Antidepressants Flashcards

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1
Q

SSRIs=serotonin reuptake inhibitors

A
  • Fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram
  • Antidepressant actions are similar in efficacy and time-course to TCAs
  • Less acute toxicity than TCAs–decreased overdose risk
  • Side effects: nausea, insomnia, sexual dysfunction
  • If given with MAOIs–>serotonin reaction (hyperthermia, muscle rigidity, CV collapse)
  • also may be associated with neuroleptic malignant syndrome.
  • Use: MDD, OCD, Panic disorder, Social anxiety disorder, PTSD, GAD, PMS, Hot flashes associate with menopause.
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2
Q

Imipramine
Amitriptyline
Clomipramine

A
  • TCAs
  • Block norepinephrine and serotonin reuptake; now used secondarily to SSRIs and other new compounds
  • Elevate mood in depressed patients after 2-3 weeks
  • Uses: MDD, Enuresis in childhood (imipramine), chronic pain (amitriptyline), OCD (clomipramine, SSRIs)
  • Decrease REM and increase stage 4 sleep
  • Anticholinergic effects: dry mouth, blurred vision, urinary retention
  • Also cause sedation, orthostatic hypotension, cardiac abnormalities (anticholinergic effects and increased NE–>palpitations, tachycardia, arrhythmias).
  • EKG: lengthened QRS, flat/inverted T wave
  • Overdose: hyperpyrexia, BP change, seizure, coma, cardiac conduction defects
  • Interacts with guanethidine, sympathomimetics
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3
Q

SSRI Withdrawal

A
  • Dizziness and light-headedness, vertigo, feeling faint
  • Shock-like sensations
  • Paresthesia
  • Anxiety
  • Diarrhea
  • Fatigue
  • Gait instability
  • Headache
  • Insomnia
  • Irritability
  • Nausea and vomiting
  • Tremor
  • Visual disturbances

(1-7 days after stopping SSRI)

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4
Q

Fluoxetine

A
  • First SSRI
  • Long half-life active metabolite
  • SR product available for PMS
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5
Q

Sertraline

A
  • similar to fluoxetine but with fewer effects on drug metabolism
  • Used for OCD, PTSD, Panic attacks
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6
Q

Paroxetine

A
  • SSRI

- Also used for hot flashes associated with menopause

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7
Q

Fluvoxamine

A
  • SSRI

- Approved for OCD

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8
Q

Citalopram

Escitalopram

A

SSRIs

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9
Q

SNRI (Serotonin Norepinephrine Reuptake Inhibitor)

A
  • Block reuptake of serotonin and NE

- side effect profile more similar to SSRI than TCA

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10
Q

Duloxetine

A
  • SNRI
  • Used for MDD and anxiety
  • Also used for neuropathic pain syndromes, fibromyalgia, back pain, osteoarthritis
  • Caution in patients with liver disease
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11
Q

Venlafaxine

A
  • SNRI

- severe depression and anxiety

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12
Q

Bupropion

A
  • Atypical antidepressant
  • Weakly blocks NE and dopamine uptake
  • Also approved for nicotine withdrawal and SAD
  • No associated weight gain or sexual dysfunction
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13
Q

Mirtazapine

A
  • Atypical antidepressant
  • Blocks presynaptic alpha-2 receptors in the brain
  • Increases appetite
  • Used in AIDS patients
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14
Q

Trazodone

A
  • Atypical antidepressant
  • Weak SSRI-like effect; sedating, so used also for insomnia
  • Low incidence of CV side effects; can cause priapism
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15
Q

Phenelzine

Tranylcypromine

A
  • MAO inhibitors
  • Uses: Major depression (not first choice) and narcolepsy
  • Selegiline patch also used to treat depression; relatively nonselective (A and B) at dose used.
  • Antidepressant action takes about 2 weeks–>mood elevation in depressed pts. May progress to hypomania, esp. in bipolar.
  • Corrects sleep disorders in depression.
  • May produce stimulation in normal people.
  • Lowers BP and may produce orthostatic hypotension.
  • Acute toxicity: agitation, hallucination, hyperpyrexia, convulsions, change in BP.
  • Tyramine in diet can increase NE effect in presence of MAOI
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16
Q

Milnacipran

A
  • SNRI

- Used for fibromyalgia