Antidepressants Flashcards
Clinical effects of TCA’s: on normal and depressed people
normal people: no stimulating effect, makes them tired
Depressed patient: elevation in mood only after 2-3 weeks
Neurochemical effects of TCA’s
- block reuptake of 5-HT and/or NE
- NE blocker is Desipramine
- 5-HT/NE blocker is Imipramine
Adverse effects of TCA’s
- Orthostatic hypotension
- antimuscarinic effects
- weight gain
- tachycardia
dosing, pharmacokinetics, enzyme that metabolizes TCA’s
- metabolized by CYP2d6
- therapeutic index is 5-10 (really low, don’t give more than one week supply)
- long half life, well absorbed–>one dose a day
MAO Inhibitors: names
Phenelzine
mechanism of MAO Inhibitors
- irreversibly blocks the oxidative deamination of monoamines
- blocks MAOA and MAOB (NE, 5HT, DA enzymes)
- begins working in 24-48 hours but symptoms don’t get better for 3+ weeks
MAOI’s adverse effects
- can’t break down dietary tyramine as well
- tyramine builds up and causes hypertensive crisis
- Food high in tyramine: aged cheese, red wine, beer
SSRI’s (selective serotonin re-uptake inhibitors) examples
- Fluoxetine
- Sertraline
- Escitalopram
SSRI’s mechanism of action
- blocks re-uptake of 5-HT (wow! never guessed it)
- The clinical effect is the inhibition of 5-HT2a
SSRI’s: adverse effects
-Nausea, Diarrhea, and weight loss
discontinue if patient gets
-stimulation effect (anxiety, nervousness, insomnia)
THE BIG SIDE EFFECT IS
-can cause increase risk of suicide in the young ones
Venlafaxine
- dual action antidepressant
- does not have side effects of TCA
- Blocks 5-HT and NE reuptake
- can’t give if patient is on MAOI’s
Mirtazapine
- Dual action antidepressant
- blocks presynaptic alpha2 on
- that increases NE and 5-HT
Ketamine
- Binds NMDA
- works in about 2 hours
- lasts 2 weeks
- get hallucinations (the goods) and nightmares (the bads)
Lithium Carbonate: used for, mechanism
- For bipolar disorder (manic phase mainly)
- starts improving clinical signs in 5-21 days
- unknown mechanism
Adverse effects of lithium carbonate
-fatigue, muscular weakness, slurred speech, ataxia, fine tremor of the hands
Valproic acid
-superior to lithium for rapid-cycling bipolar
-can combine with lithium if individual drugs don’t work
that’s all he wrote
Carbamazepine
anticonvulsant approved for prophylaxis of bipolar disorder
I’m going to treat my bipolar patient with an SSRI
well you sir are a moron
- never give an ssri as monotherapy for bipolar patients
- can cause rapid onset mania
