Antidepressants Flashcards
behaviors linked to mood disorders
pleasure
interests
libido
guilt
suicidality
sleep
behaviors linked to insomnia
memory
alertness
behaviors linked to psychoses
delusions
hallucinations
negative sx
behaviors linked to anxiety
obsessions
compulsions
ruminations
worry
fear
anxiety
pain
behaviors linked to substance use disorders
euphoria
reward
motivation
NE, serotonin, and dopamine are all linked to what behaviors
anxiety
irritability
mood
emotion
cognitive fxn
70% of depressed patients present to PCP w. only __ complaints
somatic
types of dpn’s
mdd/unipolar disorder
dysthymia
mdd usually responds specifically to (2)
electroconvulsive therapy (ECT)
antidepressants
milder form of dpn w. no long-term responses to drug therapy
dysthymia
t/f: even tho dysthymia has shown no long term response to drug therapy, pharmacotherapy is usually needed
T!
it is superior to placebo
most important factor when deciding on tx for dpn
symptoms
2 strategies for treatment resistant dpn
switching antidepressants
combining antidepressants
tx for treatment resistant dpn
buspirone
aripiprazole/olanzapine/quetiapine
lamotrigine
lithium
dsm dx for dpn includes __ sx
for at least __ weeks
5/9
2
sx of dpn
sigecaps
sleep → too much or too little
interest → anhedonia
guilt → increased
energy
concentration
appetite → increased or decreased
psychomotor agitation/retardation
suicidal ideation
classes of antidepressants
SSRIs
NDRIs
SNRIs
5HT partial agonist SSRI
TCADs
SSRIs to know
sertraline → zoloft
escitalopram → lexapro
fluoxetine → prozac
5HT partial agonist SSRI
trazodone
MAOI
phenelzine
NDRI
bupropion → wellbutrin
SNRIs
duloxetine → cymbalta
venlafaxine → effexor XR
which antidepressant is an alpha 2 antagonist
mirtazapine
which antidepressant is an alpha 1 receptor antagonist
TCAD → amytriptyline
which antidepressant targets DA reuptake
NDRI -> bupropion
which antidepressant classes target NE reuptake
SNRIs
NDRIs
TCADs
which antidepressant classes target 5HT (serotonin) reuptake
SSRIs
SNRIs
TCADs
5HT-SSRI
which antidepressant has antimuscarinic action
TCADs → amitryptyline
which 2 antidepressants have sedative action
trazodone
mirtazipine
antidepressant that has contraindication if hx of seizure
NDRI → bupropion
moa for ketamine
NMDA receptor antagonist
ketamine can be used for __ dpn
treatment resistant
moa for brexanolone
neuroactive steroid (NAS)
what can brexanolone (zulresso) be used for
post partum dpn
cons of brexanolone (zulresso)
sedation
LOC
acute s.e of SSRIs
nausea/diarrhea
activation insomnia
restlessness
delayed onset s.e of SSRIs
weight gain
sexual dysfxn
cognitive blunting
SSRIs have very low likelihood of fatalities, but what are withdrawal sx
flu like
severity of SSRI sx are related to
t½
s.e of SNRIs to know
HTN
anxiety
t/f SNRIs have more rapid appearance of withdrawal sx than SSRIs
T!
s.e of NDRI (bupropion)
tremor
anxiety
insomnia
seizures at high doses
s.e f trazodone
drowsiness
what antidepressant is used empirically as a hypnotic agent in depressed pt’s
trazodone
s.e of mirtazapine
somnolence
wt gain
which antidepressant has declining use d.t lots of s.e
TCAD →
sedation
antimuscarinic
orthostatic hypotn
weight gain
s.e of TCAD o.d
arrhythmias → sudden death
seizures
common s.e of MAOI
postural hypotn
s.e of MAOI od
sz
shock
hyperthermia
s.e of ketamine
elevated bp
2 contraindications for ketamine
AV malformation
hx of ICH
which antidepressant is a class III controlled substance
ketamine
most antidepressant agents have additive CNS depressant effects when combined w.
other sedatives
MAOIs can cause hypertensive crisis when combined w.
decongestants
foods high in tyramine
dt acute increase in NE release
what 2 drugs can cause serotonin syndrome
SSRIs
MAOIs
also SSRIs OR MAOIs combined w. meperidine, tramadol, dextromethorphan
sx of serotonin syndrome
hyperthermia
muscle rigidity
myoclonus
AMS
what antidepressant inhibits P450 drug metabolism
SSRIs
how does St. John’s Wort affect P450 drug metabolism
induces P450 drug metabolizing enzymes
which antidepressants have incomplete absorption dt significant 1st pass effect and wide variations in Cp (3)
SSRIs
TCADs
1st line tx for dpn
SSRIs →
sertraline
fluoxetine
citalopram
escitalopram → lexapro
__ may be more effective for dpn, but have more s.e
SNRIs → esp venlaxafine
__ has less weight gain and sexual s.e than SSRIs and SNRIs,
but is not effective for __
bupropion
anxious dpn
antidepressant that is good for dpn PLUS insomnia
mirtazapine
most rapid and effective tx for severe acute dpn
ect (electroconvulsive therapy)
frequency and duration of ECT
6-12 tx
2-3/week
adverse effects of ECT
cardiopulmonary
fx
orodental injuries
HA
confusion
retrograde/anterograde amnesia
best antidepressant for pt who c/o chronic pain
TCADs