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Comparison Between Mechanism of Action and Pharmacodynamics of Dothiepin and Fluoxetine Description of medicines Mechanism of action and pharmacodynamics Dothiepin Dothiepin is a tricyclic antidepressant It acts by promoting the effectiveness of several amines dopamine norepinephrine and 5-hydroxytryptamine which is also known as 5HT and serotonin It functions by inhibiting their reuptake at the terminals of nerve cells thus leading to their prolonged presence at the synaptic cleft and an increased effect on the neuron1 The reuptake pumps for the above amines are responsible for reducing the concentration of these amines Dothiepin works by blocking the pumps According to the amine hypothesis a decreased concentration of the amines and the resulting decrease in amine dependant synaptic transmission is associated with depression therefore an increase in the above would help relieve the symptoms of depression 2 Dothiepin has other actions as well It reduces norepinephrine induced CAMP formation in the brain as well as inhibiting the uptake of 5HT into platelets It also has some anticholinergic and antihistaminic activity3 Dothiepin begins to take effect after approximately 2-3 weeks Usual daily doses of Dothiepin range from 75mg to 200mg in the more severe cases 2 Fluoxetine Fluoxetine belongs to a group of antidepressants known as the SSRIs or Selective serotonin reuptake inhibitors It functions is similar to that of dothiepin above It also acts as a reuptake inhibitor but is highly selective It only inhibits 5HT reuptake and lacks many of the less useful functions of dothiepin such as the antihistaminic properties 1 As above the result in increase in the presence of serotonin at the synaptic cleft results in a decrease in many symptoms of depression Fluoxetine does however have some side effects including nausea tremors loss of libido and in some cases decreased sexual function 2 It is also possible that it may have an effect on dopamine function In some cases it also
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