08_Antidepressants Flashcards
Three Main Classes of Antidepressants
Tricyclics
SSRIs
MAOIs
*Also recent development of NDRIs and SNRIs
Tricyclic Antidepressants (TCAs):
Most common Examples
Imipramine (Tofranil)
Clomipramine (Anafranil)
Tricyclic Antidepressants (TCAs):
Most Effective Use
Depression that involves:
Decreased appetite and weight loss
Sleep disturbances
Psychomotor retardation
Anhedonia
Tricyclic Antidepressants (TCAs):
Particularly effective for this symptom presentation…
Vegetative, somatic symptoms of depression
Tricyclic Antidepressants (TCAs):
Common uses
Clomipramine: OCD (serotonin)
Imipramine: Eneurisis in children and adolescents
Tricyclic Antidepressants (TCAs):
Mechanism of Action
Increase levels of norepinephrine, serotonin and dopamine
Catecholamine Hypothesis
Depression is caused by deficiency of norepinephrine
Supported by TCA’s effect on increasing NE
Most Serious Problem with TCA’s
They are Cardiotoxic:
Tachycardia
Palpitations
Hypertension
Severe hypotension
Arrhythmia
Tricyclic Antidepressants (TCAs):
Prescribing Considerations
Used with caution with those with heart disease
Adverse effects more common in older patients
Side effects can be alleviated by lowering dosage
Lethal in overdose
Tricyclic Antidepressants (TCAs):
Suicidality Consideration
TCA’s are lethal in overdose
Prescribed in small doses for patients at high risk
SSRI’s:
Three Most Common SSRI’s
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
SSRI’s:
Uses
Depression
*particularly effective for melancholic depression
OCD
Bulimia
Panic disorder
PTSD
SSRI’s:
Advantages of SSRIs over tricyclics
Less cardiotoxic
Safer in overdose
Less likely to produce cognitive impairment
Fairly rapid onset of therapeutic effects (2 to 4 weeks)
True or False?
Prozac is linked with increased suicidality
False.
No greater than other antidepressants
Serotonin Syndrome:
Etiology
Combination of SSRI with MAOI or other serotonergic agent
Serotonin Syndrome:
Neurological Symptoms
Headache
Tremor
Dizziness
MAOI’s:
Three most commonly prescribed MAOIs
Isocarboxazid (Marplan)
Phenelzine (Nardil)
Tranylcypromine (Parnate)
MAOI’s:
Most Effective Uses
Non-endogenous and atypical DEPRESSIONs with:
Anxiety
Reverse vegetative symptoms (hypersomnia, hyperphagia)
Interpersonal Sensitivities
MAOI’s:
Most dangerous Side Effect
Hypertensive Crisis
*seek emergency treatment immediately
MAOI’s:
Foods that contain Tyramine
Aged cheeses and meets
Beer
Red wine
Chicken liver
Avocados
Bananas
Fava beans
Soy sauce
MAOI’s:
Hypertensive Crisis Symptoms
Severe headache
Stiff neck
Rapid heart rate
Nausea
Vomiting
Sweating
Photosensitivity
NDRIs:
Main example
Buproprion (Wellbutrin)
MDD
Major Depressive episode of Bipolar Disorder
Buproprion (Wellbutrin):
Brand name when used for smoking cessation
Zyban
Buproprion (Wellbutrin):
Pros
Fewer anticholinergic side effects and less cardiotoxic than TCAs
Does not cause sexual dysfunction
Effective for individuals who’ve not responded to other antidepressants
Buproprion (Wellbutrin):
Con
May aggravate pre-existing psychosis and seizures
SNRIs:
Two main examples
Venlafaxine (Effexor)
Duloxetive (Cymbalta)
Venlafaxine (Effexor):
Uses
MDD
GAD
SAD
OCD
Pain syndromes (e.g. fibromyalgia, back pain)
Venlafaxine (Effexor):
Pros
Less dangerous in overdose than TCAs
Faster onset of therapeutic effects
Venlafaxine (Effexor):
Caution
Increases blood pressure
Requires frequent monitoring
SNRIs: Duloxetine (Cymbalta)
Overview
Similar to Effexor
Prescribed for MDD and GAD
Hypertensive Crisis:
Causes
Combination of MAOIs and:
Barbiturates, amphetamines, antihistamines
Foods containing Tyramine
Serotonin Syndrome:
Changes in Mental State
Irritability
Confusion
Delirium
Serotonin Syndrome:
Physiological Symptoms
Cardiac arrhythmia
*Can progress to coma and death
