Antidepressants Flashcards
(69 cards)
when was fluoxetine first introduced
1980s
why did the introduction of SSRIs revolutionize the treatment of depression
had wider therapeutic index and fewer side effects than MAOIs and TCAs which were the only meds previously available
is any one class of antidepressant more effective than any other
no–> shown in STAR*D trial
why is paroxetine generally not recommended first line
very potent
most severe withdrawal symptoms if stopped abruptly
what side effect are we trying to prevent with the diet restriction required with MAOIs
hypertensive crisis
why is the max dose of escitalopram 20mg
risk of QTc prolongation at higher doses
antidepressants with more serotonergic action may help more with which symptoms of depression
cognitive symptoms such as rumination
antidepressants with more norepinephrine reuptake action may help more with which symptoms of depression
more of the behavioural symptoms like anhedonia and low mood
list common side effects of antidepressants
nausea
headache
GI issues
most will self resolve within 1-2 weeks
is excessive sweating common in those on SSRI/SNRIs?
can be
mechanism not understood–> likely related to 5HT receptors or NE reuptake inhibition
severe cases have been reported
what medication can you add if someone is having excessive sweating on ADs
benztropine, clonidine or terazosin may be helpful
can try switching to another SSRI
on which AD is sweating most likely to occur? least likely?
sweating is most likely to occur with paroxetine and least likely to occur with escitalopram
in the elderly, falls are more common in which ADs? less likely?
more likely to fall if on SNRIs or TCAs
less likely on SSRIs
what blood monitoring is particularly important in elderly people on ADs
monitoring of sodium levels–> risk of hyponatremia
what effect do ADs have on sleep efficiency
almost all DECREASE sleep efficiency
will also increase number of awakenings, worsen PLMS and RLS, can worsen parasomnias and increase stage 1 sleep
what effect do ADs have on REM sleep
almost all will:
increase REM latency
suppress REM
delay REM onset
what placebo response is generally seen in studies of ADs
strong placebo response up to 30-40% in MDD (but this does not explain all of the efficacy of SSRIs/SNSRIs)
is paroxetine safe for kids and teens
no
have any antidepressants been approved for kids and teens in canada
no
which aspects of sexual function are most commonly affected by SSRIs
libido and sexual interest–occasionally
ejaculation and orgasm–frequently
erection(potency) in males–rarely affected
agonism at what receptors are thought to cause sexual dysfunction with SSRIs
5HT2A and 5HT2C agonism
specifically spinal cord 5HT2A receptor agonism
*serotonergic nerve terminals also target dopamine and norepinephrine pathways in the brain and inhibit their activity and these pathways are involved in desire and arousal phases of the sexual response cycle
name two ADs that are MORE likely to cause sexual dysfunction
escitalopram and paroxetine
list 5 ADs that are LESS likely to cause sexual dysfunction
buproprion
agomelatine
mirtazapine
vilazodone
vortioxetine
list 5 medication that can be added to an existing AD regimen to address issues related to sexual dysfunction
buproprion
bupsirone
cyproheptadine
mirtazapine
sildenafil
