032315 antidepressants Flashcards
monoamine theory of depression
depression results from deficient monoamine (NE and/or 5HT) transmission in the CNS
the delay in onset of effects fails to support the traditional monoamine hypothesis
restated (new) monoamine hypothesis is that depression is due to bioegnic amine receptor or transmission imbalance
neurons containing NE are located where
locus coeruleus
neurons containing serotonin are located where
raphe nucleus
TCAs MOA
block reuptake of NE and 5HT
SSRI MOA
block reuptake of 5HT
mirtazapine MOA
atypical antidepressant
blocks serotonin and NE presynaptic alpha2 receptors
MAO inhibitors’ MOA
prevents breakdown of NE, 5HT
where is MAO located
mitochondria, liver, lung
what percent of pts w major depression respond to anti-depressants
67%
tx of major depression–order of use
SSRIs SNRIs atypical drugs TCAs MAO inhibitors
SSRIs-list them
fluoxetine sertraline paroxetine citalopram escitalopram
acute toxicity of SSRIs
less than TCAs and MAOinhibitors
- nausea, insomnia, sexual dysfxn
- suicidal thinking risk increased in children and adolescents
- SSRI withdrawal: shock-like sensations, dizziness, anxiety, etc
serotonin reaction
occurs when SSRIs are given with MAOIs
hyperthermia, muscle rigidity, cardiovascular collapse
neuroleptic malignant syndrome
SSRIs and SNRIs, are associated with when given w anti-psychotics
uses for SSRIs
- major depression
- OCD (drug of choice)
- panic disorder, social anxiety disorder, PTSD (more effec than anti-anxiety agents)
- generalized anxiety disorder (drug of choice)
- PMS
- hot flashes
side effect profile of SNRI
more SSRI-like than TCA-like (TCA can bind to lots of other receptors like those for dopamine, etc, leading to more side effects)
use of SNRIs
major depression, anxiety, fibromyalgia, etc
bupropion MOA
weakly blocks NE and dopamine uptake
use of bupropion
major depression, nicotine withdrawal, seasonal affective disorder
side effects of bupropion
NO weight gain or sexual dysfxn
mirtazapine MOA
blocks presynaptic alpha2 receptors
side effects of mirtazapine
increases appetite (AIDs pts)
trazodone MOA
weak SSRI-like effect
side effects of trazodone
priapism, sedating
use of trazodone
major depression, insomnia
vortioxetine MOA
SSRI-like action in addition to 5HT1A agonist and 5HT3 antagonist
side effects of TCAs
decreases REM, increases stage 4 sleep
ANTICHOLINERGIC effects: dry mouth, blurry vision, urinary retention
sedation
orthostatic hypotension
cardiac side effects (due to anticholinergic and increased NE)-palpitations, tachycardia, arrhythmias, longer QRS intervals, EKG changes
drug interactions of TCAs
guanethidine
sympathomimetic drugs
absoprtion and metabolism of other drugs
uses of TCAs
MDD
enuresis in childhood
chronic pain
OCD
side effects of MAOIs
lowers blood pres, orthosatic hypotension
acute toxicity: agitation, hallucinations, hyperpyrexia, convulsions, BP changes
tyramine
if not broken down, can cause release of NE, resulting in hypertensive crisis
foods that can interact w MAOIs
avocados soybean figs smoked meats fermented sausage dried fish cheese
uses of MAOIs
MDD (not first line)
narcolepsy
what if antidepressant drugs alone aren’t effective?
add antipsychotic drugs
physiological tx-ECT, transcranial magnetic stimulation, deep brain stimulation
St John’s wort
MAOI activity
