Affective Disorder Drugs Flashcards
Neurotropic hypothesis for depression
-BDNF is critical for regulation of neuroplasticity.
-Depression is associated with loss of neurotrophic support.
- antidepressants increase neurogenesis/connectivity
Monoamine hypothesis for depression
-Depression is related to deficiency in 5-HT, NE, and DA
-antidepressants increase these immediately.
-antidepressive effects delayed for weeks.
Integrated hypothesis of depression
Glutamine and monoamines stimulate BDNF production.
-increased cortisol to hippocampus and HPA Steroid abnormalities inhibit BDNF production.
-Monoamines inhibit effect of HPA steroid abnormalities.
hypothesis behind therapeutic lag
BDNF protein synthesis products takes 2 weeks or longer.
- some is pharmacokinetic in nature
-delayed postsynaptic changes
General function of the 6 classes of antidepressants
Increase noradrenergic or serotonergic neurotransmission.
SSRI Blackbox warning:
Association between antidepressant treatment and suicide. (motivation related)
Effects of SSRI/SNRI discontinuation syndrome, and how to avoid
significant withdrawal symptoms: Sleep disruption, GI, Affective symptoms, sexual sensitivity, confusion(cognitive), sensory, somatic, disequilibrium.
- avoid by tapering off dose.
Describe Serotonin Syndrome and Tx
Caused by anything that increases serotonin.
-Increased 5HT receptor activation
-increased NE release
-Thermogen, Tremor, Rigidity, increased BP, Increased HR
Tx: Mild- observe for 6hrs, benzodiazepines
Moderate- Hospitalize, Cardiac monitoring, Cyproheptadine
Life Threatening- Intensive Care, Esmolol, nitroprusside, cooling measures, ventilator.
Describe Steven Johnson Syndrome and Tx
Blisters, mucosal/epidermal detachment from full-thickness epidermal necrosis in absence of dermal inflammation. <10% surface area.
more is called SJS/TEN
Need early diagnosis and discontinuation of drug (i.e. TCAs). Need intensive supportive care.
Describe MAOIs and TCAs affect on adrenergic/dopaminergic signaling, and the side effects expected
TCA: alpha blocking effects, orthostatic hypotension, anticholinergic symptoms(dry mouth)
MAOIs food restrictions
Hypertensive Crisis with: tyromine containing foods:
Aged cheese/meat, banana peel, bean pods, marmite, sauerkraut, soy sause, draft beer.
Moderation of: wine, bottled/canned beer no more than two 12-oz
Why caution antidepressants in pt with bipolar disorder
induce switch to manic/hypomanic episode if monotherapy
SSRI Uses
Firstline Major depression and generalized anxiety.
Also for Panic disorder, PTSD, OCD, Social Anxiety, but all combined with behavioral therapy.
Fluoxetine and Sertraline for PMDD
Fluoxetine for Bulimia
(EFSPC)
SSRI Drugs Names
Effective For Sadness, Panic, Compulsions:
Escitalopram
Fluoxetine, Fluvoxamine
Sertraline
Paroxetine
Citalopram
SSRIs MOA etc.
MOA: Highly selective blockade of serotonin transporter (SERT)
AE: Sex dys
serotonin syndrome risk with MAOIs
GI (postpone procedures until tolerance)
Fluoxetine risk
prolongs duration of action of certain benzodiazepines leading to prolonged sedation
SNRI Drugs
Venlafaxine
Duloxetine
(vexed and depressed)
SNRI Uses
Major Depression and chronic pain disorders.
fibromyalgia, perimenopausal symptoms
Chronic joint and muscle pain, postherpetic neuralgia, chronic back pain
SNRI MOA etc.
MOA: Moderately selective blockade of SERT and NET
-Also adrenergic synaptic activity
AE: Anticholinergic, sedation, hypertension (venlafaxine)
Interactions: vasoconstrictors or tramadol may increase CV side effects.
5HT receptor modulator
Trazadone’s primary metabolite is a 5HT receptor antagonist.
Black box: hepatotox
AE: Modest alpha blockade (orthostatic hypotension)
and H1 blockade (sedation, weight gain, hypnosis)
Addon to SSRIs, for Major depression
(inferior to SSRI/SNRIs)
TRAZADONE for INSOMNIA (off-label)
TCA Drugs
Amitriptyline
Nortryptyline
(tryptylines)
TCA Uses
depression that is unresponsive to common commonly used antidepressants
(NOT commonly prescribed currently)
Overdose is lethal ( a weeks worth of doses at once)
-chronic pain
TCA MOA, etc.
MOA: Mixed and variable blockade of NET and SERT
AE: Significant blockade of autonomic Alpha receptors (anticholinergic) and Histamine receptors (Sedation, weight gain)
arrythmias
- worse withdrawals than SSRI/SNRIs
-cholinergic rebound
Tetracyclics, Unicyclics
Tetracyclic: Mirtazapine
Unicyclic: Bupropion
