Antidepressant Flashcards
Tricyclic antidepressant
Imi-pra-mine
Ami-tryp-tiline
Clome-pra-mine
Heterocyclic antidepressants
Amo-xa-pine
Bup-ro-pion
5-HT + NE reuptake inhibitors
Venlafaxine
فنيلا فاكسين
SSRI
Fluo-xetine
Paro-xitine
Citalopram
MAOI
موّ يحب جيلين
A. hydrazine (C - NN moity) eg phenelzine (not marked
B. Nonhydrazine Tranylcypromine Selegeline Pargeline Meclobemide
SSRI حجي
SSRIs are the first line therapy for any moderate to severe depression (any mild suppression will have non-pharmacological agents used first, such as increased exercise, increased socialising etc.), and examples include Fluoxetine, Citalopram, or Paroxetine. They 💋💋💋act by preventing the reuptake of serotonin by the presynaptic membrane, increasing the serotonin concentration in the synaptic cleft.
The drugs are almost completely absorbed from the gut, have long half lives, and are metabolised by the liver. The drugs are very safe in overdose.
SSRI 🤮🤮
The main common ADRs are anorexia, nausea, and diarrhoea, as well as rare ones of mania and extrapyramidal syndromes.
Tricyclic Antidepressants (TCAs)👾👾
blocking both the re-uptake of serotonin and noradrenaline at the presynaptic membrane
TCAs are absorbed by the gut, are lipid soluble, have long half lives, and are metabolised by the liver.
Tricyclic Antidepressants (TCAs)🤮🤮🤮🤮🤮🤮
TCAs affect multiple systems and cause multiple side-effects, so have limited clinical use. These range from
💥CNS (sedation and impaired psychomotor function),
💥 autonomic nervous system effects (reduced glandular secretions and eye accommodation block),
💥CVS (tachycardia, postural hypotension, and sudden cardiac death), and
💥GI (mainly constipation).
🤮🤮🤮🤮Serotonin-Noradrenaline Reuptake Inhibitors (SNRIs)
They have the same ADRs as the SSRIs, as well as sleep disturbances, increased BP, dry mouth, and hyponatraemia. They have a relatively short half life so may produce a withdrawal syndrome on discontinuation.
Erection dysfunction
The main drug used to treat bipolar disorder
lithium, yet sodium valproate and carbamazepine can also be used. Whilst lithium is used as both treatment and prophylaxis of bipolar disorder, it 🤮has serious ADRs of memory problems, thirst, polyuria, tremor, and acts as a nephrotoxin.
Treatment considerations in mood disorders
Treatment considerations 1. Is it primary (needs antidepressants + ECT) or secondary treat the cause, use anxiolytics, neuroleptics or MAOI)
- Is it bipolar (need mood stabilizers like Li or valproate)
- Is it schizoaffective (informed to careful unit to avoid suicide)
- Trial of treatment should span 4 - 6 wks if failed then replace with other
- Treatment duration should last 6 - 12 months
- Inform the patient about a triphasic response to achieve compliance
Unwanted effects of Antidepressants
Unwanted effects of Antidepressants
- ⬆️ NE, SHT -➡️in healthy person cause sedation, depressed thinking and mood modulation
- AntiAlphalR ➡️postural hypotension.
- ⬆️D (in MAOIs, buptopion and fluoxetine) may cause psychotic effects like paranoid, depressed thinking and aggitation,
- AntriM ➡️blurred vision, tachycardia, urine retention, constipation, dryness and hotness of skin
- Na ch, blocking = quinidine like action causes heart block and arrhythmias
Depression 💊
Moderate to sever= TCA
secondary= MAOIS,,SSSRI
Panic disorder 💊
Imipramine (TCA) ,alprazolam ( benzodiazepines), MAOIs
