Antidepressants Flashcards
5 indications for antidepressants
Depression
Anxiety
OCD
PTSD
Eating disorders (some)
Antidepressant classes (11)
SSRI
SNRI
NDRI
SPARI
Alpha-2 antagonist/NaSSa/SNDI
NRI
SARI
TCA
MAO
NMDA receptor antagonist
Multimodal
5 Common SSRIs
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
3 Common SNRIs
Duloxetine (Cymbalta)
Venlafaxine XR (Effexor XR)
Desvenlafaxine (Pristiq)
Common NDRI
Buproprion (Wellbutrin)
Multimodal Agent
Vortioxetine (Trintellix)
Common SPARI
Vilazodone (Viibryd)
SSRI metabolized by
CYP450 (1A2, 2D6, 3A4)
SSRIs for FDA-approved for PTSD
Paroxetine (Paxil)
Sertraline (Zoloft)
What can SSRIs interfere with?
Clotting Cascade
How do you dose SSRIs?
Start low, go slow, usually increase dose in 2-4 week increments
SSRI Common SE
GI upset
Akathisia
Sexual SE
HA
Dry mouth
SSRI Serious SE
Serotonin syndrome
Increased suicidal thoughts < 25 years old
Indication for Citalopram (Celexa)
FDA Approved for MDD in adults only (favorable in elderly)
Concern w/ Citalopram (Celexa)
Can cause QT prolongation > 40mg/day PO
What can Citalopram (Celexa) cause?
paradoxical yawning
When to give Citalopram (Celexa)?
Give at night (it’s a weak antihistamine)
Citalopram (Celexa) Common SE
Nausea
HA
Lightheaded
Anxiety
Sexual dysfunction
Excess sweating
(More than lexapro but not bad)
What to monitor for Citalopram (Celexa)?
EKG esp w/ other meds that prolong QT or deplete Mg or K
Quintessential SSRI
Escitalopram (Lexapro)
Escitalopram (Lexapro) Indication
FDA Approved for MDD, GAD
MDD for children 12+
What is Escitalopram (Lexapro) also effective for?
OCD, Panic disorder, PTSD, social anxiety, PMDD, PTSD
Pros of Escitalopram (Lexapro)
Fewer SE, lower doses, more predictable (10mg vs 40mg Celexa)
Most well tolerated SSRI
Very effective in treating Anxiety
Prozac (Fluoxetine) indication
MDD, OCD, panic disorder, PMDD, bulimia nervosa, bipolar disorder (w/ Zyprexa - Symbyax)
Age and Diagnosis indications for Prozac (Fluoxetine)
8-17: OCD
7-17: MDD
Pros of Prozac (Fluoxetine)
Energizing effect (good for anxiety), focus/concentration issues
Longest 1/2 life (if compliance is an issue)
Most studied agent for children (lowest SI risk)
Indication for Luvox (Fluvoxamine)
OCD and social anxiety disorder
Off label use for Luvox (Fluvoxamine)
Panic disorder and PTSD
-better for anxiety, may benefit psychosis
Age and diagnosis indication for Luvox (Fluvoxamine)
8-17: OCD
Concern with Luvox (Fluvoxamine)
-can interact with other meds
-caffeine increases potency up to 5 times
Benefit of Luvox (Fluvoxamine)
Most effective agent for social anxiety disorder and OCD
Indication for Sertraline (Zoloft)
MDD, OCD, panic disorder, PTSD, PMDD, and social anxiety disorder
-may be helpful in psychotic depression
Off-label indication for Sertraline (Zoloft)
MDD
Age and indication Sertraline (Zoloft)
6-17: OCD
Sertraline (Zoloft) side effects
Nausea
HA
Lightheaded
Anxiety
Sexual dysfunction
Less potential for weight gain
Concern with Sertraline (Zoloft)
Some drug interactions, esp. higher dose range
Indication for Paroxetine (Paxil)
OCD, panic disorder, social anxiety disorder, GAD, PMDD, PTSD
-anticholinergic, sedating calming
Most effective medication for PTSD
Paroxetine (Paxil) w/ most side effects
What is Paroxetine (Paxil) very effective for
sexually disinhibited patients
potentially w/ excessive gambling
What is Paroxetine (Paxil) associated with?
Withdrawal syndrome (shortest 1/2 life)
-Anticholinergic rebound (akathisia, restlessness, GI upset, dizziness, tingling)
Common SE of Paroxetine (Paxil)
Nausea
HA
Lightheaded
Anxiety
Sexual Dysfunction
What medication is the worst offender for inducing mania in bipolar patients?
Paroxetine (Paxil)
What is SPARI? What’s an example?
Serotonin Partial agonist re-uptake inhibitor
Vilazodone (Viibryd)
