Anti-Depressants Flashcards
Inhibits SERT increases concentration of 5HT at synaptic membrane
SSRIs
1st line agents for depression, GAD, OCD and Bulemia
SSRIs
SSRIs (4)
Fluoxetine
Paroxetine
Sertraline
Citalopram
Short acting SSRIs with discontinuation syndrome (flu like dizziness, fatigue, nausea 1-2d)
Paroxetine
Sertraline
SSRI SE (5)
Hyponatremia Inc SIADH Dec sexual dysfunction Weight gain Drowsiness Insomnia
Inhibits presynaptic reuptake of NE and 5HT
SNRIs
Apart from GAD, MDD, PTSD this relieves pain disorders
SNRIs
SNRI examples (2)
Venlafaxine
Duloxetine
Used for diabetic neuropathy
Venlafaxine
Used for chronic, neuropathic pain, OA, LBP
Duloxetine
Notorious AE of SNRI (also similar with SSRI) because of noradrenergic activity
May cause HTN and HR
SSRI and SNRIs take how long to take effect
1-2 months
Wait for how long before dismissing as inadequate treatment response
8-12 w
AE of SSRIs ans SNRIs toxicity
Serotonin Syndrome
Serotonin syndrome sx (5)
Autonomic instability Agitation Hyperkalemia Hyperreflexia Clonus
Neuroleptic Malignant Syndrome (2) by dopamine blocking agents
Hyporeflexia
Rigidity
Serotonin syndrome antidote
Cryoheptadine
Blocks NET and SERT at the presynaptic membrane during reuptake
TCA
2nd or 3rd line drug for MDD if unresponsive to others
TCAs
TCAs (5)
Imipramine Desipramine Clomipramine Amitryptiline Nortryptiline
Amine with less anticholinergic effect (2)
Desipiramine
Nortryptiline
Tx for OCD
Clomipramine
Tx for migraine with most potent anticholinergic effect
Amitryptiline
TCA use (3)
Depression resistant to tx
Migraine prevention
Pain disorder
TCA SE (4)
Sexual dysfunction
Anticholinergic property
Cardiotoxicity (depressant)
Weight gain (antihistamine)
Ventricular arrhythmia (torsade, widened QRS) from TCA antidote
Na bicarbonate
TCA poison:
Seizure antagonist
Increases transmission of norepinephrine, serotonin and dopamine
MOA Inhibitors
MAO Inhibitors MOA (2)
MAO A - deaminates serotonin, NE and dopamine
MAO B - demaminates dopamine preferentially
MAOIs are especially used for depression with (2):
1 hyperphagia
2 hypersomnia
MAOI examples (4)
Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline
Non selective, irreversible MAOI
Tranylcypromine
Phenelzine
Isocarboxazid
Selective inhibtor of MAO B useful in PD
Selegiline
Discontinue SSRIs and SNRIs at least weeks before giving MAOI
2 week wash off period
MAO I SE (3)
orthostatic hypotension
weight gain
Most sexually debillitating
MAOIs should not be taken with rich food
tyramine
Tyramine interacts with MAOIs by
MAOIs prevent metabolism of tyramine increasing risk for sympathomimetic effects
Antidote HTN induced by tyramine toxicity
Phentolamine
Phentolamine MOA
alpha 1 and 2 block
Used for MDD resistant with first and second lines
Atypical antidepressant
inhibits reuptake of Norepinephrine and Dopamine has no effect on serotonin but has CNS activating effect
Bupropion
User in depression with hypersomnolence, low energy and in tobacco dependence
Nicotine dependence and withdrawal symptoms
Bupropion
Bupropion has no SE
sexual dysfunction
weight gain
Bupropion is CI in
Bulemics
Bupropion SE
seizure
a2 blocker in presynaptic membrane used in depression with insomnia
post synaptic serotonin blocking activity
antihistamine activity
Inc noradrenergic and serotonergic neurotransmission
Mirtazipine
Mirtazipine can cause this se because of serotonin receptor 2, 3 blockade
weight gain
Antagonist at serotonin 5HT2A post synaptic receptor and weakly inhibits serotonin reuptake
Antagonist at H1
Antagonist at a1 postsynaptic
Trazodone
Nefazodone
May cause priapism due to vasodilatory effect
Mirtazipine
Persistent erection of >4 hours not associated with sexual dysfunction
Priapism
Trazodone should be used cautiously in patients with (2)
Sickle cell disease
Multiple myeloma
Trazodone specifically blocks the
5ht2A receptor
Inhibits recycling of neuronal membrane inositol lipids (activation of PLC to IP3 and DAG)
Inhibits inositol phosphatase enzymes that regenerates PIP2
Inhibits glycogen synthase kinase 3 (GSK3) mimicking Wnt pathway (inhibits axon remodelling, synapse formation and neurogenesis)
For depression and bipolar disorder
Narrow therapeutic index
Mood stabilizer
Lithium
Activation of GSK 3 is associated with
Bipolar disorder