Antidepressants Flashcards
SSRIs, NaSSAs, SNRIs, TCAs, MAOI
SSRIs
Peak action after 10-14 days, safe in OD, inhibit the 5-HT re- transporter
Citalopram
SSRI
Sertraline
SSRI
Fluoxetine
SSRI - Least withdrawal symptoms (longest half-life), SE: agitation
Paroxetine
SSRI - Most withdrawn symptoms (shortest half-life)
SSRI Discontinuation syndrome
SYM: agitation, anxiety, nausea, diarrhoea, flu-like symptoms, dizziness, balance problems
TX: reassurance, monitoring with reintroduction and tapered withdrawal
Mirtazipine
NaSSA (noradrenergic and specific serotenergic) antidepressant acts at alpha 2 receptors - accumulates in kidney failure
Amitriptyline, imipramine, dothiepin
TCA - rarely used due to adverse effects and risk of OD, bind to Noradrenaline and 5HT re-uptake receptors, increase monoamine levels in the synaptic cleft, anticholinergic (antimuscarinic - dry mouth, constipation, urinary ret, cognitive effects) SE also: agitation, nightmares, sexual dys, akathisia (restlessness) muscle twitches, cardiac arrhythmias, Ami - sedative
TCA Overdose
confusion tachycardia and other arrhythmias hypotension mydriasis (dilation of pupils) - seizures coma cardiorespiratory arrest.
Venlafaxine
SNRI (serotonin and noradrenaline reuptake inhibitor), particularly effective in mixed depression, anxiety, SE; headache, nausea, hypertension @ risk of discontinuation syndrome
Duloxetine
SNRI no HTN SE
MOAIs - Phenelzine
Inhibits Monoamine Oxidase - preventing 5-HT, DA and NA being broken down
Interact with tyramine (cheese, red wine)
Hypertensive due to NA can lead to hypertensive crisis
Moclobemide
MAOI with lower risk of hypertensive crisis
Serotonin Syndrome
Do not combine MAOI + SSRI
Autonomic hyperactivity
Neuromuscular abnormality
Mental status changes
