Anti-depressants Flashcards
For mild to moderate depression, what is the clinical indication
Drugs do not show clinical improvement in studies, yet some patients will report improvement within a day or two, others they take weeks and weeks
What event do all antidepressants increase the likelihood of
all antidepressants lower the seizure threshold, especially when combined with alcohol; increase in suicidal thinking and/or behavior
when would a tricyclic antidepressant be indicated
When the patient also has a hard time falling and/or staying asleep (insomnia)
Which antidepressant class has the most severe side effects
MAOI monoamine oxidase inhibitor
What dietary restrictions come with MAOI drugs
No high tyramine foods: raisins, aged cheeses and meats, red wine, many soy products
What happens if a person on an MAOI eats tyramine containing foods
potentially toxic elevation of catecholamine levels, resulting in severe headaches, nausea and hypertension.
Hypertensive emergencies and fatal accelerated hypertension have been reported
What is the MOA of tricyclic antidepressants (TCA)
Diminishing the reuptake of monoamine neurotransmitters is clearly one of the chief effects. Subsequent down regulation of postsynaptic receptors may be the true mechanism of action
What are the indications for TCA
obsessive compulsive disorders, enuresis, panic attacks, chronic pain and migraine headaches as well as depression
What are side effects of TCA
anti-cholinergic signs and symptoms such as dry mouth, constipation, urinary hesitancy, orthostatic hypotension and sedation
What side effect of TCA is of note for men
it causes constriction of the bladder neck, important if the man has BPH
What drug class is amitriptyline (Elavil)
tricyclic antidepressant (TCA
What are the indications of amitriptyline
major depression, bipolar disorder, migraine and tension headaches, chronic pain
What is the MOA of SSRIs
blockade of serotonin reuptake at the pre-synaptic terminal which results in the subsequent increased level of serotonin available for further neurotransmission
What are common side effects of SSRIs
increased number of bowel movements, dizziness, HA, fatigue, anxiety, insomnia, impotence, weight gain, nausea
What drug class is fluoxetine (prozac)
SSRI
What are the indications for fluoxetine (prozac)
Major depressive disorder, obsessive compulsive disorder, bulimia and panic disorder
What are symptoms of serotonin syndrome
fever, agitation, diarrhea, elevated BP
What drug class is Duloxetine (cymbalta)
serotonine and norepinephrine reuptake inhibitor (SNRI)
What are the indications for duloxetine (cymbalta)
neurogenic pain, fibromyalgia, GAD, painful peripheral neuropathy
What comorbidity indicates prescription of a tri- or tetra-cyclic antidepressant
insomnia
what drug class is trazodone (Desyrel)
tetracyclic antidepressant
What are the indications for trazodone (desyrel)
Panic disorder, anxiety, insomnia, MDD
What are the side effects of trazodone (desyrel)
sedation, orthostatic hypotension, fatigue, cardiac dysrhythmia, mania in a bipolar patient
What drug class is bupropion (wellbutrin)
norepinephrine and dopamine reuptake inhibitor (NDRI) and nicotine receptor agonist
What are the indications for bupropion (wellbutrin)
major depression, smoking cessation, bipolar, ADD
What are some side effects of bupropion
weight loss, Headache, insomnia, dry mouth, tremors, restlessness, agitation, anxiety, sweating and dizziness
What nutrient deficiency is correlated with depression
folate (folic acid) because it is essential for neurotransmitter production
