Antidepressants Flashcards
What are depressive episodes characterised by?
depressive mood, sadness severe enough to interfere with function
loss of interest or pleasure in daily activities (up to 2 weeks).
Sleep and appetite disturbances
Low energy levels, Decreased cognition
Aetiology of depression?
Unknown but involves genetic and environmental factors.
‣heredity, changes in neurotransmitter levels (decrease in
monoamines, serotonin & norepinephrine), altered
neuroendocrine function and psychosocial factors thought to play a
role
Drugs that induce depression?
- Beta-blockers (Atenolol)
- calcium channel blockers (Amlodipine)
- Benzodiazepines (Diazepam)
- Dopaminergic agents (Levodopa, α-methyldopa)
- Corticosteroids (Methylprednisolone)
- Anabolic steroids (Testosterone)
Depression treatment?
- Psychotherapy +
- Pharmacotherapy
tricyclic antidepressants
selective serotonin reuptake
inhibitors (SSRIs)
Serotonin-norepinephrine
reuptake inhibitors (SNRIs)
5-HT2antagonists
monoamine oxidase
inhibitors (MAOIs)
atypical antidepressants
lithium
Selective Serotonin Reuptake Inhibitors (SSRIs) drugs?
FESC (FUSEK FEELINGS)
Fluxoxetine
Escitalopram
Sertraline
Paroxetine
Selective Serotonin Reuptake Inhibitors (SSRIs) MOA?
prevent the (presynaptic) reuptake of 5-HT→more 5-HT to
stimulate postsynaptic 5-HT1 receptors
SSRIs I?
major depression, anxiety disorders (PTSD, PD, OCD, PDD etc.)
Fluoxetine: 20 - 40 mg po od;
What is the risk of fluxetine in the elderly?
cardiovascular & suicide risk
in the elderly
SSRIs S/E?
BAD SSRI
Body weight increase
Anorexia(first few months)
Dizziness
Suicidal Thoughts
Serotonin Syndrome
Reproductive-Sexual Dysfunction
Insomnia
SSRI DI?
DI: do not use with MAOI; fluoxetine can inhibit cytochrome P-450
isoenzymes and thus the metabolism of certain β -blockers including
propranolol and metoprolol → hypotension, bradycardia
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) drugs?
Very Damned
Venlafaxine, desvenlafaxine, duloxetine
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) drugs MOA for selective SNRI?
prevent the (presynaptic) reuptake of 5-HT, NE and DA (weak)→more 5-HT and NE to stimulate postsynaptic 5-
HT and NE receptors.
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) drugs MOA for TCA?
prevents the (presynaptic) reuptake of 5-HT and NE by
neuronal membrane; may also downregulate β–adrenergic and 5-HT
receptors
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) drugs I?
major depression, anxiety disorders (PTSD, PD, OCD, PDD etc.
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) drugs A/E?
N, D, anxiety, restlessness, insomnia, sexual dysfunction, ↑BP,
↑HR, agitation, serotonin-withdrawal syndrome; TCAs [additional
antimuscarinic (dry mouth, constipation, urinary retention),
orthostatic hypotension due to peripheral α1-blockade]
Monoamine oxidase inhibitors drugs?
Takes Pride In Shanghai
Tranylcypromine, moclobemide, phenelzine
Monoamine oxidase inhibitors MOA?
MOA:Inhibit one or both forms of MAO and thus the oxidative
deamination of NA, DA and 5-HT→ ↑ cytosolic stores of the
neurotransmitters
Monoamine oxidase inhibitors I?
I:refractory or atypical depression when SSRIs, TCAs and
sometimes even electroconvulsive therapy is ineffective.
MAO Tranycypromine?
irreversible, non-selective (inhibit MAO-A
and MAO-B);
↑ dose (20 - 30 mg po bid) for depression refractory to
sequential trials of other antidepressants