Antidepressant drugs review article Flashcards
Antidepressants are not first-line treatment options for
- Short duration or sub-threshold depression
2. depression in children or adolescents.
If there is no response to the antidepressant of choice in ______ to _____ weeks, a change in dose or drug is warranted.
4-6.
All current antidepressants function how?
Increase the transmission of one or more of the monoamines: serotonin, NA or dopamine.
How do the MAOIs differ in function to most other current antidepressants?
Most others (SSRIs, TCAS, SNRIs, NRIs and NDRIS) inhibit the transporter responsible for re-uptake of the monoamines.
MAOIs block the mitochondrial enzyme monoamine oxidase, which in turn reduces the breakdown of serotonin, noradrenaline and dopamine.
What is mirtazapine?
Presynaptic alpha -2- adrenoreceptor antagonist that increases noradrenaline and serotonin transmission by reducing the action of the alpha - 2 - adrenoreceptor negative feedback pathway.
How does Agomelatine work?
It is an agonist at melatonin type 1 and 2 receptors and 5-HT2c antagonist.
The effect on melatonin is thought to improve sircadian rhythm and sleep quality while the 5-HT2c blockade increases both noradrenaline and dopamine release.
In the absence of any negative indicators, what are the treatment class of choice?
SSRIs.
Fluoxetine has longest half-life and is associated with a lower risk of discontinuation symptoms.
Paroxetine has the shortest half-life and is associated with a higher incidence of discontinuation symptoms.
There is no evidence to support a dose related response in depression with any SSRI except escitalopram.
Switching between antidepressants can be problematic, especially when changing from fluoxetine or an MAOI to another serotonergic drug. Should refer to Maudsley Prescribing Guidelines.
Which SSRI has the longest half-life and lowest incidence of discontinuation symptoms?
Fluoxetine
What SSRI has the shortest half-life and the highest incidence of discontinuation symptoms?
Paroxetine
Escitalopram is the only SSRI for which there exists evidence supporting
A dose related response in the treatment of depression.
what guidelines should be referred to when switching between antidepressants?
Maudsley Prescribing Guidelines.
Quetiapine (in the extended release form) is licensed as an add-on treatment to antidepressants in what patient group?
Those who have not responded to antidepressant monotherapy.
Quetiapine can cause what side effects?
Sedation
Weight gain
Hypotension
Emerging diabetes
SSRIs are associated with an increased risk of what?
Bleeding. Consider prescribing a GI protective drug in older people who are ALSO taking NSAIDs or aspirin.
Does NICE recommend the use of Agomelatine in the treatment of major depressive episodes?
Unable to make a recommendation as no evidence submitted by manufacturer.
