1. Pharm: Antidepressants Flashcards
- What is considered a “response” to antidepressants?
- A > 50% reduction in symptoms from BL.
What is considered a PARTIAL RESPONSE when taking anti-depressants?
25 - 50% reduction of symptoms.
Goal in treatment of depression with antidepressants
Remission and recovery
- Remission = symptom free = very low => no sx
- Recovery = 2-6 months of ongoing remission
Difference between relapse and recurrence of depressive symptoms
- Relapse = when sx return after remission but before recovery
- Recurrence = when sx return after recovery
How long do anti-depressants take to kick in?
What happens if the patient does not respond after ___ weeks?
- 3-8 weeks, depending on the severity of depression, duration and the dose of the drug.
- If the patient does not respond after ~8 weeks => switch to a drug with a different mechanism.
65-75% of patients will see a _____ ( 50% ↓ in symptoms) with antidepressants in _____ weeks.
response
3-4 weeks
What percentage of patients reach remission (sx free => no sx) on anti-depressants?
20 - 35%
Test Q: When DQing ALL anti-depressants, what is recommended and why?
Slowly titrate down (deprescribe) to to prevent withdrawal syndrome, which causes [FINISH]
- Flu-like symptoms
- Insomnia
- Nausea
- Imbalance
- Sensory distubances
- Hyperarousal
MOA of most anti-depressants
- Monoamine theory: Most want to ↑ 5HT or NE in the synaptic cleft by blocking pre-synaptic reuptake via SERT, NET or both.
- Block or stimulate pre/post synaptic receptors
- Affect DA system
Besides depression, anti-depressants are also affective for:
- Nicotene withdrawal
- Enuresis
- Diabetic peripheral neuropathy, fibromyalgia, chronic MSK pain
- Stress incontinence
Which anti-depressant also treats:
- Nicotene withdrawal
- Enuresis
- Diabetic peripheral neuropathy, fibromyaligia, chronic MSK pain
- Stress incontinence
- Buproprion
- Imipramine
- Duloxetine
- Duloxetine
Which anti-depressant is used off-label for diabetic peripheral neuropathy, fibromyalgia, chronic MSK pain, and stress incontinence?
Duloxetine
_________ may interact with antidepressants and migraine medicines to cause serotonin syndrome.
Opioids
Impact of SSRIs on [Histamine, Muscarinic and Adrenergic Receptors]
SSRIs have less SE than TCAs because they do not affect the Histamine, Muscarinic and Adrenergic Receptors.
Which SSRI is the broadest and strongest CYP450 inhibitor, thus, having the MOST drug-drug interactions?
Fluoxetine
Which 3 SSRIs are only low/mild CYP450 inhibitors?
- Citalopram
- Sertraline
- Vilazodone
Which SSRI is the least CYP450 inhibitor, thus, having the LEAST drug-drug interactions?
- Vortioxetine
- Escitalopram
AE’s associated with TCA’s antagonizing α1-adrenergic receptors?
CV –> Tachycardia + Orthostatic hypotension + Dysrhythmias
AE’s associated with TCA’s antagonizing histamine (H1) receptors?
- Sedation/Fatigue
- Dizziness/Seizures
AE’s associated with TCA’s antagonizing muscarinic cholinergic receptors?
Anticholinergic => dry mouth + urine retention/constipations + blurry vision/IOP
OD on TCA’s causes
3 C’s
- Coma
- Cardiotoxicity (conduction abnormalities), a quinidine-like effect
- Convulsions
Patient wants an antidepressant that has LESS risk of sexual dysfunction: should he take a SNRI or SSRI?
SNRI
MAO-I Drug Interactions
- Interacts with drugs that affect 5HT/NE to prevent 5HT syndrome, thus, you should only give after a 2 week washout period (if fluoxetine = 5 weeks)
MAO-I SE
Hypertensive Crisis:
Lithium Indications and Off-Label Use
- Acute and maintenance tx of mania/bipolar I disorder
- Augmentation in unipolar depressive pt’s with inadequate response to antidepressant therapy
- Off label: reduced risk of suicide and all-cause mortality in pt’s with mood disorders
TEST Q = Which mood stabilizer is a major CYP450 inducer?
Carbamazepine
