AntiDepressants Flashcards
Fluoxetine
Prozac
SSRI
longest T1/2 - no need to taper - weekly dosing available
safe in pregnancy, children
more common sleep changes, anxiety
CYP inhibitor - can increase neuroleptic levels
Sertraline
Zoloft
SSRI
highest risk of GI disturbance
more common sleep changes
Paroxetine
Paxil
SSRI
short T1/2 about 1d - withdraw phenomenon
Fluvoxamine
Luvox
SSRI
only one FDA approved for OCD
n/v, lots of drug interactions
Citalopram
Celexa
SSRI
fewest drug interactions
fewer sexual side effects
Escitalopram
Lexapro
SSRI
Venlafaxine
Effexor SNRI treats Depression, Anxiety, ADHD XR form for daily dosing can increase BP new form = Desvenlafaxine (pristiq)
Duloxetine
Cymbalta
SNRI
treats Depression and neuropathic pain, fibromyalgia
more side effects in those with liver disease or heavy EtOH use
Buproprion
Wellbutrin
NE/Dopa Reuptake Inhibitor
no sexual side effects
treats depression, ADHD, Anxiety
increase risk of seizure and psychosis at high dose
contraindicated in those with seizure disorder or active eating disorder or taking MAOI
Trazodone, Nefazodone
Desyrel, Serzone
Serotonin receptor antagonist/agonist
treat refractory MDD, MDD with anxiety, insomnia
no sexual side effects, does not affect REM sleep
SE: nausea, dizzy, orthostatics arryhthmias, priapism, sedation
*Nefazodone has black box warning for rare but serious liver failure
Mirtazepine
Remeron
Alpha adrenergic receptor antagonist
treats refractory MDD (especially when patients need weight gain)
SE: sedation, wt gain, dizzy, somnolence, tremor, dry mouth, constipation, rare agranulocytosis
no sexual side effects
TCAs
inhibit reuptake NE and serotonin
long T1/2 - qd dosing
toxicity: cardiotoxicity, convulsions, coma
treat TCA OD with NaHCO3
SE: anti-HAM, wt gain, sexual dysfunction
Contraindicated in preexisting conduction abnormality, recent MI
Amitriptyline
Elavil
TCA - tertiary amine
treat chronic pain, migraines, insomnia
SE: highly anti-cholinergic, more sedating, more lethal in OD
Imipramine
Tofranil TCA - tertiary IM form treats enuresis, panic disorder SE: highly anti-cholinergic, more sedating, more lethal in OD
Clomipramine
Anafranil TCA - tertiary amine SE: anticholinergic, more sedating, more lethal in OD most serotonin specific treats: OCD
Doxepin
Sinequan
TCA - tertiary amine
anticholinergic, more sedating, more lethal in OD
treats chronic pain, sleep aid at low dose
Nortriptyline
Pamelor, Aventyl
TCA - secondary amine - less anticholinergic, less sedating than tertiary
treats chronic pain
least orthostatic
Desipramine
Norpramin
TCA - secondary amine - least anticholinergic
Amoxapine
Asendin
TCA - tetracyclic
metabolite = Loxapine which is an antipsychotic
Maprotiline
Ludiomil
TCA - tetracyclic
SE: increase rate of seizure, arrythmia, lethal in OD
MAOI
MAOI-A - deactivates serotonin, dopamine, tyramine
MAOI-B- deactivates NE/E, dopamine, tyramine
more effective in atypical depression
SE: SSRI + MAOI leads to serotonin syndrome (also need to avoid opiates, decongestants) hypertensive crisis, orthostatics most common, pts with pyridoxine deficiency can have parasthesias (treat with Vit. B6)
Phenelzine
Nardine
MAOI
Tranylcypromine
Parnate
MAOI
Isocarboxazid
Marplan
MAOI
Selegiline
MAOI
comes in patch form - less dietary restrictions at low dose
SSRI
inhibits presynaptic pump that takes up serotonin
3-4 weeks for effect
withdraw phenomenon - dizziness, h/a, insomnia, malaise
SE: sexual dysfunction, seizure, serotonin syndrome, can increase levels of warfarin
