Antidepressants Flashcards
Example of MAOIs
Phenelzine
Moclobemide
Selegiline
Tranylcypromine
How long do you have to wait after stopping TCAs before starting MAOIs?
7-14 days
How do you have to wait after stopping MAOIs to start another antidepressant?
2 weeks washout
How long do you have to wait after stopping SSRIscbefore starting MAOIs?
7 dyas
What dietary restrictions have with MAOIs and why?
Cheese and chocolate
Interaction between MAOI and
Method of action of MAOis
Block MonoAmineOxidase enzyme from destroying Monoamine oxidase
MAO is responsible for
What is MAO responsible for?
(MAO) is an enzyme involved in the degradation process for various monoamines released by neurons and glia cells, including DA, serotonin and norepinephrine (NE).
Therefore MAOIs - stop the degradation of these NTs and allow them to build up more
SSRI examples
Fluoxetine
Sertraline
Citalopram
Escitalopram
Paroxetine
What is the mode of action of SSRIs?
acts as a reuptake inhibitor of the neurotransmitter serotonin by blocking the action of the serotonin transporter. This in turn leads to increased extracellular concentrations of serotonin and, therefore, an increase in serotonergic neurotransmission
What antidepressant group increases bleeding risk?
SSRIs
What antidepressants are first line?
SSRIs
What antidepressants are first line?
SSRIs
What side effect can SSRIs cause electrolyte wise?
Hyponatremia
What side effect is a concern with citalopram?
QTc interval prolongation
Which SSRI has a significantly shorter half life?
Paroxetine
What use when SSRIs fail?
SNRIs - dual effect
MOA of SNRIs?
serotonin-norepinephrine reuptake inhibitor. This means that it increases the levels of serotonin and norepinephrine in the brain by blocking their reabsorption (reuptake) into neurons.
Examples of SNRIs?
Venlafaxine
Duloxetine
Examples of novel antidepressants?
Vortioxetine
Agomelatine
Mode of action of vortioxetine
Multimodal modulates serotonergic activity
Antagonist at some 5HT receptors, agonist at others
When is vortioxetine used?
Inadequate response to 2 antidepressants
What is vortiocetine useful in?
SD
Hyponatremia
When is agomelatine useful?
Patients who experience adverse effects with SSRIs
Cipriani meta analysis
What novel antidepressant is sleep enhancing
Agomelatine
Mode of action of agomelatine
Melatonergic agonist - MT1 and MT2 receptors
+ 5HT2C antagonist
Examples of TCAs?
Amitryptilline
Nortiptyline
Dosulepin
Lofepramine
Imipramine
Clomipramine
What antidepressant is cardiotoxix?
TCAs
What is the big problem with TCAs?
Difficult to tolerate side effect burden esp in older patients
What antidepressants are anticholinergic?
TCAs
When are TCAs prescribed?
By specialists eg RADs in resistant cases
What is a NARI?
Noradrenaline/epinephrine reuptake inhibitor
What type of antidepressant is reboxetine?
NARI
NaSSA mode of action
Noradrenergic and specific serotenergic antidepressant
Presynaptic alpha 2 antagonist
Acts to disinhibit both NA and 5HT neurones, increasing NA and 5 HT
What improves tolerability of NaSSAs>
5HT2,3 antagonism
Improved tolerability non selevtive serotonin agents
Useful for patients experiencing adverse effects with SSRIs
Sleep enhancing
