Common and widespread mental

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Introduction:

Depression is a common and widespread mental disorder affecting millions of people worldwide; [6] Thus, this review is mainly aimed to focus upon the action mechanisms, side effects, toxicity and the logical analytical approaches possibly used in forensic toxicology for the identification of one or more Antidepressant Drugs and their metabolites from biological test matrices.

Antidepressant: Types & Functions

Antidepressant covers many varieties of drugs having different modes of actions like [16]

Figure: Mechanism action of Monoamine reuptake inhibitors (MAOIs), Tricyclic anti-deprassant (TCA) and Selective serotonin reuptake inhibitors (SSRIs).

According to the “Monoamine Theory of Depression,” (proposed by Schildkraut in 1965) the decrease in monoamine neurotransmission is thought to be responsible for inducing depression in an individual. Thus, medication with Antidepressantdrugs (TCAs, MAOIs, SSRIs, and SNRI etc.) rise in the amount of neurotransmitters. Tricyclic antidepressants (TCAs) and heterocyclic antidepressants (SSRIs, SNRIs) inhibit the norepinephrine transporter (NET) and the serotonin transporter (SERT) by competing for the binding site of the amine transporter results in the increase levels of both NE (Norepinephrine) and 5HT (5-hydroxytryptamine or Serotonine) in the synaptic cleft. In addition to this the Monoamine reuptake inhibitors (MAOIs) inhibits an enzyme MAO (monoamino oxidase) released from mitochondria (MO) which convert 5-HT to 5 hydroxyindole acetic acid (HIAA) and norepinephrine (NE) to 3-methoxy 4-hydroxy phenyl glycol (MHPG). This phenomenon increases the stores of NA and 5-HT thus contributes to higher level of Neurotransmitters in Brain. [19]

Adverse effects

Antidepressants are supposed to increase the risk of suicidal thinking and behavior, especially in children accompanying other depressive and psychiatric disorders. [17] [18] [19] The European Medicines Agency showed warning on the use of Antidepressants which might increase the risk of suicidal behavior in children and adolescents. [19] Thus, these drugs may be responsible for the fatality and intoxication and their growing rate all over the world may show threatening effects which is the matter of global concern. Thus, increasing prescription rate and adverse effects of antidepressant drugs results in a growing interest for their determination from biological matrices, proved to be very helpful in the field of Forensic.

Biological Samples use for the Screening of Antidepressant Drugs

Biological samples are the basic requirement of Forensic Toxicology as it solves several related questions which make basis of judgement, consultation and expertise for the field. The biological matrices generally encountered for analysis are urine [34], hair, nails, vitrous humour etc.

The most important and encountered biosample used for analytical purposes is Blood (plasma, serum). Toxicological effects can correlate more effectively with their concentrations in blood which can be determined qualitatively [42]

Another important biological sample is Urine which is a widely used specimen employed for screening, identification and testing of unknown drugs accompanying advantages that it forms in high amount, readily available, easy to collect and contains much useful information about the major metabolic functions of the body. [48]

A next alternative to the blood and urine specimen is the Oral fluid;

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