Antidepressants

Question 1

4 Functional Roles of ALL Biogenic Amines

Answer 1

Modulate appetite, sleep reg, anxiety, and sexual behavior

Question 2

Progression of Depression Treatment (5)

Answer 2

30s: ECT
40s: Lithium
50s: TCAs
60s: MAOIs
80s: SSRIs

Question 3

Tricyclic Antidepressants (TCAs)

Answer 3

Now predominantly to treat painful peripheral neuropathies and migraine headaches

Question 4

Old Generation Antidepressant Problems

Answer 4

Noncompliance due to adverse effects, or PCPs didn’t want to use bc of lethal overdose potential from CV toxicity.
Had anticholinergic effects, HTN, weight gain

Question 5

2 Old Gen Antideps

Answer 5

TCAs and MAOIs

Question 6

Special consideration w/ MAOI

Answer 6

Hypertensive crisis from not metabolizing DA/NE. can’t be on any other meds that increase BP, and have to control diet trp (cheese) as a precursor

Question 7

New Gen Antideps

Answer 7

Comparable efficacy as old gen, but less side effects and lower potential for overdose

Question 8

3 New Gen Antideps

Answer 8

SSRIs, SNRIs, Atypical Antideps

Question 9

Atypical Antideps (only 1 and why atypical)

Answer 9

Bupropion/Wellbutrin - doesn’t modulate 5HT, only DA/NE. So no sexual side effects

Question 10

Dirty Drugs

Answer 10

Things like TCA bind other Rs giving a ton of side effects. Things like SSRIs are more specific

Question 11

AutoRs 5HT1A and 5HT1D

Answer 11

On presyn, get bathed in 5HT and thus densensitized over time, which increases firing rate and amount of NT released w/ each nerve impulse, so you really get a crescendo

Question 12

4 SNRIs

Answer 12

Nefazadone
Venlafaxine (Effexor)
Mirtazapine (Remeron)
Duloxetine (Cymbalta)

Question 13

7 SSRIs

Answer 13

Luvox
Prozac
Zoloft
Paxil
Celexa
Lexapro
Viibryd

Question 14

Prior Antidep Treatment (3)

Answer 14

Prior treatment response rechallege: 85% response rate
1st degree relative treatment response: 75%
Novel: 65%

Question 15

3 Adverse Effects from SS/NRIs

Answer 15

Insomnia (so dose in morning)
GI distress
Sexual dysfunction, w/ anything that modulates 5HT so Bupropion only one that doesn’t: decreased libido/delayed orgasm/anorgasmia/delayed ejaculation

Question 16

5 Adverse Effects of Bupropion

Answer 16

Insomnia
Dry mouth
Mild tremor
Headache
Exacerbate seizures - avoid in epileptics
Side effects tend to be transient and resolve w/in 1wk

Question 17

Recovery Progression on Treatment

Answer 17

Physical/somatic symptoms improve in 1st 2 weeks
Then appetite, then crying and shit
Emotional symptoms improve greatly wks 3-4. Get windows of optimism first, then these get longer and more frequent. Ask if back to old self, if still have symptoms, increase the dose until good. Once in remission keep at that dose for 9 months then wean off. If don’t remove all symptoms, higher relapse risk