Antidepressants Flashcards
What drug is first line for an uncomplicated, physically healthy outpatient with depression?
SSRI
Is it recommended to increase dose or switch agents to get better response?
switch agents
How do most antidepressants work?
inhibit transporter molecules allowing more neurotransmitter to stay in the synapse
Which two neurotransmitters are associated with depression?
- Serotonin
- Norepinephrine
TCA
Ex. Amitryptyline
Indications: MDD, Chronic pain, Enuresis
-have anticholinergic effect
Overdose: arrhythmias, seizures
MAO inhibitors
Ex. Phenelzine, Tranylcypronine, Selegiline
Indications:
- MDD (unresponsive to other drugs)
- Anxiety, panic disorder
- Selegiline-Parkinson’s Disease
ADE: Hypertension with sympathomimetics
Serotonin syndrome with SSRIs*
What do you need to be careful with mixing with MAOIs
several different foods (ex. beer, sardines, MSG, liver, raisins, soy sauce, licorice, etc..)
SSRIs
Ex. citalopram, escitalopram, Fluoxetine*, Sertraline
Indications: MDD, anxiety disorder, OCD, PMDD, PTSD, Bulima
Interactions: Warfarin
Toxicities: sexual dysfunction**
Which SSRI is associated with QT prolongation at higher doses?
Citalopram (Celexa)
What adverse drug reaction is associated with SSRIs
suicidality
SNRIs
Ex. Venlafaxine*, duloxetine
Indications:
- MDD
- Pain disorders like fibro
- stress urinary incontinence
- vasomotor sx of menopause
ADE: Venlafaxine can cause HTN.
Duloxetine can cause orthostatic hypotension
5-HT2 Receptor Antagonists
Ex. Trazodone, Nefazodone
Indications:
- MDD
- Hypnosis (Trazodone)
Trazodone–> very sedating!*, priaprism
Norepinephrine and dopamine Reuptake Inhibitor (NDRI)
Ex. bupropion (Wellbutrin)
ADE: Sezuires esp if hx of seizure, alcohol withdrawal, head trauma, CNS tumor
Mirtazapine ADE
weight gain
How long should an SSRI be continued for MDD maintainence?
12-36 months
