Anti-depressive Drugs (PSYCH) Flashcards
How long for anti-depressives to exert there effect?
6-8 weeks
For what % of people are anti-depressive effective?
60-70%
First generation anti-D drugs are
TCA and MAO-I
2nd generation anti-D drugs are
SSRI, SNRI
Name 6 big classes of anti-D
- Serotonin receptors targets
- NE receptor targets
- Dopamine receptor targets
- All receptor blockers
- Dual receptor blockers (serotonin & NE)
- Benzodiazepines
SSRI
Main Agent Other agents Mechanism Drug Interactions Black box warning or Major concern Side Effects
Main Agent
Citalopram
Other agents escitalopram fluoxetine paroxetine fluvoxamine
Mechanism
SSRI
Drug Interactions
Inc. MAO-I
Inc. TCA
Black box warning or Major concern
Sucidal ideation
Side Effects Activation of sympathetics GI distress Decreased sexaul desire Poor sleep Mania Na changes
SNRI
Main Agent Other agents Mechanism Drug Interactions Black box warning or Major concern Side Effects
Main agent
Venlafaxine
Others
Desvenlafaxine
Duloxetine
Mechanism
Selective NE reuptake inhibitor
(SNRI)
Drug Interactions
Inc. MAO-I
Inc. TCA
Black box warning or Major concern
Sucidal ideation
Side Effects RAISES BLOOD PRESSURE Activation of sympathetic GI distress Decreased sexual desire Poor sleep Mania Na changes
Serotonin
SNRI -TCA
Main Agent Other agents Mechanism Drug Interactions Black box warning or Major concern Side Effects
Main Agent
Nortriptyline
Other Agents
Imipramine Amitriptyline
Desipramine
Mechanism
Amitriptyline is a tertiary amine and is metabolized to a 2ndary tricyclic amine (TCA) , Nortriptyline, which inhibits NE reuptake
TCAs that are not metabolized have greater serotonergic rather than NE effects
BB Warning
Lethal overdose
Side Effects DECREASE BP • Weight gain • Sedation • Ach • Hypotension • Arrhythmia • Sexual • Sweating
NDRI
Main Agent
Mechanism
Black box warning or Major concern
Side Effects
Main Agent
Bupropion
Mechanism
Blocks reuptake of NE & DE
Blocks NN – smoking cessation
Does not affect serotonin
No sexual side effects
Less likely to cause mania
Can reduce sexual side effects of other anti-depressants
Black box warning or Major concern
Avoid in patients with seizure or eating disorders
Side Effects • Insomnia • Tremor • Tinnitus • Seizures
MAO-I
Main Agent
Other agents
Black box warning or Major concern
Side Effects
Main Agent
Phenelzine
Other agents
Tranylcipramine
Black box warning or Major concern
Since this drug kills all monoamine receptors when switching from another antidepressant to MAO-I either
• Wait to weeks for the other drug to be completely cleared or
• Allow MAO enzyme to be replenished
Side Effects Serotonin Syndrome • Careful when given with an SSRI • MS changes • Autonomic instability • Neuromuscular • Meperidine (opiate) lead to famous case with Libby Zion
HTN Crisis
• Tyramine effect
Dual Reuptake Inhibitors (5HT & NE) NaSSA
Main Agent
Mechanism
Drug Interactions
Side Effects
Main Agent
Mirtazapine
Mechanism
• Dual Reuptake Inhibitors of 5HT and NE
• Alpha-2 agonist blocker
• Histamine receptor blocker
Drug Interactions
DO NOT COMBINE WITH MAO-I
Side Effects
• Weight gain
• Sedation
• Low sexual desire
Dual Reuptake Inhibitors (5HT & NE) SARIs
Main Agent
Mechanism
Main Agent
Nefazodone
Trazodone
Mechanism • Dual Reuptake Inhibitors of 5HT and NE • Serotonin receptor & reuptake blocker • Alpha-1 receptor blocker • Histamine receptor blocker
Diazepam Main Agent Mechanism Uses other than depression Drug Interactions Side Effects
Main Agent
Diazepam (valium)
Mechanism
Safer than barbiturates because they cannot activate GABA receptors on their own because are only + allosteric modulators
REVERSE ACTION WITH FLUMAZENIL
Hepatic clearance
Other Uses Sedative Anxiolytic Seizure control Muscle relaxant Anterograde amnesia (anesthetic)
Drug Interactions
CNS depressants
Opiates
Cimetidine
Side Effects • Sedation • Depression • Amnesia • Ataxia • Dependence • Withdrawal
Which 2 Anti-D drug classes increase MAO-I and TCA
SSRI - Citalopram
SNRI - Venlafaxine
Which Anti-D drug class increase MAO-I, tramaldol and TCA
TCA-SNRI - Nortrypytyline
