Antidepressants

Question 1

What are the indications for antidepressants?

Answer 1

Unipolar and bipolar depression
Organic mood disorders
Schizoaffective disorder
Anxiety disorders, including
-OCD
-panic
-social phobia
-PTSD
Premenstrual dysphoric disorder
-impulsivity associated with personality disorders

Question 2

What are the general guidelines for antidepressant prescription?

Answer 2

Choose agent based on
-past history of response
-side effect profile
-coexisting medical conditions
3-6 weeks after therapeutic dose achieved before improvement
If no improvement after 2 month at therapeutic dose, switch or augment

Question 3

What are the classifications of antidepressants?

Answer 3

TCAs
SSRIs
SNRIs
MAOIs
Novel

Question 4

Where to tertiary TCAs act?

Answer 4

Mainly serotonin receptors

Question 5

What are examples of tertiary TCAs?

Answer 5

Amitriptyline

Imipramine

Question 6

Where do secondary TCAs act?

Answer 6

Primarily blocking noradrenaline

Question 7

What are examples of secondary TCAs?

Answer 7

Noritriptyline

Desipramine

Question 8

In what type of TCAs are side effects more common?

Answer 8

Tertiary, due to side chain

Question 9

What are the side effects of TCAs?

Answer 9

Antihistaminic- sedation, weight gain
Anticholinergic- dry mouth, blurred vision
Antiadrenergic- orthostatic hypotension, sexual dysfunction
QT lengthening
Lethal in overdose

Question 10

What is the method of action of MAOIs?

Answer 10

Bind irreversible to monoamine oxidase, thereby preventing inactivation of amines, such as serotonin and dopamine

Question 11

What ar the common side effects of MAOIs?

Answer 11

Orthoststic hypotension
Weight gain
Dry mouth
Sedation
Sexual dysfunction
Sleep disturbance
Hypertensive crisis when taken with tyramine rich foods or sympathomimetics (cheese)

Question 12

What is the risk of side effects with MAOIs?

Answer 12

Common and severe

Question 13

What drugs to MAOIs interact with?

Answer 13

Those that increase serotonin- serotonin syndrome

Question 14

What are the signs and symptoms of serotonin syndrome?

Answer 14

Abdo pain
Diarrhoea
Sweats
Tachycardia
HTN
Myoclonus
Irritabiloty
Delorium
Can lead to hyperpyrexia, CV shock and death

Question 15

What is the mode of action of SSRIs?

Answer 15

Block presynaptic serotonin reuptake

Question 16

What are the 2 most common side effects of SSRIs?

Answer 16

GI upset

Sexual dysfunction

Question 17

What are the symptoms of discontinuation syndrome of a SSRIs?

Answer 17

Agitation
Nausea
Disequilibrium
Dysphoria

Question 18

What are some examples of SSRIs>

Answer 18

Sertraline- short half life, few drug interactions
Fluoxeine- long half life
Citalopram- few drug interactions, short half-life
Paroxetine- short half life, good for anxiety

Question 19

What is the mode of action of SNRIs?

Answer 19

Inhibit both serotonin and noradrenergic reuptake

Question 20

What are examples of SNRIs?

Answer 20

Venlafaxine

Duloxetine

Question 21

What are the pros and cons of venlafaxine?

Answer 21

Minimal drug interactions and short half life

Sexual dysfunction and discontinuation syndrome

Question 22

What are 2 novel antidepressants?

Answer 22

Buproprion

Mirtazepine

Question 23

What are the pros and cons of bupropion?

Answer 23

Good augmenting agent
No weight gain, sexual side effects or sedation or cardiac interactions
Seizure risk at high dose

Question 24

What is mirtazepine good for?

Answer 24

Augmenting SSRIs

Question 25

What is the general protocol for antidepressant use?

Answer 25

Start on SSRI

Then move to SNRI