Antidepressant Meds

Question 1

Antidepressants – How they work

Answer 1

•Restore neurotransmitters while client learns coping
•May have other indications:
–Anxiety/ Anxiety disorders
–Chronic pain
–Eating disorders
•Affects:
–Serotonin (5-HT2)
–Norepinephrine

Question 2

Norephinephrine affects…

Answer 2

Alertness

energy

Question 3

Serotonin affects…

Answer 3

Obsessions and compulsions

Question 4

Dopamine affects…

Answer 4

Attention
Motivation
Pleasure
Reward

Question 5

Antidepressant categories

Answer 5

• 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

Question 6

Facts common to most antidepressants

Answer 6

• 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

Question 7

Adverse effects common to most

antidepressants

Answer 7

• Anticholinergic effects
• Weight gain
• Sexual side effects

Question 8

Antidepressants main facts

Answer 8

• 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!!!!

Question 9

SSRI Examples

Answer 9

• Fluoxetine (Prozac, Sarafem)
• Paroxetine (Paxil)
• Sertraline (Zoloft)
• Citalopram (Celexa)
• Escitalopram (Lexapro)

Question 10

SSRI Main Facts

Answer 10

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

Question 11

SSRI s/e’s

Answer 11

• Insomnia/ somnolence
• Anxiety/ agitation/ restlessness
• Nausea

Question 12

Serotonin main facts

Answer 12

• Potentially life-threatening
• Related to serotonin overdose
• Other medications contribute:
– MAOI’s
– St. John’s Wort
– Lithium
No lab test, just supportive treatment

Question 13

Serotonin Syndrome Symptoms clinical

triad:

Answer 13

• Cognitive: mental confusion,
hypomania, hallucinations, agitation,
headache, coma.
• Autonomic: shivering, sweating, fever,
hypertension, tachycardia, nausea,
diarrhea.
• Somatic : myoclonus/clonus (muscle
twitching), hyperreflexia, tremor.

Question 14

SSNRI/NSRI Examples

Answer 14

• Serotonin & Norepinephrine
• Venlafaxine (Effexor)
• Nefazodone (Serzone)
• Duloxetine (Cymbalta)

Question 15

SSNRI/NSRI Main facts

Answer 15

• Less weight gain
• Less sexual dysfunction
• May be more anxiolytic (also may
produce anxiety)
• May increase BP
• Serzone: liver failure
• Cymbalta: treat fibromyalgia

Question 16

Heterocyclics/TCAs main facts

Answer 16

• 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

Question 17

Heterocyclics/TCAs examples

Answer 17

– Amitriptyline (Elavil)
– Clomipramine (Anafranil)
– Imipramine (Tofranil)

Question 18

Heterocyclics/TCAs adverse effects

Answer 18

• **Anticholinergic effects – review them!!!
• Other:
– Photosensitivity
– Decreased seizure threshold
• OVERDOSE DANGEROUS!

Question 19

Monamine Oxidase Inhibitors (MAOI’s) main facts

Answer 19

• Inhibit monamine oxidase, enzyme that
breaks down NE & 5-HT2
• Effective
• Not used often 2nd interactions

Question 20

MAOIs examples

Answer 20

– phenelzine (Nardil)
– Isocarboxazid (Marplan)
– tranylcyromine (Parnate)

Question 21

MAOI s/e’s

Answer 21

• Orthostatic hypotension
• Edema
• Constipation
• Hypomania
• Insomnia
• Usual s/e

Question 22

Tyramine

Answer 22

• Natural product of bacterial fermentation
• Displaces NE from storage vessels =
INCREASED BP
• Must be AVOIDED
• Long list of foods/ drugs to be avoided

Question 23

Foods containing tyramine

Answer 23

• Anything aged: cheeses, meats, extracts, fish, some
wines
• Flavor cubes
• Bananas
• Sauerkraut
• Soy
• Draft beer
• Brewer’s yeast

Question 24

Interactions with MAOIs

Answer 24

• 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

Question 25

Hypertensive crisis

Answer 25

• It’s what happens when you mix tyramine with
MAOI’s
• S/S are same as those of severe HTN:
– Headache
– Nosebleeds
– Tachycardia
– N/V
– Diaphoresis
– Chest pain/ coma/ stroke

Question 26

Misc antidepressants

Answer 26

–Buproprion (Wellbutrin, Zyban) -
seizures
–Trazodone (Desyrel) - sleep
–Mirtazapine (Remeron)

Question 27

Antipsychotics as adjuncts

Answer 27

“atypical antipsychotic medications” such as Seroquel or Abilify are now being used to supplement antidepressant drugs in severely depressed people.