Antidepressants Flashcards
Depression is due to
Decreased NE, 5-HT, and/or dopamine
Monoamine oxidase inhibitors
3rd line treatment for depression after SSRI/TCA
Increase all 3 amines: NE, 5-HT and DA
Phenelzine
Nonselective MAO inhibitor
Tranylcypromine
Nonselective MAO inhibitor
Food and dru interaction with MAO
Tyramine rich food
Can cause hypertensive crisis when combined with drugs that increase NE
Can cause serotonin crisis when combined with drugs that increase serotonin
TCA
2nd line agent for tx of depression
Block NE and 5-HT
Also block H1, a1 and M receptors
Used for resistant depression
Blocking of M receptors with TCA causes
Classic anticholinergic activity: cardiotoxicity, convulsions, coma
Imipramine
TCA used for enuresis
Clomipramine
TCA used for OCD
SSRI is better for OCD though
Amitriptyline
TCA used for neuropathic pain and migraine
SSRI
First line agent for tx of depression, panic, GAD, bulimia, OCD, PTSD
Fewer autonomic side effects
6 SSRI’s
Fluoxetine Fluvoxamine Paroxetine Sertraline Citalopram Escitalopram
Adverse affects of SSRI
GI upset, anorgasmia, stimulant effect (insomnia, headache, anxiety, agitation), bleeding, weight gain, increased ADH leading to hyponatremia
What should you give initially when prescribing an SSRI
Benzodiazepine due to anxiety and agitation
Serotonin syndrome
Rigidity, hyperthermia, hypertension, autonomic instability, myoclonus, confusion, coma, death
Treat serotonin syndrome with
Benzos, intubation and 5-HT antagonist (Cyproheptadine)
SNRI
No autonomic side effects
No H1 blockade
Trazadone
Serotonin 2A antagonist and reuptake inhibitors
Also block a1 receptors: cause decreased BP, arrhythmias, and priapism
Can also act as a sedative
Mirtazapine
a2 antagonist
Increases NE release
Blocks H1 causing sedation
Associated with weight gain–good for anorexia
SSRI used to treat
GAD, PTSD, Depression, OCD
SNRI can specifically treat
Pain disorder such as diabetic neuropathic pain or fibromyalgia
Withdrawal of SSRI abruptly can cause
Flu like symptoms
Side effects of TCAs
anticholinergic, cardiotoxicity, coma, convulsions, weight gain and increased appetite, decreased libido and anorgasmia
Selegiline
MAO-B inhibitor causing breakdown of dopamine–can be used for treatment of parkinson’s
