Antidepressants Flashcards
What is the common mechanism of how all antidepressants work?
Increase the amount of neurotransmitter in the synaptic cleft and approximately 2 weeks later there is a down-regulation of post-synaptic receptors.
Why have SSRIs replaced tricyclic antidepressants recently?
SSRIs have the same effectiveness with more desirable side effects.
What are common side effects of SSRIs?
Nausea, Insomnia, nervousness, and sexual dysfunction
What is “serotonin reaction”?
When SSRI and MAO inhibitors are together can cause hyperthermia, muscle rigidity, and cardiovascular collapse.
What can happen if you suddenly discontinue taking SSRIs?
You would go into SSRI withdrawal causing dizziness, shock-like sensations, visual disturbances, anxiety, headache, etc.
How can you prevent SSRI withdrawal and which drugs cause more withdrawal?
Short acting SSRIs - Sertraline cause more withdraw due to shorter half-life, compared to Fluoxetine.
You can prevent by tapering the dose when the patient is discontinuing the drug. Fluoxetine has a long half-life and typically does not elicit withdrawal symptoms.
What are the differences between Mesolimbic tract and Mesocortical tract?
Mesolimbic tract - arousal, memory, stimulus processing, motivation. Too much dopamine = Positive Symptoms
Mesocortical tract - cognition, communication, and social activity. Diminished dopamine = negative symptoms
How do SSRIs work in the synaptic cleft?
They block SERT preventing the reuptake of serotonin.
What is another approved use of SSRIs other than depression and anxiety?
Fibromyalgia and chronic pain.
How do Tricyclic Antidepressants work, compared to SSRI drugs?
Tricyclic drugs block NE reuptake
SSRI drugs block Serotonin reuptake
What drug blocks with serotonin and norepinephine reuptake?
Duloxetine
Side effects - more similar to SSRI
How does the overdose risk of SSRIs compare with MAOIs and Tricyclic drugs?
Acute toxicity with SSRIs are significantly less than that of MAOI and Tricyclic.
What is a unique side effect of SSRIs when they are being taken by a teenager?
Can increase risk of suicidal in children and teenagers.
What is a short-half life SSRI and what is it used for?
Sertraline.
Used for OCD, PTSD, and Panic
What is a long-half life SSRI that does not usually cause withdrawal?
Fluoxetine
What atypical antidepressant is used for nicotine withdrawal?
Bupropion
How does Bupropion work and what are the benefits?
Blocks the reuptake of NE and Dopamine.
There is no weight gain or sexual dysfunction.
What drug blocks the Alpha2 receptors from negative feedback?
Mirtazapine.
Where are the highest amounts of Tricyclic antidepressants found in the body?
Brain and Heart. Thus reasoning for contraindication in individuals with recent MIs.
What Tricyclic antidepressant has a very long plasma half life and is a prodrug?
Amitriptyline
What is are notable side effects of Amitriptyline?
Decreases REM sleep, Anticholinergic effects, Sedation, Cardiac abnormalities, and can cause acute overdose more easily. Drug interactions with adrenergic HTN drugs.
What tricyclic drug is used for obsessive complusive disorder?
Clomipramine. Block Serotonin more than NE.
What tricyclic drug is used primarily for treating chronic pain?
Amitriptyline
How do MAO inhibitors work and common side effects?
Blocks the breakdown of NE, Dopamine, and Serotonin.
Patient must restrict food intake - Tyramine (not broken down) can cause hypertensive crisis.
Acute Toxicity is possible.
What is the most commonly used MOA inhibitor?
Phenelzine, treats depression and narcolepsy.
