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
