Antidepressants Flashcards
What is the withdrawal phenomenon of antidepressants?
dizziness, nausea, headaches, insomnia, malaise. Tx: taper depending on the dose and half-life
Mechanism of SSRIs
inhibit presynaptic serotonin pumps that take up serotonin, leading to increased availability of serotonin clefts.
Which SSRI has the longest half life?
Fluoxetine (Prozac) - can be dosed weekly so no need to taper
Can Prozac be given in pregnant women?
yes
Side effects of Prozac?
sleep changes and anxiety
Prozac can increase serotonin–> serotonin syndrome. Can also be seen in people on antidepressants using cough medication
Which antidepressant will give you GI upset (and sleep changes?)
Sertraline (Zoloft)
Which antidepressant is most highly protein bound leading to several drug interactions?
Paroxetine (Paxil)
Which antidepressant causes the most anticholinergic side effects such as sedation, dry mouth, dry eyes, constipation and weight gain?
Paroxetine
Which antidepressant has the shortest half-life leading to withdrawal phenomena if not taken consistently?
Paroxetine - Paxil packs a punch
Which SSRI is approved for OCD?
Fluvoxamine (Luvox) - has lots of drug interactions
Which has the fewest drug interactions and sexual side effects? Which has theee fewest?
Citalopram/ Escitalopram (Lexapro)
How can you augment the sexual side effects of SSRIs?
add Bupropion, change to an non-SSRI antidepressant and add sildenafil
Why is it that SSRIs have fewer side effects than TCAs and MAOIs?
they are selective only for serotonin and they are much safer in overdose
Side effects of SSRIs?
- sexual dysfunction: decreased interest, anorgasmia, delayed ejaculation
- GI disturbance: nausea and diarrhea
- insomnia and vivid dreams
- headache
- anorexia, weight loss
- restlessness: akithisia
- seizures
Which drug interaction should you monitor for with SSRIs?
SSRI combining with Warfarin
SNRI- Serotonin Norepinephrine Reuptake inhibitor
Venlafaxine (Effexor) is used for
Generalized Anxiety Disorder, ADHD
Which SNRI is best for neurpathic pain, fibromyalgia and depression?
Duloxetine- and SNRI
Which antidepressant is an Norepinephrine-Dopamine Reuptake Inhibitors (NDRI)?
Bupropion - increases levels of both DA and NE
What’s good and what’s bad about Bupropion?
good- no sexual side effects
bad- causes seizures and psychosis @ high doses
*Not for people with eating disorders, those on MAOI and people with epilepsy
Which antidepressant is a 5HT2 receptor blocker and partial agonist?
Trazadone and Nefazodone
When do you use Trazaone/Nefazadone?
for refractory depression
major depression with anxiety
insomnia (HIGHLY SEDATING)
Nefazadone can cause liver failure
Which antidepressants is an alpha-2 blockers?
Mirtazapine (Remeron)
When do you use Mirazapine?
refractory major depression, especially in people who need to gain weight- sleep and appetite
TCAs
very sedating and very anticholinergic with arrhythmias and greater lethality in overdose./ high seizure risks
