Anti-Depressants/Mania

Question 1

Desipramine (Norpramin), Imipramine (Tofranil)

Answer 1

• Tricyclic antidepressant (TCA)
• Blocks reuptake of NE selectively

Adverse effects:

• Blocks muscarinic receptor- 50% experience dry mouth and tachycardia. Takes 2-3 wks. Acute confusional state, constipation, glaucoma
• Weight gain (histamine receptor block)
• Orthostatic hypotension (block alpha 1 receptor)
• Low therapeutic index, don’t give more than one week supply (can commit suicide with this)

Interactions

• Potentiates central depressants
• Increases inactivation of levodopa!

Question 2

Phenelzine (Nardil)

Answer 2

• MAO inhibitor (1st drugs to treat depression)
• IRREVERSIBLY blocks the oxidative deamination of monoamines (e.g. NE & 5-HT)
• Very low therapeutic index, toxicity need to hospitalize for 1 week due to loss of MAO, treat symptomatically

Interactions: Potentiates sympathomimetic amines, results in circulating TYRAMINE with certain foods (increases NE and 5HT);can result in hypertensive disaster

Question 3

Fluoxetine (Prozac); Sertraline (Zoloft); Citalopram (Celexa); Escitalopram (Lexapro)

Answer 3

-Selective Serotonin Reuptake Inhibitors (SSRIs)
-Only prevent reuptake 5HT. 7 types of receptors; 5HT2A receptor appears to be responsible for clinical improvement
-Large therapeutic index, chance of being able to commit suicide with pills is very small.
Adverse Effects:
-Weight loss, nausea, diarrhea, anxiety, nervousness, sexual dysfunction, non-sedating

*DO NOT USE ALONE IN BIPOLAR DISORDER, need to include a mood stabilizer

Question 4

Venlafaxine (Effecor, Effexor XR)

Answer 4

• Atypical (Dual/Mixed Action) antidepressants
• Selective serotonin and norepinephrine reuptake inhibitor (SNRI)
• Does not affect adrenergic, histaminergic, or cholinergic receptors
• Raising the dose causes increased serotonin, norepinephrine, dopamine, respectively.

Question 5

Desvenlafaxine (Pristiq)

Answer 5

• Active metabolite of venlafaxine

- No evidence it is more effective than venlafaxine, maybe less interactions

Question 6

Lithium carbonate (Eskalith)

Answer 6

• Treats bipolar disorder
• Clinical effect in 5-21 days (does nothing in normal subjects)
• Mechanism not known
• Competes with sodium for reabsorption, thus sodium deficiency (low sodium diet, diuretics) increases lithium toxicity (body mistakes lithium for sodium and sequesters it)

Adverse effects:

• fatigue, muscular weakness, slurred speech, ataxia, fine tremor of the hands
• Blocks ADH, nephrogenic diabetes insipidus

Question 7

Valproic Acid (Depakote, Depakene)

Answer 7

• Anticonvulsants for bipolar disorder
• Good for non-rapid cycling bipolar disorder
• Superior to lithium for rapid cycling bipolar disorder
• Work better for acute manic episodes than for long-term management of bipolar disorder

Question 8

Carbamezepine (Tegretol)

Answer 8

-Anticonvulsants approved by the FDA for prophylaxis of bipolar disorder

Question 9

Quetiapine (Seroquel)

Answer 9

• Atypical antipsychotic
• Good for mood stabilizers in bipolar disorder
• Blocks 5-HT2A subtype

Question 10

Lurasidone (Latuda)

Answer 10

• Atypical antipsychotic
• Approved to treat BIPOLAR DEPRESSION in 2013
• D2 and 5HT2A receptor antagonism seems to be involved, mechanism not known.
• Doesn’t cause light switch to go in bipolar disorder like the SSRIs