5.5 Pharmacology For Depressive Disorders

Question 1

Antidepressants

Answer 1

• Increases neurotransmitters such as serotonin, dopamine, and norepinephrine.

Mechanism of Action
- Blocking Synthesis
- Blocking degradation
- Preventing Reuptake
- Mimic Binding

Question 2

Treatment Classes

Answer 2

Tricyclics
SSRIs
Monoamide Oxidase Inhibitors
Atypical Anti-depressants
SNRIs
Psychotherapeutic Combinations

Question 3

Trycyclics

Answer 3

• Blocks reuptake of NI and serotonin
• Given when SSRIs dont work
• Gold standard for OCD, depression, and chronic pain
• Low therapeutic range

Adverse Effects
- FATAL CARDIAC DYSRHYTHMIAS
- TAKES 4 WEEKS TO WORK
- OVERDOSE IS LIFE THREATENING
- Contraindicated in cardiac events or narrow-angle glaucoma
- Reduces seizure threshold
- Reduces antihypertensive effectiveness

Question 4

Monoamine Oxidase Inhibitors (MOIs)

Answer 4

• Prevents destruction of monoamines
• RARELY USED DUE TO MULTIPLE INTERACTIONS AND POTENTIAL FOR HYPERTENSIVE CRISIS

Side Effects
- HYPERTENSIVE CRISIS (hypertension, occipital headache, neck stiff, dilated pupils, palpitations, constricting chest pain

Question 5

Hypertensive Crisis

Answer 5

• Can be caused by foods with thyamine

Question 6

Hypertensive Crisis

Answer 6

• Can be caused by foods with tyramine

FOODS TO AVOID
- Aged cheese
- Caviar
- Wine, Beer
- Raisins
- Chocolate/Colas
- Pickled Herring
- Coffee
- Yeast products
- Sour cream and yogurt
- Broad beans
- Smoked Meats
- Soy Sauce
- Beef/Chicken Liver
- Cold remedied
- Canned Figs
- Diet Pills

Question 7

SSRIs

Answer 7

• Never use with MAOIs
• Serotonin Syndrome can occur with concurrent use of other drugs that increases serotonin

Question 8

Serotonin Syndrome

Answer 8

Symptoms
- Agitation, restlessness, confusion
- Tachycardia, Increased BP
- Dilated Pupils
- Ataxia (affects coordination and balance)
- Apraxia (difficulty with certain muscle movements)
- Diaphoresis
- Diarrhea
- Shivering/Goosebumps

SEVERE
- High fever, seizures, irregular heartbeat, unconscious

Question 9

Education

Answer 9

• Continue to take medication even if symptoms have subsided
• Caution when driving due to dizziness
• Do not discontinue abruptly or withdrawal may occur (nausea, vertigo, insomnia, malaise, nightmares, return of symptoms prior to medication)

REPORT IMMEDIATELY
- Sore Throat
- Fever
- Yellow Skin
- Malaise
- Unusual Bleeding
- Easy Bruising
- Severe Headache
- Rapid HR
- Weight loss

EDUCATION
- Move slowly due to orthostatic hypotension
- Important to take sips of water or chew sugarless gum or candy for dry mouth and proper oral care.

Question 10

Pharmacogenetics