Antidepressants

Question 1

What is the withdrawal phenomenon of antidepressants?

Answer 1

dizziness, nausea, headaches, insomnia, malaise. Tx: taper depending on the dose and half-life

Question 2

Mechanism of SSRIs

Answer 2

inhibit presynaptic serotonin pumps that take up serotonin, leading to increased availability of serotonin clefts.

Question 3

Which SSRI has the longest half life?

Answer 3

Fluoxetine (Prozac) - can be dosed weekly so no need to taper

Question 4

Can Prozac be given in pregnant women?

Answer 4

yes

Question 5

Side effects of Prozac?

Answer 5

sleep changes and anxiety
Prozac can increase serotonin–> serotonin syndrome. Can also be seen in people on antidepressants using cough medication

Question 6

Which antidepressant will give you GI upset (and sleep changes?)

Answer 6

Sertraline (Zoloft)

Question 7

Which antidepressant is most highly protein bound leading to several drug interactions?

Answer 7

Paroxetine (Paxil)

Question 8

Which antidepressant causes the most anticholinergic side effects such as sedation, dry mouth, dry eyes, constipation and weight gain?

Answer 8

Paroxetine

Question 9

Which antidepressant has the shortest half-life leading to withdrawal phenomena if not taken consistently?

Answer 9

Paroxetine - Paxil packs a punch

Question 10

Which SSRI is approved for OCD?

Answer 10

Fluvoxamine (Luvox) - has lots of drug interactions

Question 11

Which has the fewest drug interactions and sexual side effects? Which has theee fewest?

Answer 11

Citalopram/ Escitalopram (Lexapro)

Question 12

How can you augment the sexual side effects of SSRIs?

Answer 12

add Bupropion, change to an non-SSRI antidepressant and add sildenafil

Question 13

Why is it that SSRIs have fewer side effects than TCAs and MAOIs?

Answer 13

they are selective only for serotonin and they are much safer in overdose

Question 14

Side effects of SSRIs?

Answer 14

1. sexual dysfunction: decreased interest, anorgasmia, delayed ejaculation
2. GI disturbance: nausea and diarrhea
3. insomnia and vivid dreams
4. headache
5. anorexia, weight loss
6. restlessness: akithisia
7. seizures

Question 15

Which drug interaction should you monitor for with SSRIs?

Answer 15

SSRI combining with Warfarin

Question 16

SNRI- Serotonin Norepinephrine Reuptake inhibitor

Venlafaxine (Effexor) is used for

Answer 16

Generalized Anxiety Disorder, ADHD

Question 17

Which SNRI is best for neurpathic pain, fibromyalgia and depression?

Answer 17

Duloxetine- and SNRI

Question 18

Which antidepressant is an Norepinephrine-Dopamine Reuptake Inhibitors (NDRI)?

Answer 18

Bupropion - increases levels of both DA and NE

Question 19

What’s good and what’s bad about Bupropion?

Answer 19

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

Question 20

Which antidepressant is a 5HT2 receptor blocker and partial agonist?

Answer 20

Trazadone and Nefazodone

Question 21

When do you use Trazaone/Nefazadone?

Answer 21

for refractory depression
major depression with anxiety
insomnia (HIGHLY SEDATING)
Nefazadone can cause liver failure

Question 22

Which antidepressants is an alpha-2 blockers?

Answer 22

Mirtazapine (Remeron)

Question 23

When do you use Mirazapine?

Answer 23

refractory major depression, especially in people who need to gain weight- sleep and appetite

Question 24

TCAs

Answer 24

very sedating and very anticholinergic with arrhythmias and greater lethality in overdose./ high seizure risks

Question 25

What is amytriptyline good for?

Answer 25

chronic pain
migraine
insomnia

Question 26

Which TCA is best for enuresis (bedwetting) and panic disorder?

Answer 26

imipramine

Question 27

Which TCA is best for OCD?

Answer 27

Chlomipramine

Question 28

What kind of antidepressant is Doxepin? What is it useful for?

Answer 28

TCA

treating chronic pain, sleep aid

Question 29

Which TCA is least likely to cause orthostatic hypotension and for treating chronic pain?

Answer 29

Nortriptyline

Question 30

Which TCA is the least sedating and least anticholinergic?

Answer 30

Desipramine

Question 31

How do you treat a TCA overdose?

Answer 31

sodium bicarbonate

Question 32

What are the signs of atypical depression? What is the treatment of atypical depression?

Answer 32

• Hyperphagia, hypersomnia, increased sensitivity to personal rejection, feet feel heavy
• MAOIs

Question 33

MAOIs inhibit MAO-a and MAO-b increasing the # of neurotransmitters available. MAO-a inactivates serotonin. MAO-b deactivates NE/Epi.

Name some examples, and their uses

Answer 33

Phenelzine, Tranylcypromine, Isocarboxazid and they are used for refractory depression.

-assoc w. HTN crisis, Serotonin Syndrome

Question 34

Antidepressants in other disorders

Answer 34

OCD: SSRI, TCA (clomipramine)
Panic disorder: SSRI, Imipramine (TCA), MAOI
Eating disorders: SSRIs, TCA, MAOI
Dysthymia: SSRI
Social phobia: SSRI, TCA, MAOI
GAD: SSRI, Venlafaxine, TCA
PTSD: SSRI
Irritable Bowel Syndrome: SSRI, TCA
Enuresis: TCA (imipramine)
Neuropathic pain: TCA-amytriptyline, nortriptyline, SNRI-Duloxetine
Fibromyalgia: SSRI
Chronic pain: SSRI, TCA
Migraines: TCAs, SSRI
Smoking cessation: Bupropion
Premenstrual dysphoric disorder: SSRI
Depressive phase of manic depression: SSRI
Insomnia: Mirtazapine, TCAs (amytriptyline)