and dysthymia. Due to their reversibility, they are safer in single-drug overdose
than the older, irreversible MAOIs,and weaker in increasing the monoamines important in depressive disorder.RIMAs have not gained widespread market share
in the United States.

While safer than general MAOIs, RIMAs still possess significant and potentially serious drug interactions with many common drugs;
in particular, they can cause serotonin syndrome or hypertensive crisis when combined with almost any antidepressant or stimulant,
common migraine medications, certain herbs, or even most cold medicines (including decongestants, antihistamines, and cough syrup).

One famous victim of such interaction was of Libby Zion who died following a reaction between phenelzine and pethidine.
The Libby Zion law was passed after her death.

These days MAOI's are seldom used as first line of therapy.

2-->

Tricyclic antidepressants (TCAs) are a class of medications that are used primarily as antidepressants.
TCAs were discovered in the early 1950s and were marketed later in the decade.They are named after their chemical structure,which contains three rings of atoms. Tetracyclic antidepressants (TeCAs), which contain four rings of atoms, are a closely related group of antidepressant compounds.

Although TCAs are sometimes prescribed for depressive disorders, they have been largely replaced in clinical use in most parts of the world by newer antidepressants such as selective serotonin reuptake inhibitors (SSRIs), serotonin–norepinephrine reuptake inhibitors (SNRIs) and norepinephrine reuptake inhibitors (NRIs). Adverse effects have been found to be of a similar level between TCAs and SSRIs.Tricyclic antidepressants are particularly dangerous in overdose and thus are no longer prescribed as a first line of therapy.

Most, if not all, of the TCAs also potently inhibit sodium channels and L-type calcium channels, and therefore act as sodium channel
blockers and calcium channel blockers, respectively.The former property is responsible for the high mortality rate upon overdose seen
with the TCAs via cardiotoxicity.It may also be involved in their efficacy as analgesics, however.
In summary, tricyclic antidepressants can act through NMDA antagonism, opioidergic effects, sodium, potassium
and calcium channel blocking, through interfering with the reuptake of serotonin and acting as antagonists to SHAM
(serotonin, histamine, alpha, muscarinic) receptors. Thus their dangerous side effect profile limits their use in daily practice.