Antidepressants

Question 0

Lexapro

Answer 0

Escitalopram
SSRI
Initial: 10mg Maintenance: 10-20mg

Question 1

Celexa

Answer 1

Citalopram
SSRI
Initial: 20mg Maintenance: 20-40mg (20mg of celexa=10mg of lexapro)
QT prolongation. Avoid in hepatic impairment and FQs(other QT prolonging drugs)

Question 2

Zoloft

Answer 2

Sertraline
SSRI
Initial: 50mg Maintenance: 50-200mg
Improves energy, increases DA: activating

Question 3

Prozac

Answer 3

Fluoxetine
SSRI
Initial: 20mg Maintenance: 20-80mg
Strong CYP2D6 inhibitor

Question 4

Paxil, Brisdelle, Pexeva

Answer 4

Paroxetine
SSRI
Initial: IR=20mg CR=25mg Maintenance: IR=20-50mg CR=25-62.5
Strong CYP2D6 inhibitor
Pregnancy category D
Sedation, sexual dysfxn, anticholinergic SEs , weight gain, withdrawal SEs

Question 5

Luvox

Answer 5

Fluvoxamine
SSRI
Initial: 50mg Maintenance: 50-300mg
Strong CYP1A2 inhibitor

Question 6

Effexor

Answer 6

Venalfaxine
SNRI
Prodrug
Initial: IR-75mg, XR-75mg
Maintenance: IR 75-375mg/day, XR 75-225mg/day
Acts like SSRI at low doses. Higher doses will start the block NET
SEs: GI upset, increase blood pressure, sweating and weight loss
Withdrawal syndrome bc of short half life

Question 7

Pristiq, Khedezla

Answer 7

Desvenlafaxine
SNRI
Initial: 50mg Maintenance: 50-400mg/day
Active metabolite of Effexor. Initial dose will block SERT and NET
Empty capsule may be present in stool

Question 8

Cymbalta

Answer 8

Duloxetine
SNRI
Initial: 30mg Maintenance: 30-120mg/day
Approved for fibromyalgia and neuropathic pain
Avoid use in alcoholics or hepatic impairment bc of hepatotoxicity risks

Question 9

Savella

Answer 9

Milnacipran
SNRI
Initial: 12.5 mg on day 1 than titrate per PI
Maintenance: 50-100mg BID
Avoid use in alcoholics or hepatic impairment bc of hepatotoxicity risk
SEs: headache, constipation, nausea, HTN

Question 10

Fetzima

Answer 10

Levomilnacipran
SNRI
Initial: 20 mg daily for 2-4 days increase to 40mg
Maintenance: 40-120mg/day take doses at same time qd
SEs: diaphoresis, constipation and nausea

Question 11

Remeron

Answer 11

Mirtazapine
Atypical (Seretonin receptor modulator)
Initial: 15mg QHS. Maintenance: 15-45mg/day
Increases lipids
Adjunct to treat: anxiety, insomnia, sexual dysfunction, GI SEs
Using with clonidine can cause rebound HTN

Question 12

Wellbutrin, Aplenzin, Forfivo

Answer 12

Bupropion
Atypical (NE, DA re uptake inhibitor)
Strong CYP2D6 inhibitor
Contraindicated in: epilepsy, eating disorders, abrupt discontinuation of alcohol or sedatives
Use as adjunct therapy to treat; lack of weight gain, sexual dysfxn, sedation
*lowers seizure threshold

Question 13

Desyrel, Oletro

Answer 13

Trazodone
Atypical (Seretonin receptor modulator)
3A4 metabolism to iminoquinone/reactive species leads to hepatotoxicity
SEs: priapism, orthostasis, sedation, dry mouth, nausea
Take on empty stomach. Used as adjunct therapy bc high doses as mono therapy lead to increased SEs
IR:300-600 mg/day
XR: 150-375 mg/day

Question 14

Serzone

Answer 14

Nefazodone
Atypical
BLACK BOX WARNING: life threatening hepatic failure

Question 15

Viibryd

Answer 15

Vilazodone
Atypical
Initial: 10mg. Maintenance: 40mg
Take with food

Question 16

Buspar

Answer 16

Buspirone

Atypical

Question 17

Brintellix

Answer 17

Vortioxetine
Atypical
Initial: 10mg. Maintenance: 5-20mg
SE: nausea

Question 18

Sinequan, Silenor

Answer 18

Doxepin
TCA-tertiary amine
Initial: 25mg QHS. Maintenance:100-300mg/day

Question 19

Anafranil

Answer 19

Clomipramine
TCA-tertiary amine
Initial: 25mg QD. Maintenance:100-200mg/day

Question 20

Elavil

Answer 20

Amitriptyline
TCA-tertiary amine
Initial: 25mg QHS. Maintenance:100-300mg/day

Question 21

Tofranil

Answer 21

Imipramine
TCA-tertiary amine
Initial: 75mg QHS. Maintenance:75-300mg/day

Question 22

Norpramin

Answer 22

Desipramine
TCA- secondary amine
Initial: 25mg QHS. Maintenance:50-150mg/day

Question 23

Pamelor

Answer 23

Nortriptyline
TCA-secondary amine
Initial: 25mg QHS. Maintenance:100-300mg/day

Question 24

Emsam

Answer 24

Selegiline patch
MAOI
Initial 6mg/24hours. Maintenance:6-12mg/24hours
Selectively inhibits MAO-B in the gut so not dietary restrictions required

Question 25

Nardil

Answer 25

Phenelzine
MAOI
Initial:15mg/day. Maintenance: 30-90 mg/day

Question 26

Parnate

Answer 26

Tranylcypromine
MAOI
Initial:10 mg/day. Maintenance:30-60 mg/day in 2-4 divided doses

Question 27

Marplan

Answer 27

Isocarboxazid
MAOI
Initial:10mg BID Maintenance: 10-60 mg/ day in 2-4 divided doses

Question 28

Common side effects of SSRIs

Answer 28

Nausea, diarrhea, vomiting, sleep disturbances,headache and sexual dysfunction

Question 29

Bupropion IR dose

Answer 29

Initial: 100mg BID
Maintenance: 150mg TID

Question 30

Bupropion SR dose

Answer 30

Initial: 150 mg in AM
Maintenance: 150-200 mg BID

Question 31

Bupropion XL dose

Answer 31

Initial: 150mg daily
Maintenance: 150-300mg/day

Question 32

Common side effects of SNRIs

Answer 32

GI, nausea,vomiting, constipation 
Insomnia/activation
Sexual dysfunction
Increased HR, BP
Dilated pupils
Dry mouth
Excessive sweating

Question 33

TCA tertiary side effects

Answer 33

Sedation, anticholinergic, weight gain, conduction abnormalities
SERT inhibition > NET
Imipramine (Tofranil)
Amitriptyline (Elavil)
Clomipramine (Anafranil)
Doxepin (Silenor)

Question 34

TCA secondary amine

Answer 34

Less side effects

Norpramin (desipramine), Pamelor (nortriptyline)

Question 35

MAOIs common side effects

Answer 35

Orthostasis
Sedation
Insomnia
Headache
Weight gain
Sexual dysfunction
Peripheral edema
Constipation
 Hypertensive crisis from MAO-A inhibition in gut and tyramine.mavoid eating tyramine containing foods 14 days after MAOI D/C
Seretonin syndrome

Question 36

Discontinuation syndrome

Answer 36

Avoid by tapering antidepressant dose by no more than 25%/week
Onset is 1-3 days upon abrupt discontinuation
Don’t need to taper MAOIs upon d/c