Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NOTES: Psych Review by Minnie > 117b - Antidepressants > Flashcards

117b - Antidepressants Flashcards

You may prefer our related Brainscape-certified flashcards:
Psychology 101 flashcards GRE® Psychology flashcards
1
Q

Which classes of antidepressants are useful in the treatment of chronic pain?

A

SNRIs: increase 5HT at lowest does and NE at high doses; it is helpful for neuropathic pain;

TCAs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which class of antidepressants is especially useful for treating migraine?

A

TCAs

(Especially amitryptiline)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which amino acid is a precursor for serotonin?

A

Tryptophan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Tyrosine is a precursor for which neurotransmitters?

A

Dopamine, NE

(Dopamine is a precursor for NE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List 3 common features of all classes of antidepressants

A
  • Takes 3-8 weeks to be maximally effective
  • All have equivalant response and remission rates
    • 50-70% response
    • 35-50% remission
  • Placebo-drug differences depend on the level of severity of depression
    • More severe depression = less placebo effect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

If a patient experiences partial improvement at the maximally tolderated dose of antidepressant A, what is the next step in their management?

A

Add another antidepressant of a different class

OR

Target residual symptoms with other treatments

Remeber: The goal of treatment is complete response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
A

c. Bupropion

  • Helpful in depression w/o anxiety symptoms
  • Will treat comorbid tobacco dependence
  • Bupropion (Wellbutrin) is an NE-DA reuptake inhibitor that acts as activating antidepressant so it often makes anxiety worse
    • it doesn’t cause sexual dysfunction or weight gain
    • it is useful in ADHD, nicotine dependence, and sexual dysfunction caused by other antidepressants
    • contraindicated in seizure disorder and eating disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How should you select a first-line antidepressant?

(What factors should influence your decision?)

A
  • Side effect profile
  • Past response
  • Comorbid medical and psichiatric problems

Remember: no significant differences in efficacy among first line medications

Consider psychotherapy in addition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which classes of antidepressants are first line for treating depression?

A
  • SSRI
  • SNRI
  • Mirtazapine
  • Bupropion

Select agent based on side-effect profile

All have comparable efficacy

TCAs and MAOIs are not first line due to higher side effect burden, potential for lethal overdose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the 6 most common side effects of SSRIs and SNRIs?

Which ones usually improve?

A
  • GI upset
  • Anxiety, agitation
  • Insomnia
  • Headache
  • Sweating
  • Sexual dysfunction

All except sexual dysfunction usually improve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

List 3 serious risks of antidepressant treatment

A
  • Increased risk of suicidal thinking, behavior in young people
    • Highest in the first few days on the medication
    • Risk of treatment < risk of untreated depression
  • Serotonin syndrome
  • Do not give antidepressant monotherapy for anyone with bipolar disorder
    • Increases manic episodes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is serotonin syndrome?

How can it be avoided?

A

Result of increased 5HT activity in the brain, usually from multiple serotoninergic drugs

  • Mental status change
  • Hyperthermia
  • Hyperreflexivity

Never combine MAOIs with TCAs or SSRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which SSRI has the longest half life?

Why is this important?

A

Fluoxetine (Prozac)

  • No need to taper, is easy to stop
  • Requires long wash-out if transitioning to MAOI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which SSRI has the highest risk of drug-drug interactions?

Why?

A

Paroxetine (Paroxil)

It is a potent CYP26 inhibitor

  • has the shortest half life so if a patient misses a dose, they will notice the difference right away
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which SSRI has the shortest half life?

Why is this important?

A

Paroxetine

; it has the shortest half life so if a patient misses a dose, they will notice the difference right away —> Results in the worst discontinuation symptoms (must taper)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which SSRI should be avoided in anyone with cardiac comorbidities?

A

Citalopram

  • Citalopram (Celexa) is a SSRI that can cause QTc prolongation so should be avoided in cardiac disease
18
Q

Which SSRI is preferred in pregnancy?

A

Sertraline

19
Q

What is the most common side effect of the SNRIs?

A

Hypertension (at higher doses)

(In addition to the side effects common to all agents that increase 5HT and NE: GI upset, weight gain, sweating, sexual dysfunction)

20
Q

What is the mechanism of action of TCAs?

A

Inhibit NE and 5HT reuptake

21
Q

What are the common side effects of TCAs?

A
  • all TCAs have “HAM” side effects:
    • antiHistamine – setation, weight gain
    • antiAdrenergic – hypotension, dizziness, reflex tachycardia, QTc prolongation
    • antiMuscarinic – dry mouth, blurred vision, urinary retention, constipation, confusion
22
Q

What special diet must be followed when a patient is on a MAOI?

What happens if they do not follow this diet?

A

Tyramine free diet: No aged cheese, red wine, fava beans, cured meats

Can cause hypertensive crisis if ingested while on MAOI

23
Q

Which antidepressant should you prescribe to a patient that does not have anxiety symptoms and does not want to experience weight gain or sexual dysfunction?

A

Buproprion

May worsening existing anxiety symptoms

(Mirtazapine does not have sexual side effects, but can cause weight gain)

24
Q

Which antidepressants carry the lowest risk of switch to mania if there is undiagnosed bipolar disorder?

A

Bupropion

Mirtazapine

25
Q

What are the mechanisms of action of mirtazapine?

A
  • Mertazapine (Remeron) is an alpha 2 receptor antagonist, which increases NE and 5HT
    • at low doses it preferentially blocks H1 (antihistaminic) helps anxiety and sleep
    • at high doses it preferentially acts on NE receptor more activating
26
Q

Which antidepressant is often used elderly patients with insomnia and low appetite?

A

Mirtazapine

Side effects of sedation and weight gain may be helpful!

27
Q

What is the mechanism of trazodone?

A
  • Trazadone (Desyrel) is an 5HT antagonist and agonist that is used to treat insomnia
    • the effective dose that would treat depression is limited by its side effects of sedation and orthostatic hypertension
    • side effects include sedation, headache, and priapism
    • to treat insomnia, use it at lower dose
28
Q

Which antidepressant has the potential side effect of priapism?

A

Trazodone

  • side effects include sedation, headache, and priapism

priapism = prolonged erection of the penis

29
Q

List the different SSRIs

A
  • SSRIs all selectively block the 5HT receptor; all are once a day dosing and have very low toxicity
    • Fluoxetine (Prozac) has the longest half-life and is easy to stop; need to have a long washout b4 switching to a MAOI
    • Paroxetine (Paxil) has more drug-drug interactions and is a potential CYP2D6 inhibitor; it has the shortest half life so if a patient misses a dose, they will notice the difference right away
    • Citalopram (Celexa) can cause QTc prolongation so should be avoided in cardiac disease
    • Escitalopram (Lexapro) has fewer side effects of Citalopram
30
Q

Describe bupropion

A
  • Bupropion (Wellbutrin) is an NE-DA reuptake inhibitor that acts as activating antidepressant so it often makes anxiety worse
    • it doesn’t cause sexual dysfunction or weight gain
    • it is useful in ADHD, nicotine dependence, and sexual dysfunction caused by other antidepressants
    • contraindicated in seizure disorder and eating disorders
31
Q

Describe Trazadone

A
  • Trazadone (Desyrel) is an antidepressant; 5HT antagonist and agonist that is used to treat insomnia
    • the effective dose that would treat depression is limited by its side effects of sedation and orthostatic hypertension
    • side effects include sedation, headache, and priapism
    • to treat insomnia, use it at lower dose
32
Q

Describe Mertazapine

A
  • Mertazapine (Remeron) is an alpha 2 receptor antagonist, which increases NE and 5HT
    • at low doses it preferentially blocks H1 (antihistaminic) helps anxiety and sleep
    • at high doses it preferentially acts on NE receptor more activating
    • side effects: sedation, weight gain, dizziness, dry mouth, constipation
    • has no sexual side effects
    • often used in depression w/ prominent insomnia and low appetite
    • is dosed at bedtime b/c of its sedative properties

NOTES: Psych Review by Minnie (36 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions