Antidepressants Flashcards
Types of antidepressants
TCA TeCAs Unicyclic antidepressants MAOI SSRI SNRI SSNRI
Tricyclic antidepressants (TCA) general info and indication
1950s
Largely replaced by newer antidepressant
GAD SOCIAL PHOBIA OCD PANIC DISORDER PTSD BODY DYSMOROHIC DISORDER ANOERXIA BULIMIA BORDERLINE ADHD PARKINSONS ADJUNCT IN SCHIZOPHRENIA
Side effects of TCA
Many side effects are related to anti-muscarinic properties of TCA.
Dry mouth, nose (m) Blurry vision Constipation (m) Urinary retention Memory impairment Increased body temp Drowsiness Anxiety Confusion Restlessness Dizziness Akathisia Hypersensitivity Weight gain Sweating Sexual dysfunction Sedation (H1) Hypotension Tachycardia (m)
Mode of action for TCA
Primarily blocking SERT and NET
In addition they can be antagonists at 5-HT2,6 and 7, a1 and NMDA Receptors.
TCAs
Imipramine (5-HT/NE); used to control night bed wetting, strong anti-cholinergic effect
Desipramine (NE)
Amitriptyline (5-HT/NE); neuropathic pain and migraine
Nortryptiline (5-HT/NE)
Clomipramine (5-HT)
TCAs
Imipramine Desipramine Amitriptyline Nortryptiline Clomipramine Doxepin Dosulepin
Tetracyclic antidepressants (TeCAs)
Maprotiline (NE)
Mianserin
Mirtazapine
Mode of action of TeCAs
Do not inhibit reuptake of serotonin (except amoxapine), but they do inhibit NE.
Block 5-HT2, a1, H1
Unicyclic antidepressants
Bupropion
Buproprion
DA receptor inhibitor; ME-DA REUPTAKE INHIBITOR
Antidepressant and smoke cessation
Can be alone or add-on to SSRI
Side effects of bupropion
Dry mouth Trouble sleeping Agitation Suicidal ideation Headache Risk for epileptic seizures Weight loss
Indication for bupropion
Depression Smoke cessation ADHD Sexual dysfunction Obesity
Bupropion is contraindicated in
Epilepsy Anorexia Bulimia Active brain tumors Alcohol withdrawal Liver damage Kidney disease Severe hypertension
MAO Inhibitors indication
Panic disorder w/ agoraphobia Social phobia Atypical depression Mixed anxiety disorder Depression Bulimia PTSD Borderline
MAOI side effects
Orthostatic hypotension, insomnia, irritability, sexual disturbance, seizures, weight gain
Cheese effect
MAO inactivates tyramine present in cheese, wine and more. If MAO is inhibited this inactivation will be decreased. Tyramine can cause release of large amounts of stored catecholamines from nerve terminals resulting in hypertensive crisis, occipital headache, stiff neck, tachycardia, nausea, hypertension, arrhythmia, seizure and death
MAO-a
Delaminates serotonin, melatonin, epinephrine and norepinephrine
MAO-b
Deaminates phenethylamine abs certain trace amines
Non-selective MAOIs
Used in USA
Severe depression
Isocarboxazid Nialamide Phenelzine Hydracarbazine Tranylcypromine
Selective MAO-a inhibitors
Moclobemid (reversible)
Pirlindole
Toloxatone
Bifemelane
Selective MAO-b inhibitors
Rasagiline
Selegiline (irreversible)
Safinamide
RIMA (reversible inhibitors of monoamine oxidase a)
Moclobemide
Minaprine
Toloxatone
Metralindole
SSRI (selective serotonin reuptake inhibitors) indication
Depression GAD Panic disorder PTSD OCD Bulimia Chronic pain
2 weeks to function
Side effects of SSRI
Nausea Anxitogenic in the beginning Weight gain (SIADH may occur) Decreased appetite Sexual dysfunction Photosensitive Platelet dysfunction Serotonin syndrome Etc
Serotonin syndrome
Hot flash, sweating/hyperhydrosis, increased muscle rigidity, dyskinesia, hypertension, increased hr, dilated pupils
SSRIs drugs
Fluoxetine (Prozac) Paroxetine Fluvoxamine Citalopram Escitalopram Sertraline (Zoloft) Dapoxetine
NRIs indication
ADHD narcolepsy Obesity Antidepressant Anxiety
NRIs drugs
Reboxetine
Atomoxetine
SSNRIs indication
MDD OCD ADHD Anxiety Chronic neuropathic pain Menopausal symptoms
Not responding to SSRI
Types of SSNRIs
Venlafaxine; low dose = SSRI, high dose = SSNRI
Duloxetine
Milnacipran
Receptor antagonists (antidepressants)
Nefazodone (5-HT2a)
Trazodone (5-HT)
Mirtazapine and mianserine (5-HT2a); highly sedative
Vortioxetine (5-HT reuptake inhibitor, 3a and 7 antagonist, 1b and 1a agonist)
Agomelatine (M1 and M2 agonist)
Tianeptine (AMPA, NMDA)
