Anti-Depressants Flashcards
Tricyclic: Tertiary Amines
Doxepine Imipramine Trimipramine Amitriptyline Clomipramine
*Low therapeutic index (lethal dose is close to therapeutic dose)
Tricyclic: Secondary Amines
Nortriptyline
Desipramine
Protriptyline
*Low therapeutic index (lethal dose is close to therapeutic dose)
Tetracyclic
Amoxapine
*Low therapeutic index (lethal dose is close to therapeutic dose)
MAOI: Classical
Phenelzine
Tranylcypromine
MAOI: Selective
Selegeline
SSRI
Fluvoxamine (Luvox) Paroxetine (Paxil) Sertraline (Zoloft) Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac)
Atypical
Bupropion
Trazadone
Mirtazapine
SNRI
Venlafaxine
Duloxetine
*work most rapidly
NRI
Reboxitine
Tricyclic: General side effects/Problems
Anticholinergic Antihistaminic Anti-alpha1 Sexual side effects Overdose and lethality (most associated w/ completed suicide)
SSRI: General Side Effects/Problems
Weight gain sexual side effects (40%) GI problems Drug interactions effects on sleep Serotonin syndrome Withdrawal/Serotonin discontinuation syndrome
Serotonin Syndrome
Build up of serotonin
agitation, confusion, dilated pupils, muscle twitching/loss of muscle coordination, diarrhea, heavy sweating, headache, shivering, goose bumps
high fever, seizure, unconsciousness, irregular heartbeat
Mimics NMS, but missing rigidity and antipsychotics
Serotonin Discontinuation syndrome
usually with high dosage, short acting SSRIs
poor sleep, jittery, nervous, flu-like
Doxepine
Tricyclic Tertiary Amine
antidepressant
blocks re-uptake of all NTs (NE, 5HT, DA). Blocks postsynaptic M1, A1, H1 receptors
Most anti-cholinergic of the TCAs
Imipramine
Tricyclic Tertiary Amine antidepressant, treats bedwetting blocks re-uptake of all NTs (NE, 5HT, DA). Blocks postsynaptic M1, A1, H1 receptors Fatal in overdose up to a month to take effect Reliable blood levels
Trimipramine
Tricyclic Tertiary Amine
antidepressant
blocks re-uptake of all NTs (NE, 5HT, DA). Blocks postsynaptic M1, A1, H1 receptors
Amitriptyline
Tricyclic Tertiary Amine antidepressant blocks re-uptake of all NTs (NE, 5HT, DA). Blocks postsynaptic M1, A1, H1 receptors Very sedating commonly used helpful w/ neurologic/non-specific pain
Clomipramine
Tricyclic Tertiary Amine
antidepressant
blocks re-uptake of all NTs (NE, 5HT, DA). Blocks postsynaptic M1, A1, H1 receptors
Most SSRI-like of TCAs
Nortriptyline
Tricyclic Secondary Amine
Antidepressant
Blocks re-uptake of all NTs (NE, 5HT, DA)
Blocks postsynaptic M1, A1, H1 receptors
Least anti-cholinergic of TCAs
Therapeutic window (not useful below or above a certain dose)
Least problem with hypotension (least anti-alpha 1)
Good for elderly
Reliable blood levels
Desipramine
Tricyclic Secondary Amine Antidepressant Blocks re-uptake of all NTs (NE, 5HT, DA) Blocks postsynaptic M1, A1, H1 receptors Least anticholinergic least anti-alpha 1 reliable blood levels
Protriptyline
Tricyclic Secondary Amine
Antidepressant
Blocks re-uptake of all NTs (NE, 5HT, DA)
Blocks postsynaptic M1, A1, H1 receptors
Amoxapine
Tetracyclic antidepressant, antipsychotic Blocks re-uptake of all NTs (NE, 5HT, DA) Blocks postsynaptic M1, A1, H1 receptors Also blocks postsynaptic D2 receptor Risk of EPS, TD, NMS May cause gynecomastia Low therapeutic index (lethal dose is close to therapeutic dose)
Phenelzine
Classical MAO Inhibitor Antidepressant Irreversible inhibition of MAO-A and MAO-B(A is for serotonin, B is for dopamine) Can block Alpha-1 receptors Hypotension (Alpha-1 block) anticholinergic Weight gain Avoid meals w/ tyramine Serotonin syndrome Hypertensive crisis (BP >200) sexual dysfunction
Tranylcypromine
Classical MAO Inhibitor Antidepressant Irreversible inhibition of MAO-A and MAO-B(A is for serotonin, B is for dopamine) Can block Alpha-1 receptors Hypotension (Alpha-1 block) anticholinergic Weight gain Avoid meals w/ tyramine Serotonin syndrome Hypertensive crisis (BP >200) sexual dysfunction
Selegiline
Selective MAO Inhibitor
Antidepressant
Selective inhibition for MAO-B (degrades dopamine)
Does not run the risk of serotonin syndrome or hypertensive crisis, unless there is a drug-drug interaction that causes loss of selectivity for MAO-B (some contraceptives)
Fluvoxamine (Luvox)
1/2 life = 17 hours (shortest of SSRIs)
Antidepressant, first med approved for OCD
Blocks re-uptake of serotonin
blocks phase one metabolism of other drugs (leads to toxicity)
Worst Rx-Rx interactions
Headaches and migraines
Paroxetine (Paxil)
1/2 life = 21 hours Antidepressant Blocks re-uptake of serotonin blocks phase one metabolism of other drugs (leads to toxicity) Some sedation (anti-H1) significant weight gain most anticholinergic increased risk of EPS with Antipsychotics not lethal in overdose
Sertraline (Zoloft)
Antidepressant Blocks re-uptake of serotonin blocks phase one metabolism of other drugs (leads to toxicity) GI problems not much drug interaction
Citalopram (Celexa)
Antidepressant Blocks re-uptake of serotonin blocks phase one metabolism of other drugs (leads to toxicity) least amount of drug interactions little/no weight gain
Escitalopram (Lexapro)
Antidepressant
Blocks re-uptake of serotonin
blocks phase one metabolism of other drugs (leads to toxicity)
Most potent portion of citalopram molecule
Fluoxetine (Prozac)
1/2 life > 70 hours Antidepressant Blocks re-uptake of serotonin blocks phase one metabolism of other drugs (leads to toxicity) no weight gain (some weight loss) Most activating (give in the morning) May boost anxiety May prevent 5HT discontinuation syndrome
Bupropion
Atypical Antidepressant, anxiolytic, aid to smoking cessation, ADHD Blocks re-uptake of NE and dopamine RIsk of psychosis risk of seizures in people with eating disorders some drug interactions no weight gain no sexual side effects
Trazodone
Atypical Antidepressant, hypnotic Blocks re-uptake of NE and dopamine major anti-histaminic heavily sedating priapism not addictive
Mirtazapine
Atypical Antidepressant heavily anti-histaminic (sedation and weight gain) No sexual side effects slight risk of agranulocytosis (0.3%)
Venlafaxine
SNRI
antidepressant
blocks re-uptake of NE (mostly), 5HT and DA
Hypertension (6-13%) because of NE re-uptake blockage
short 1/2 life
serotonin discontinuation syndrome
Duloxetine
SNRI Antidepressant Blocks re-uptake of NE and 5HT little weight gain short 1/2 life
Reboxitine
Antidepressant
blocks re-uptake of NE
Tricyclics With Reliable Blood Levels
Desipramine
Imipramine
Nortriptyline
