Antidepressants Flashcards
What factors influence medications
Neurobiological
Structural Brain Differences
Genetic
Environmental
Other than monoamines what other factors play a role in neurobiological causes of depression
neurotrophins or growth factors such as BDNF
Growth factors like BDNF is like
miracle grow for the brain. Plays a role in neuroplasticity for the synapse and is critical for the maintence and survival of neurons.
Stress hromones
play a role in depression. There is a malfunction of the HPA axis. There is an impaired inhibition of cortosol release and elevated levels of cortosol. This interferes with normal neurogenesis in the hippocampus of the brain. They also impact the function of BDNF.
Inflmmation
can be another cause of depression
gut brain axis
Functional interplay between brain function and gut microbiota
Structural abnormalities in the brain with people in depression also have these located in the
frontal cortex and hippocampus
Antidepressants can be used for
Depressive Disorders Obsessive-Compulsive Related Disorders Anxiety Disorders Phobias Panic PTSD and other trauma related disorders Sleep Chronic Pain Migraine Prophylaxis Others
Selective Serotonin Reuptake Inhibitor (SSRI) - Examples
Fluoxetine Paroxetine Sertraline Escitalopram Citalopram Fluvoxamine
SSRI function
- Block reuptake of 5HT (Reuptake Inhibitor)
- Increases synthesis of important proteins (BDNF)
SSRI labs
not routinely done. But if there are comorbid factors you might want to check.
Impact on platelets Electrolytes Hyponatremia Vitals Including weight LFTs ECG- QTc prolongation
A lot of serotonin receptors are found in
gut
SSRI side effects
Discontinuation syndrome GI upset, N&V, diarrhea Headache Drowsiness, dizziness Insomnia Activation, restlessness Sexual dysfunction Appetite, weight loss/gain Black box warning Serotonin Syndrome
SSRI side effects are often
transient. usually resolve in a week or two.
Seronin syndrome
Agitation or restlessness Insomnia Confusion Rapid heart rate and high blood pressure Dilated pupils Loss of muscle coordination or twitching muscles High blood pressure Muscle rigidity Heavy sweating Diarrhea Headache Shivering Goose bumps
Discontinuation syndrome symptoms
The mnemonic FINISH summarizes the symptoms of antidepressant discontinuation syndrome: Flu-like symptoms (lethargy, fatigue, headache, achiness, sweating), Insomnia (with vivid dreams or nightmares), Nausea (sometimes vomiting), Imbalance (dizziness, vertigo, light-headedness), Sensory disturbances (“burning,” “tingling,” “electric-like” or “shock-like” sensations) and Hyperarousal (anxiety, irritability, agitation, aggression, mania, jerkiness).
SSRI effect on platelets
can decrease platelet activation and aggregation and impar hemostasis. use with caution in people with coagulation disorders
which SSRI has QTC issues
most due, but citalopram is the worst.
Serotonin-Norepinephrine Reuptake inhibitor - Examples
Venlafaxine desvenlafaxine duloxetine levomilnacipran milnacipran atomoxetine
When we inhibit NE it increases
DA in the prefrontal cortex
SNRI action
Serotonin-Norepinephrine Reuptake inhibitor
Venlafaxine note
serotonin inhibition is really potent at lower doses it isn’t until it gets to higher doses that it starts to impact NE
SNRI monitoring
LFTs
Electrolytes
Vitals
BP-Dose Dependent
Norepinephrine Dopamine Reuptake Inhibitor (ndRI)
Bupropion
NDRI is not great for
anxiety
NDRI uses
- Block reuptake of DA and NE
- Depression
- ADHD- off label
- Smoking cessation (Zyban)
- Sexual dysfunction
NDRI side effects
Anxiety, irritability, restlessness Insomnia Constipation Decreased appetite, weight loss Headache Increased sweating
NDRI Labs
Decreases seizure threshold Alcohol use Vitals LFT, BUN, GFR ECG EEG
NDRI note
Decreases seizure threshold
Alcohol use - also decreases seizure threshold
Tricyclic Antidepressant (TCA) - uses and action
Block reuptake of NE and 5HT in presynaptic nerve terminals
Migraine prophylaxis
Chronic Pain
Sleep
TCA examples
amitriptyline clomipramine doxepin imipramine nortripamine desipramine amoxapine protriptyline
TCA side effects
Anticholinergic SEs - (Dry mouth. Blurred vision. Dry eyes. Constipation. Urinary retention. Dizziness due to drop in blood pressure on standing up (postural hypotension) Cognitive problems (confusion) Heart rhythm disturbance.)
Orthostatic hypotension Sexual side effects Weight loss/gain Serotonin Syndrome Overdose potential
POTENTIAL WITH DEATH FROM OVERDOSE WITH TCA AND MAOI
TCA labs
TCA level-trough ECG- steady state and hx of cardiac problems, toxicity Weight BP, pulse Lipids, glucose
TCA have action on the
sodium level system on the heart and the brain. Can lead to abnormal rhythm brain damage and death.
MAOI action and types
block action of monoamine oxidase
2 sub types
A- 5HT, NE, DA, Tyramine
B- DA, Tyramine, Phenylethylamine
MAOI examples
selegiline
isocarboxazid
tranylcypromine
phenelizine
MAOI side effects
Drowsiness, dizziness, confusion Nausea Headache Weight gain Drug-drug, drug-food reactions Serotonin syndrome
MAOI have a lot of
drug to drug interactions
MAOI what to watch out for and monitor
Overdose potential Hypertensive crisis Orthostatic BP and pulse LFTs Weight Glucose, lipid
MAOI need to know
Tyramine linden food can lead to hypertensive crisis. S/S occipital headache, palpitations, neck stiffness, photophobia, tachy or brady, chest pain
Serotonin Partial agonist/reuptake inhibitor (SPARI) - action and note
Block reuptake of serotonin
5HT1A Partial agonism
N&V, diarrhea
*Take with food
SPARI example
vilazodone
SARI action and note
Block 5HT2A and 5HT2C receptors H1-histaminergic and ⍺1-adrenergic antagonism Different actions Sleep Depression ECG
SARI examples
trazodone
nefazodone
Review different 5ht receptors and their actions
See alix chart
Alpha-2 antagonist/ Noradrenergic specific serotonergic Antidepressant (Nassa) - Action and note
Alpha-2 antagonism Enhances release of 5HT and NE Antagonist 5HT2A, 2C, 3 Antagonist H1 Weight gain, drowsiness Less sexual SE, less GI (5HT3) BUN, creatinine, LFT, Lipid Agranulocytosis
NaSSA examples
mirtazapine
mianserin
