Anti-Depressants Flashcards
What are the indications for anti-depressants
Unipolar and bipolar depression Organic mood disorders Schizoaffective disorder Anxiety disorders including OCD Panic Social phobia PTSD
What are the different classifications of antidepressants
SSRIs SNRIs TCA Monoamine Oxidase Inhibitors (MAOIs) Novel antidepressants
What is generally the first line antidepressant class used
SSRI
Action of SSRIs
Block pre-synaptic serotonin reuptake
Most common SE of SSRIs
GI upset Sexual dysfunction Anxiety Restlessness Sedation
Name 3 types of SRRIs
Sertraline
Fluoxetine
Citalopram
Paroxetine
What is the action of SNRIs
Inhibit both serotonin and noradrenergic reuptake like the TCAS but without the antihistamine, antiadrenergic or anticholinergic side effects
Which antidepressant is no longer recommended 1st line
TCAs
What is the major issue with TCAs
They are lethal in overdose
Which 2 types of anti-depressants are rarely used nowadays and if they are it is in secondary care
Monoamine Oxidase Inhibitors
TCAs
What can TCAs be very good to treat
Neuropathic pain
What is generally 2nd line treatment for depression
Try another SSRI
Then SNRI
Prophylaxis with antidepressants after 1 episode
Continue for 6mnths-1yr
Prophylaxis with antidepressants after 2 episodes
Continue for 2yrs
Prophylaxis with anti-depressants after 3 episodes
Discuss lifelong
Rx for treatment resistance depression
Combination of antidepressants e.g SSRI or SNRi with Mirtazepine
Adjunctive treatment with Lithium
Adjunctive treatment with atypical antipsychotic eg Quetipaine, Olanzapine or Aripiprazole
ECT!!
What does ECT stand for
Electroconvulsive therapy
What are the 2 novel antidepressant drugs
Mirtazapine
Buproprion
What class of drug is amitryptiline
TCA
Pros of Sertraline
Weak P450 interactions
Short half-life (low build up)
Less sedating than paroxetine
Cons of Sertraline
Max. absorption requires a full stomach
no. GI side adverse reactions
Pros of paroxetine
Short half life
No build up
Sedating properties offers relief from insomnia and anxiety
Cons of paroxetine
Sedating
Weight gain
Likely cause of discontinuation syndrome
Which patients is fluoxetine not good for
Patients with hepatic illness
Give 2 drug examples of SNRIs
Venlafaxine
Duloxetine
Pros of venlafaxine (SNRI)
Minimal drug interactions Almost no P450 activity Short ½ life Fast renal clearance Avoids build up
Cons of venlafaxine
Can cause increased in diastolic BP
Can cause bad discontinuation syndrome
Sexual side effects >30%
Pros of duloxetine (SNRI)
Some data to suggest efficacy for physical depression symptoms of depression
Cons of duloxetine (SNRI)
Strong inhibtors:
CYP2D^ and CYP1A2
Higher dorp out rate
Drug examples of monoamine oxidase inhibitors
Tranylcypromine
Phenelzine
Isocarboxazid
What is the cheese reaction
Hypertensive crisis can develop when monoamine oxidase inhibitor is taken with tyramine rich foods or sympathomimetics
Action of monoamine oxidase inhibitors
Bind irreversible to monoamine oxidase thereby preventing inactivation of amines such as
Norepinephrine
Dopamine
Serotonin
Leading to increased synaptic levels
Side effects of monoamine oxidase inhibitors
Orthostatic hypotension Weight gain Dry mouth Sedation Sexual dysfunction Sleep disturbance
What are the cons of TCAs
Lethal in overdose
Can cause QT lengthening syndromes
potentially unacceptable side effect profile:
Antihistaminic
Anticholinergic
Antiadrenergic
Which has the most effect on BP Venlafaxine or Duloxetine
Venlafaxine
Action of mirtazapine (novel)
5HT2 and 5HT3 receptor antagonist
What else is Buproprion (novel) used to treat
2nd line agents for ADHD
cons of bupropion (novel)
May increase seizure risk at high doses Avoid in: Brain injury Bulimia Anorexia
Does not treat anxiety
Drugs examples of tertiary TCAs
Amitriptyline
Doxepin
Clomipramine
Drug examples of secondary TCAs
Desipramine
Nortriptyline
