Antidepressant Meds Flashcards
Antidepressants – How they work
•Restore neurotransmitters while client learns coping •May have other indications: –Anxiety/ Anxiety disorders –Chronic pain –Eating disorders •Affects: –Serotonin (5-HT2) –Norepinephrine
Norephinephrine affects…
Alertness
energy
Serotonin affects…
Obsessions and compulsions
Dopamine affects…
Attention
Motivation
Pleasure
Reward
Antidepressant categories
• Selective Serotonin Reuptake Inhibitors
(SSRI’s)
• Selective Serotonin-Norepinephrine
Reuptake Inhibitors (SSNRI’s) OR… Nonselective
Reuptake Inhibitors
• Heterocyclic Antidepressants (tricyclics –
TCA’s)
• Monamine Oxidase Inhibitors (MAOI’s)
• Miscellaneous Antidepressants
Facts common to most antidepressants
• Take 1- 6 weeks to improve mood, although serotonin levels rise sooner • 30% clients need different drug • “First break” treatment 6 – 12 months • Some clients need longer treatment
Adverse effects common to most
antidepressants
- Anticholinergic effects
- Weight gain
- Sexual side effects
Antidepressants main facts
• No addiction
• Withdrawal effects may occur
• Clients at greater risk for suicide when they
begin to have more energy!
• ***ALL now have black box warning: watch for
extreme personality changes leading to
suicide!!!!
SSRI Examples
- Fluoxetine (Prozac, Sarafem)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
SSRI Main Facts
First line therapy for depression
• Useful for anxiety, eating disorders, OCD
• Less side effects than older antidepressants
• Watch “washout” for Prozac
• *SSRI discontinuation syndrome – flu-like
symptoms, vivid dreams, agitation
SSRI s/e’s
- Insomnia/ somnolence
- Anxiety/ agitation/ restlessness
- Nausea
Serotonin main facts
• Potentially life-threatening • Related to serotonin overdose • Other medications contribute: – MAOI’s – St. John’s Wort – Lithium No lab test, just supportive treatment
Serotonin Syndrome Symptoms clinical
triad:
• Cognitive: mental confusion, hypomania, hallucinations, agitation, headache, coma. • Autonomic: shivering, sweating, fever, hypertension, tachycardia, nausea, diarrhea. • Somatic : myoclonus/clonus (muscle twitching), hyperreflexia, tremor.
SSNRI/NSRI Examples
- Serotonin & Norepinephrine
- Venlafaxine (Effexor)
- Nefazodone (Serzone)
- Duloxetine (Cymbalta)
SSNRI/NSRI Main facts
• Less weight gain • Less sexual dysfunction • May be more anxiolytic (also may produce anxiety) • May increase BP • Serzone: liver failure • Cymbalta: treat fibromyalgia
Heterocyclics/TCAs main facts
- Oldest class
- Effective 70% of time
- Also inhibit NE & 5-HT2 reuptake
- Start low, go slow
- 4 – 8 weeks before full effect
- Also for chronic pain
Heterocyclics/TCAs examples
– Amitriptyline (Elavil)
– Clomipramine (Anafranil)
– Imipramine (Tofranil)
Heterocyclics/TCAs adverse effects
• **Anticholinergic effects – review them!!! • Other: – Photosensitivity – Decreased seizure threshold • OVERDOSE DANGEROUS!
Monamine Oxidase Inhibitors (MAOI’s) main facts
• Inhibit monamine oxidase, enzyme that
breaks down NE & 5-HT2
• Effective
• Not used often 2nd interactions
MAOIs examples
– phenelzine (Nardil)
– Isocarboxazid (Marplan)
– tranylcyromine (Parnate)
MAOI s/e’s
- Orthostatic hypotension
- Edema
- Constipation
- Hypomania
- Insomnia
- Usual s/e
Tyramine
• Natural product of bacterial fermentation
• Displaces NE from storage vessels =
INCREASED BP
• Must be AVOIDED
• Long list of foods/ drugs to be avoided
Foods containing tyramine
• Anything aged: cheeses, meats, extracts, fish, some wines • Flavor cubes • Bananas • Sauerkraut • Soy • Draft beer • Brewer’s yeast
Interactions with MAOIs
• Assume drugs not safe with ANYTHING (RX or OTC) else unless you have other information!! • Give adequate “washout” time (10 days) prior to OR, other meds
