Antidepressants

Question 1

Tranylcypromine (Parnate)

Answer 1

C: MAOI
M: Irreversibly inhibit both MAOa and MAOb
T: Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
SE: Hypertensive crisis (with tyramine-rich foods); serotonin syndrome (MAOI + SSRI); agitation (rare), delerium –> seizures** Anticholinergic, orthostatic hypotension, sexual dysfunction, weight gain, sedation
MISC: –

Question 2

Phenelzine (Nardil)

Answer 2

C: MAOI
M: Irreversibly inhibit both MAOa and MAOb
T: Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
SE: Hypertensive crisis (with tyramine-rich foods); serotonin syndrome (MAOI + SSRI); agitation (rare), delerium –> seizures** Anticholinergic, orthostatic hypotension, sexual dysfunction, weight gain, sedation
MISC: –

Question 3

Desipramine (Norpramin)

Answer 3

C: Tricyclic
M: Block reuptake of NE or 5-HT at varying potencies and selectivity; also variably block muscarinic, a-adrenergic, dopamine, and histamine receptors
T: Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
SE: Sympathomimetic (cardiac arrhythmias and conduction defects, especially at OD)** Antimuscarinic, orthostatic hypotension, sedation (additive with alcohol), seizures
MISC: Not very safe; rarely used anymore

Question 4

Imipramine (Tofranil)

Answer 4

C: Tricyclic
M: Block reuptake of NE or 5-HT at varying potencies and selectivity; also variably block muscarinic, a-adrenergic, dopamine, and histamine receptors
T: Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
SE: Sympathomimetic (cardiac arrhythmias and conduction defects, especially at OD)** Antimuscarinic, orthostatic hypotension, sedation (additive with alcohol), seizures
MISC: Not very safe; rarely used anymore; forms active metabolite (desipramine)

Question 5

Amitriptyline (Elavil)

Answer 5

C:Tricyclic
M: Block reuptake of NE or 5-HT at varying potencies and selectivity; also variably block muscarinic, a-adrenergic, dopamine, and histamine receptors
T: Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism; prevention of tension headaches, migraines
SE: Sympathomimetic (cardiac arrhythmias and conduction defects, especially at OD)** Antimuscarinic, orthostatic hypotension, sedation (additive with alcohol), seizures
MISC: Not very safe; rarely used anymore; forms active metabolite (nortriptyline)

Question 6

Nortriptyline (Pamelor)

Answer 6

C: Tricyclic
M: Block reuptake of NE or 5-HT at varying potencies and selectivity; also variably block muscarinic, a-adrenergic, dopamine, and histamine receptors
T: Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
SE: Sympathomimetic (cardiac arrhythmias and conduction defects, especially at OD)** Antimuscarinic, orthostatic hypotension, sedation (additive with alcohol), seizures
MISC: Not very safe; rarely used anymore

Question 7

Fluoxetine (Prozac)

Answer 7

C: SSRI
M: Inhibit reuptake of 5-HT (and NE to lesser extent)
T: Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism; pre-menstrual dystrophic disorder
SE: Serotonin syndrom (with MAOIs)** Fewer than tricyclics; mostly nausea, decreased sexual function
MISC: Potent P450 inhibitor; forms active metabolite (norfluoxetine)

Question 8

Paroxetine (Paxil)

Answer 8

C: SSRI
M: Inhibit reuptake of 5-HT (and NE to lesser extent)
T: Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
SE: Serotonin syndrom (with MAOIs)** Fewer than tricyclics; mostly nausea, decreased sexual function
MISC: Potent P450 inhibitor

Question 9

Sertraline (Zoloft)

Answer 9

C: SSRI
M: Inhibit reuptake of 5-HT (and NE to lesser extent)
T: Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
SE: Serotonin syndrom (with MAOIs)** Fewer than tricyclics; mostly nausea, decreased sexual function
MISC: –

Question 10

Escitalopram (Lexapro)

Answer 10

C: SSRI
M: Inhibit reuptake of 5-HT (and NE to lesser extent)
T: Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
SE: Serotonin syndrom (with MAOIs)** Fewer than tricyclics; mostly nausea, decreased sexual function
MISC: –

Question 11

Citalopram (Celexa)

Answer 11

C: SSRI
M: Inhibit reuptake of 5-HT (and NE to lesser extent)
T: Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
SE: Serotonin syndrome (with MAOIs)** Fewer than tricyclics; mostly nausea, decreased sexual function
MISC: –

Question 12

Duloxetine (Cymbalta)

Answer 12

C: SNRI
M: Inhibits reuptake of 5-HT and NE
T: Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
SE: --
MISC: --

Question 13

Venlafaxine (Effexor)

Answer 13

C: SNRI
M: Inhibits reuptake of 5-HT and NE
T: Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
SE: --
MISC: --

Question 14

Bupropion (Wellbutrin)

Answer 14

C: Atypical
M: Blocks DA and NE reuptake
T: Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism; maintain nicotine abstinence in quitting smokers
SE: Lowers seizure threshold
MISC: --

Question 15

Mirtazapine (Remeron)

Answer 15

C: Atypical
M: 5HT2a antagonists; also inhibit 5HT reuptake
T: Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism
SE: –
MISC: –

Question 16

Lithium

Answer 16

C: –
M: Unknown; lithium depletes secondary messengers IP3 and DAG, important in a-adrenergic and muscarinic-cholinergic transmission
T: Anti-manic/mood-stabilizing (bipolar); long-term cluster headache prevention
SE: If elevated levels: neurotoxicity, cardiac toxicity, renal dysfunction** Drowsiness, weight gain, tremor, polydipsia, polyuria
MISC: Nausea and vomiting early sign of lithium OD; indomethacin and Na-depleting diuretics should be avoided (increase [Li])