Antidepressants Flashcards
Antidepressants are also used to treat what type of conditions?
Anxiety disorders; generalized anxiety disorder, social anxiety disorder, panic disorder, posttraumatic stress disorder, obsessive-compulsive disorders
Antidepressants have been historically marketed to treat what condition?
Depression
What other conditions are antidepressants used to treat?
Bulimia nervosa, diabetic neuropathy pain, fibromyalgia pain, as well as to facilitate smoking cessation
Citalopram, escitalopram, paroxetine, fluoxetine, fluvoxamine, and sertraline are what category of antidepressants?
Selective serotonin reuptake inhibitor’s (SSRIs)
Celexa
Citalopram
Lexapro
Escitalopram
Paroxetine
Paxil
Fluoxetine
Prozac
Fluvoxamine
Luvox
Sertraline
Zoloft
Desvenlafaxine, venlafaxine, duloxetine, milnacipran, and levomilnacipran represent what category of antidepressants?
Serotonin norepinephrine reuptake inhibitor’s (SNRIs)
Amitriptyline, clomipramine, Desipramine, imipramine, trimipramine, nortriptyline, and Proptriptyline represent what category of antidepressants?
Tricyclic antidepressants (TCAs)
Elavil, Endep
Amitriptyline
Anafranil
Clomipramine
Norpramin
Desipramine
Tofranil
Imipramine
Surmontil
Trimipramine
Pamelor
Nortriptyline
Vivactil
Proptriptyline
Phenelzine, selegiline, and tranylcypromine represent what class of antidepressants?
Monoamine oxidase inhibitor’s (MAOIs)
Nardil
Phenelzine
Emsam
Selegiline
Parnate
Tranylcypromine
What is wellbutrin?
Bupropion
What is Remeron?
Mirtazapine
What is Serzone?
Nefazadone
What is Desyrel?
Trazodone
What is Viibryd?
Vilazadone
What is brintellix?
Vortioxetine
Monoamine oxidase inhibitors work by inhibiting what two enzymes? What three neurotransmitters are prevented from breaking down as a result? What is the end result?
Monoamine oxidase A and B; dopamine, serotonin, and norepinephrine; the levels of these neurotransmitters are increased in the synapse
Which two categories of antidepressants inhibit the reuptake of serotonin and norepinephrine? They do this by inhibiting what?
Tricyclic antidepressants and serotonin norepinephrine reuptake inhibitors; They do this by blocking monoamine reuptake transporters
What neurotransmitter do SSRIs inhibit the reuptake of? They do this by blocking what?
Serotonin; monoamine reuptake transporters
Bupropion inhibits the reuptake of which two neurotransmitters? It does this by blocking what?
Norepinephrine and dopamine; by blocking the monoamine reuptake transporters
Trazodone, nefazodone, and mirtazapine inhibit the reuptake of which neurotransmitter? How else do they work?
Serotonin; they also have additional serotonin receptor antagonist activity
Vilazadone blocks the reuptake of which neurotransmitter? It is also a partial agonist of which receptor?
Serotonin; the 5HT-1A receptor
Vortioxetine inhibits the reuptake of which neurotransmitter? It is a partial agonist at which receptor? Which receptor does it antagonize?
Serotonin; 5HT-1A; 5HT-3
What are the FDA-approved uses of antidepressant medications?
Major depressive disorder, generalized anxiety disorder, social anxiety disorder, panic disorder, posttraumatic stress disorder, obsessive-compulsive disorder, premenstrual dysphoric disorder, bulimia nervosa, diabetic neuropathy, fibromyalgia, and smoking cessation.
What two uses are non-FDA approved for antidepressants?
Premature ejaculation and insomnia
What is the classic black box warning for antidepressant medications?
Increased risk of suicidal thinking and behavior in children, adolescents, and young adults (18-24-year-olds)
What are three very common side effects of serotonergic antidepressant agents?
Gastrointestinal side effects, sexual dysfunction, and CNS effects
Which specific side effect of serotonergic antidepressant agents is seen in the geriatric population?
Hyponatremia
Why do serotonergic antidepressant agents put some patients at risk of bleeding?
Serotonin-related platelet impairment
Can serotonin syndrome occur with monotherapy?
Yes, but it is more common when using more than one Serotonergic medication
What side effect is very common with tricyclic antidepressants?
Anticholinergic side effects
The TCAs amoxapine and maprotilene are known to cause what specific side effect?
Seizures
Patients run the risk of what specific side effect if tricyclic antidepressants elevate to supratherapeutic levels in the blood?
Cardiac abnormalities
What may happen if a monoamine oxidase inhibitor is used in combination with a sympathomimetic medication and/or tyramine-containing foods and beverages?
Hypertensive crisis
What may be the outcome if bupropion is used at higher doses or is rapidly titrated?
Seizure
What could the use of bupropion in combination with such medications as antipsychotics, stimulants, and hypoglycemic drugs lead to? Why?
Seizures; because these are drugs that lower the seizure threshold
Duloxetine (Cymbalta) and nefazodone (Serzone) are potentially toxic to which organ? They should be avoided in patients with what type of dysfunction?
Hepatotoxicity; hepatic dysfunction
Pristiq
Desvenlafaxine
Cymbalta
Duloxetine
Savella
Milnacipran
Fetzima
Levomilnacipran
Effexor
Venlafaxine
Venlafaxine (Effexor), paroxetine (Paxil) and duloxetine (Cymbalta) are associated with a withdrawal syndrome for what pharmacological reason? What three instances increase the likelihood of a withdrawal syndrome?
Shorter half-life (approximately 12-16 hours); it occurs particularly with missed doses, marked dose reductions, and abrupt discontinuation
What adverse effect is venlafaxine (Effexor) commonly associated with? What are three rarely seen adverse effects?
Dose-related increases in blood pressure; increased triglycerides and cholesterol levels, interstitial pneumonia, and pulmonary eosinophilia
Remeron (mirtazapine) can cause what two rare, but serious, side effects?
Agranulocytosis and neutropenia
Which three antidepressants are known inhibitors of CYP 450 enzymes?
Fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft)
Which 3 specific CYP 450 enzymes is Prozac (fluoxetine) a potent inhibitor of?
CYP 1A2
CYP 2C19
CYP 2D6
Sertraline (Zoloft) is a moderate inhibitor of what three specific CYP 450 enzymes?
CYP 2C19
CYP 2D6
CYP 3A4
Paroxetine (Paxil) is a potent inhibitor of which CYP 450 enzyme? What other antidepressant also strongly inhibits this specific enzyme?
CYP 2D6; Bupropion
What have studies consistently found regarding antidepressant medications?
Studies have found that the agents are similar in efficacy
What are the major determining factors for selecting a specific antidepressant?
Tolerability, personal or family history of response, and cost
Why are the “newer” antidepressant agents considered the first-line of therapy? Which two categories of antidepressants are excluded from being first-line therapy for these reasons?
Because they are safer (including in overdose) and easier to tolerate.
These findings were recently identified in the study “paroxetine versus other antidepressant agents for depression” by purgato et al (2014)
What did the STAR*D study conclude regarding antidepressant therapy?
They concluded that when evaluating the efficacy of a therapeutic regimen:
1 – maximize the antidepressant dose
2 – ensuring adequate trial duration
3 – adding another antidepressant agent may produce additional therapeutic benefits and can be an alternative earlier in therapy
True or false: the STAR*D study used a “real world” design to evaluate patients with at least 1-3 previous trials
True
Is electroconvulsive therapy safe in pregnancy?
Yes, it has no known teratogenic effects and may be preferred to antidepressant pharmacological therapy in some cases
All antidepressant agents are categorized as category C, with regard to pregnancy, except which one?
Paroxetine (Paxil)
Category D
True or false: most studies have not identified an increase in congenital malformations associated with antidepressant exposure
True
The risk of cardiovascular and other congenital malformations may be higher with which antidepressant?
Paroxetine (Paxil)
SSRI exposure late in the third trimester may lead to what non-teratogenic side effects in the newborn?
Respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, low birth weight, vomiting, hypoglycemia, hypo or hypertonia, hyperreflexia, jitteriness, irritability, constant crying, lower Apgar scores and tremor.
The effects of antidepressants during the third trimester may be due to toxic effects of the SSRI or drug withdrawal due to discontinuation. Therefore, what technique should be used? And for how long prior to delivery?
Consider tapering or discontinuing antidepressant medication 10-14 days prior to delivery
What do we know about the long-term effects of in utero SSRI exposure on infant development and behavior?
Nothing
Do psychotropic agents cross into the breastmilk?
Yes, they all due to some extent
If a mother on antidepressant medications chooses to breast-feed… How should that be managed?
The baby should be monitored for side effects secondary to medication exposure
What do we know about the long-term effects for the baby from exposure to antidepressant medications through breastmilk?
Nothing
