Antidepressants Flashcards
What are the indications for antidepressants?
DAN
- Depression (major depression)
- Anxiety d/os (panic, OCD, GAD, PTSD)
- Neuropathic pain (TCAs)
Onset of antidepressants?
SLOW:
- some improvement W1; 2-4w for marked improvement
- full recovery rare under 6w
What is the efficacy of antidepressants?
-More effective than placebo (70-80% v 30%)
How does response to antidepressants vary between and within classes?
-No difference in response b/w members of same class
-no difference in response within class
IN TRIALS:
-there is difference for an INDIVIDUAL
SSRIs? (include mnemonics)
- Effective - escitalopram
- For - fluoxetine, fluvoxamine
- Sadness - sertraline
- Panic - paroxetine
- &Compulsions: citalopram
How should SSRIs be initiated?
Start low, then increase after 1-2/52
Initial dose of SSRIs?
- 10-20mg: fluoxetine, paroxetine, citalopram
- 50mg: sertraline, fluvoxamine
Usual daily dose SSRIs?
10-20mg: escitalopram
20-40mg: fluoxetine, paroxetine, citalopram
50-200: sertraline
150-300: fluvoxamine
Which SSRIs have notably higher doses than the others?
-Sertraline
-Fluvoxamine
THINK: San Fran has high drug use, therefore require increased doses due to tolerance.
AEx SSRIs?
AEx SSRIs = SSRI
- -Stomach problems
- -Serotonin Syndrome
- -Reproductive issues (sexual dysfunction)
- -Insomnia (CNS stimulation)
What are the classes of antidepressants?
- TCAs
- MAOis
- SSRIs
- Dual acting
- SNRIs
- Other
What are the dual uptake inhibitors and their indications?
Vexed and Depressed = venlafaxine, duloxetine, desvenlafaxine
- -Vexed = GAD
- -Depressed = major depression
MoA dual uptake inhibitors?
Block reuptake serotonin AND NA into presynaptic nerve terminal
How should dual uptake inhibitors be ceased?
Slowly to prevent marked withdrawal
What are the common AEx dual uptake inhibitors?
-Same as SSRIs (=SSRI)
-+ adrenergic effects (HTN, tachy, sweating ++, tremor, insomnia)
May also rarely cause hypoNa and seizures
