Antidepressants Flashcards
Major categories of antidepressants
Selective Serotonin Reuptake Inhibitors (SSRIs)
Heterocyclic antidepressants (TCAs and tetracyclic antidepressants)
Monoamine Oxidase Inhibitors (MOAIs)
Most antidepressants require a trial of how long for noticeable effects
3-4 weeks
antidepressant withdrawal phenomenon sx?
dizziness, headaches, nausea, insomnia, and malaise
why are SSRIs the most commonly prescribed antidepressants?
low incidence of side effects and most resolve with time, no food restrictions, and much safer in overdose
6 examples of SSRIs
Fluoxetine, Sertraline, paroxetine, fluvoxamine, citalopram, escitalopram
SSRI with highest rick of GI disturbances
Sertraline (zoloft)
SSRI safe in pregnancy and used in children
Fluoxetine (prozac)
SSRI with anticholinergic like side effects of sedation, constipation, weight gain
Paroxetine (paxil)
SSRI with short half life leading to the withdrawal phenomena more often
Paroxetine
SSRI with fewest drug-drug interactions and fewer sexual side effects
Citalopram
what should you worry about in somebody who is taking a high dose SSRI and cough medicine
serotonin syndrome- over the counter cold remedies have drugs that increase serotonin
sexual side effects of SSRIs can be treated how?
augmenting the regimen with buproprion, changing to a non-SSRI antidepressant or by adding a medication like sildenafil for men
what is the FDA’s black box warning against all SSRIs for
“increased suicidal thinking and behavior”
side effects of SSRIs
sexual dysfunction, GI disturbances, insomnia, headache, anorexia, weight loss, restlessness, seizures and of course serotonin syndrome
what drugs taken with SSRIs increases risk for serotonin syndrome
MAOIs, triptans, over the counter cough remedies
SSRIs can increase levels of which drug which requires increased monitoring when starting and stopping these medications
warfarin
Venlafaxine, and duloxetine are what class of drug?
serotonin-norepi reuptake inhibitors (SNRIs)
Venlafaxine is often used for what?
generalized anxiety disorder
Venlafaxine should not be used in what kind of patients
patients with untreated or labile blood pressure (can increase blood pressure)
Duloxetine is often used for ?
depression and neuropathic pain or in fibromyalgia
Duloxetine may show more side effects in which kind of patients
liver disease or heavy alcohol use patients may have increased liver side effects
antidepressant with relative lack of sexual side effects
Bupropion (wellbutrin)
antidepressant that can lower seizure threshold
Bupropion
Bupropion should be used with caution in which patients?
patients with epilepsy and eating disorders (lowers seizure threshold)
Serotonin Receptor Antagonists and agonists
Trazodone and Nefazodone
Positives of Trazodone and Nefazodone
do not have sexual side effects and do not affect rapid eye movement sleep
Indications for Trazodone and Nefazodone
refractory major depression, major depression with anxiety and insomnia
Nefazodone carries a black box warning for?
rare but serous liver failure
alpha2-adrenergic receptor antagonist used as antidepressant
Mirtazapine (remeron)
used for depression in elderly because it helps with sleep and appetite
mirtazapine
Mirtazapine side effects?
sedation, WEIGHT GAIN (useful in pts who need to gain weight), dizziness, somnolence, tremor, dry mouth, constipation and rare agranulocytosis
mainstay for TCA overdose
IV sodium bicarbonate
TCA useful in enuresis and panic disorder
Imipramine
TCA useful in treatment of OCD
Clomipramine
TCA least likely to cause orthostatic hypotension
Nortriptyline
TCAs in general are useful in treating?
chronic pain
major complications of TCA’s
cardiotoxicity, convulsions, coma
EKG changes due to TCAs
widening qrs, qt and pr intervals
what must you assess before prescribing TCAs
SUICIDE RISK - they are lethal in overdose
prevent the inactivation of biogenic amines such as norepi, serotonin, dopamine, and tyramine
MAOIs
MAOIs are very effective in treating which conditions?
refractory depression and refractory panic/anxiety disorders
Name 3 MAOIs
phenelzine, tranylcypromine, isocarboxazid, selegiline
which MAOI used to treat depression does not require following dietary restrictions when used in low doses but decongestants and serotonergic drugs must still be avoided
selegiline
foods to avoid when taking a MAOI
foods with tyramine (red wine, cheese, chicken liver, fava beans, cured meats). will give you a hypertensive crisis
most common side effect of MAOIs
orthostatic hypotension