Anti depressants Flashcards
amine hypothesis of depression
1) reserpine: depletes NE, 5HT, DA and causes severe depression
2) acute mech of antidepressants: increase NE and 5HT
3) biological lag: 4-6 wks
neurotrophic hypothesis
BDNF needed for neuron survival and growth
BDNF found in CSF is decreased in depression
CREB, sprouts help neuron connection
neuroendocrine factors
steroid and corticotropin - reloading hormone levels are increased in depression
thyroid dysregulation
estrogen def
selective blockade of 5HT reuptake
no anti M, H1, alpha1 receptor
SSRIs
SSRIs
fluoxetine paroxetine - teratogenic sertraline citalopram fluvoxamine escitalopram
used: DOC for MDD, OCD, bulimia, anxiety, PMDD
SSRIs
toxicity - serotonin syndrome
potent inhibitors of hepatic microsomal oxidases p450
SSRIs
sweating, rigidity, myoclonus, hyperthermia, ANS stability, seizures
serotonin syndrome SE
TCAs
amitriptyline
imipramine
clomipramine
nonspecific blockade of 5HT and NE reuptake
TCAs
used: MDD, phobic and panic anxiety states, OCDs (clomipramine), neuropathic pain, enuresis (imipramine)
TCAs
toxicity the 3 Cs of TCAs
coma
convulsions
cardiotoxicity
hypertensive crisis with MAOI
serotonin syndrome
prevent antihypertensive action of A2 and guanethidine
drug interactions of TCAs
SE of TCAs
A1 histamine blockade anti cholinergic seizures Heart - quinidine - like actions: QRS widen, QT prolong, arrhythmias
BPH, narrow angle glaucoma, recent MI, HB and epilepsy
CI of TCAs
MAOI
phenelzineu
tranylcypromine
selegiline
moclobemide
irreversible inhibition of MAO A and MAO B
MAOI
used for atypical depression
MAOI
tx for serotonin syndrome
stop current drug
cyproheptadine - 5HT2A antagonist
BZD agitation
weight gain restlessness insomnia hepatotoxicity orthostatic hypotension HTN
SE of MAOIs
for anti dep: breaks down 5HT, NE, DA
inhibit MAO - A
anti Parkinsonism: breaks down DA
inhibit MAO -B
drug interactions
1) cheese rxn
2) hypertension crisis
3) serotonin syndrome
DI of MAOI
tx for hypertensive crisis
due to increase NE
tx with phentolamine, phenoxybenzoamine, label
serotonin reuptake and 5HT2 antagonist and blocks A1 and histamine
extremely sedating and tx insomnia
assoc with cardiac arrhythmias and priapism (painful penile excretion)
trazodone
DA and NE reuptake blocker
used in smoking cessation
increase risk of seizures
bupropion
A2 and 5HT2 antagonist
used as sedative
SE: weight gain
mirtazapine
serotonin and NE reuptake inhibitor and 5HT2 antagonist
SE: liver damage, orthostatic hypotension
nefazodone
partial agonist of nicotinic receptors and is used in smoking cessation (DOC)
varenicline
can boost monoamines
cocaine
SNRIs
venlafaxine
duloxetine
serotonin and NE reuptake inhibitors
Used: MDD, chronic pain (Dul), fibromyalgia (milnacipran), perimenopausal sx
SNRIs
fxn as TCA
block NE reuptake & D2 receptor
used as antipsychotic - parkinsonian syndrome
amoxapine
