16. Drugs for Depression and Anxiety Flashcards
What are the core symptoms of depression?
Depressed mood
Anhedonia
Lack of energy
What are the treatment options for depression?
Mild: CBT
Moderate to severe: pharmacological
Severe resistant: electroconvulsant therapy
Name 2 tricyclic antidepressants
Imipramine
Amitriptyline
What is the MOA of tricyclic antidepressants?
Stop serotonin and NA reuptake
What are the side effects of tricyclic antidepressants?
H1 receptors: drowsiness and sedation
a1 adrenergic: postural hypotension, dizziness
Muscarinic: dry mouth, blurred vision, memory impairment
Narrow therapeutic range
Name 2 SSRIs
Fluoxetine
Sertraline
What is the MOA of SSRIs?
Selectively block serotonin uptake
What are the side effects of SSRIs?
nausea, bleeding
Headache, anxiety, insomnia, sexual dysfunction
Hyponatraemia
Serotonin syndrome
When are serotonin norepinephrine reuptake inhibitors used?
SSRIs don’t work
Name 3 SNRIs
Venlafaxine
Desvenlafaxine
Duloxetine
What are the side effects of SNRIs?
Nausea
Dose-related hypertension
When are monoamine oxidase inhibitors used?
Rarely as lethal interactions
What are the side effects of monoamine oxidase inhibitors?
With tyramine causes intracranial haemorrhage
Headache, hypotension
What are the active compounds in St John’s Wort?
Hyperforin and adhyperforin
What is the first line treatment for generalised anxiety disorders?
SSRI such as sertaline
2-3 week lag before working so co-prescribe short term benzodiazepine
Name a tricyclic antidepressant useful in obsession and phobia
Clomipramine
What anxiety disorders are MAO-Is useful in?
Resistant morbid anxiety
Panic attacks
What is the treatment for anxiety that is not improved after sertaline for 2 months?
Increase dose or switch to alternative SSRI or SNRI
What are the side effects of benzodiazepines?
Withdrawal and dependence
Enhance depressant effects of alcohol
Resp insufficiency with underlying conditions
Name 2 benzodiazepines that can be used as hypnotics for sleep disturbance
Nitrazapam
Flurazepam
What drugs should be used in the short term vs long term treatment of sleep disturbance?
Short: hypnotics
Chronic: TCAs
Name 3 classes of non-benzodiazepine hypnotics
Z-drugs
Anti-histamines
Melatonin
What are the uses of b-blockers in anxiety?
Used for physical symptoms eg. tremor, sweating, shortness of breath
What is the MOA of buspirone?
Partial agonist at 5-HT1
