Antidepressant and Antimanic Drugs, Unit IV

Question 1

TCADs (major representatives and important info)

Answer 1

[Amitriptyline, imipramine, desipramine]

• Block MA reuptake
• Sedation (A>D), Antimuscarinic effects (A>D), Sudden death from cardiac causes and sz in overdose
• Useful in neuropathic chronic pain
• Don’t mix with closed-angle glaucoma
• Amitryptaline has strong sedative and antimuscarinic action, fairly nonspecific for SERT or NET
• Imipramine is slightly weaker on both counts, fairly nonspecific for SERT or NET
• Desipramine is weakest on both counts, NET specific

Question 2

SSRIs (major representatives and important info)

Answer 2

[Fluoxetine, paroxetine, sertraline]

• Block MA reuptake
• All have a mild sedative action
• Cause naus/diah, insomnia, dry mouth
• Later, weight gain, sexual dysfunction, cognitive blunting
• MAOIs+SSRIs- Serotonin Syndrome
• Inhibition of P450
• Can cause hypomania in bipolar

Question 3

NDRI (major representatives and important info)

Answer 3

[Bupropion]

• Block MA reuptake
• NET and DAT selective
• Causes anxiety and sz at high doses

Question 4

SNRI (major representatives and important info)

Answer 4

[Venlafaxine]

• Block MA reuptake
• Fairly nonspecific for SERT or NET

Question 5

Mixed Serotonin Reuptake Blocker/ Receptor Antagonist

Answer 5

[Trazodone]

• Block MA reuptake
• Serious sedative problem

Question 6

Alpha-2-adrenergic Agonist

Answer 6

[Mirtazapine]

• Inhibit presynaptic autoreceptor on NE neurons
• Kill feedback, increase signalling
• Serious sedative problem

Question 7

MAOIs

Answer 7

[Phenelzine]

• Block degradation, cause presynaptic accumulation, cause chronic compensatory shanges
• Postural hypotension, sz, shock, hyperthermia
• Hypertensive crisis with some drugs or foods
• MAOIs+SSRIs- Serotonin Syndrome

Question 8

Lithium

Answer 8

• Antimanic Agent
• Thought to effect 2nd messengers at the membrane and G-proteins
• Good maintenance treatment, often used in combo
• Diuretics, NSAIDs can LOWER renal clearance
• Narrow therapeutic index
• Don’t have too much salt with lithium
• Tremor, loss of sex drive, polyuria, polydipsia

Question 9

Olanzapine-Fluoxetine

Answer 9

-Antimanic Agent