21. pharmacotherapy + somatic txs of depr Flashcards
name of the first antidepressant - what kind of drug is it?
imipramine - tricyclic
when was prozac introduced? what is it?
1987 - SSRI
4 categories of antidepressants
- tricyclics TCA
- monoamine oxidase inhibitors MAOIs
- selective serotonin reuptake inhibitors SSRI
- serotonin norepinephrin reuptake inhibitors SNRIs
what are the first line meds for depression?
which used for most severe depr?
SSRI + SNRI
SNRI
what are TCAs usually used for? why aren’t they as popular today?
sleep problems, have lots of side effects
why aren’t MAOIs popular?
require dietary restrictions
who most benefits from use of antidepressants? why? what about the others?
- severe depression
- can’t engage in CBT, v difficult
- effects minimal or non-existent at mild/moderate sx
when’s it most important to track progress with antidepressants? why?
most early stages - if don’t work early, won’t work at all
- why do people discontinue their meds?
- when do people usually discontinue?
- how long should people use antidepress to feel full effects?
- feel like it doesn’t work/feel like don’t need anymore
- within 3 mo
- at least 9 mo, full cycle
how do SSRIs work?
- inhibit reuptake of seroronin in synaptic cleft
- makes serotonin more available in CNS
dx that also use SSRIs
- OCD (higher doses)
- panic disorder
- ED (reduce bingeing)
biggest difference between SSRIs and TCAs
TCA can be deadly if OD
what happens if you stop SNRI abruptly?
flu like sx
what’s wellbutrin? talk about it chop chop
- bupropion
- act on NE + DOP (no effects on SERT)
- stimulating
- no sexual side effects, no weight gain
- side effects: insomnia, anx, tremor, headache
meds + therapy works best on…
mild/moderate depr
what is tx-refractory?
- when someone is tx resistant
- refers to people who haven’t responded to min. 2 forms of tx
- for depr: no response to 2 distinct classes of meds
what is ECT?
mode of delivery, pros, cons, post-administration
- electroconvulsive therapy
- induce seizures via electrical current
- delivered unilaterally
- anesthetic + muscle relaxants given prior
- effective in short-term
- 50% relapse
- only give if life threatning
why do we administer ECT unilaterally?
- best results if bilateral, but too many neg side effects + mem loss
- retrograde amnesia still reported
what is deep brain stimulation?
used for?
- neurostimulator sends electrical impulses to specific (subcortical) region of brain
- for tx of mvmt + affective disorders
what is ketamine?
results from study?
- drug used as horse tranquilizer
- marked improvement in 24h post administration
- good to reduce suicidal ideation in emergency situations
- maintained effects over time
limits of ket
not lots of research
doesn’t nec decr suicide
