Antidepressants Flashcards
Medical Conditions That May Cause Depression
Hypothyroidism Pregnancy/post-partum Perimenopause Diabetes CNS Parkinson’s,Alzheimer’s MS Epilepsy CV,CVA),(CAD CHF IBS AIDS RA Fibromylagia Cancer
Medications/Substances That May Cause Depression
rawal (chronic use)
CV Agents Clonidine Resperine Propranolol(beta blockers) Sedative Hypnotics ETOH Barbiturates Hormonal Therapy Steroids (prednisone) Oral contraceptives Tamoxifen Interferon Isotretinoin Keppra Efavirenz Varenicline Stimulant withd
Norepinephrine (NE) Effects
mood (depression), beta1
attention (post-syn alpha2)
Limbic: agitation, emotions, energy level
Cerebellum: tremor
Brainstem: BLOOD PRESSURE
Spinal cord: heart rate (beta1) or bladder (alpha1)
Other: Erectile function
Use with caution with CV disease
Serotonin (5HT) effects
> 12 subtypes
Frontal-regulate mood
Basal ganglia: control movements (akathesia, agitation), obsessions and compulsions (5HT2A)
Limbic area: anxiety and panic (5HT2A and 5HT2C)
Hypothalamus: appetite and eating behavior (bulimia) (5HT3)
insomnia (5HT2A)
Spinal cord: sexual dysfunction (orgasm and ejaculation)
Brain stem vomiting center: nausea and vomiting (5HT3)
Gut: appetite, GI motility (cramps, diarrhea)
Serotonin deficiency syndrome
may include depression, anxiety, panic, phobias, obsessions, compulsion, food craving
Dopamine (DA) effects
Psychomotor activation
Anti-Parkinson effect
Psychosis aggravation
Antidepressants
Selective serotonin reuptake inhibitors (SSRIs)
-opram, xetine, xamine, traline
citalopram (Celexa)- QT heart. most tolerable escitalopram (Lexapro) fluoxetine (Prozac)- long 1/2 fluvoxamine (Luvox)-not ok paroxetine (Paxil)-ANTIACH, wt gain sertraline (Zoloft)
MOA: Inhibition 5-HT transporter in the neurons of (Block the reuptake of serotonin)
leads to an INCREASE in the synaptic cleft
DOC
Tricyclic antidepressants (TCAs)norepinphrine and serotonin
-pramine, -tyline, -apine, -xepin Tertiary Amines: amitriptyline (Elavil)-ANTIACH clomipramine (Anafranil) doxepin (Silenor) imipramine (Tofranil)-ANTIACH protriptyline (Vivactil)
Secondary Amines:
desipramine (Norpramin)- ANTIACH
nortriptyline (Pamelor)-ANTIACH
amoxapine (generic only)
MOA-unknown Pain indications High SE NO Elderly Narrow TI OD lethal, sucideal-15d
Serotonin norepinephrine reuptake inhibitors (SNRI)
-done, -pran, xine, tine, iline
venlafaxine (Effexor)
desvenlafaxine (Pristiq)-metabolite of ven
duloxetine (Cymbalta)- dec. dose renal
levomilnacipran (Fetzima)- CYP34a drug interaction
MOA- blocks reuptake of serotonin and NE
Dopamine & Norepinephrine Reuptake Inhibitor
bupropion (Wellbutrin, Zyban, Aplenzin)
smoking cessation
less sex dysfx
Monoamine oxidase inhibitors (MAOIs)
-line, -omine,-zine, zid selegiline (Emsam) tranylcypromine (Parnate) phenelzine (Nardil) isocarboxazid (Marplan)
MOA- inhibit degradtion of NE, 5HT and DA
Dont use w/in 2 wks of d/c serotonin (fluoxeetin 5wks)
Serotoin syndrome
ADE- CV, CVB, Liver/Kidney
FATAL hypertensive
AVoid tyramine- aged foods
Antidepressants
Receptor Antagonist Effects
Muscarinic (ACh)
Blurry vision Dry mouth Tachycardia Constipation Urinary retention Cognitive impairment (elderly) AVOID Elderly
Receptor Antagonist Effects
Histamine (H)
Sedation Weight gain Hypotension CNS sedative potentiation of antihypertensives, sedatives Cognitive impairment (elderly)
Antidepressants
Receptor Antagonist Effects
Alpha-1
Orthostatic hypotension Dizziness Reflex tachycardia Anti-Hypertensive medication potentiation Sedation
Antidepressants
Receptor Antagonist Effects
5HT2a, c
Vasodilation (dec BP) Anxiolytic-dec anxiety Insomnia Anti-depression Anti-hallucinatory
SSRI indications
MDD GAD PTSD OCD - fluvoxamine Panic disorder PMDD Bulimia Pain disorders
SSRI ADE
nausea,
sexual dfx
Dry mouth, headache, insomnia, sedation, diarrhea, constipation
Less common
Akathesia, anxiety/agitation, increased sweating, bruxism
Rare
Serotonin syndrome
Discontinuation syndrome**: SSRI
Ideal to taper over 7-10 days
1-7 days after d/c
Fluvoxamine worse
Fluoxetine-lease
Flu like symptoms, vivid dreams, tremor, dizziness, crying nausea, poor concentration, sensory disturbance
Others no class
maprotiline (Ludiomil)
vilazodone (Viibryd)
vortioxetine (Trintellix)
Serotonin syndrome
combining 5HT agents MAOI+ anxiety shivering diaphoresis-sweat mania hyperreflexia Gi Confusion ANS instability or DEC BP and HR
mirtazapine (Remeron)
ANTIACH (NASSAS)
block autorecpetor Inc NE and 5HT
Sedation Wt gain
Nefazodone (Serzone)
Rare liver dysfx
no wt gain, sex, agitation
potent 3A4 inhib- many drug interactions
trazodone (Desyrel, Oleptro ER)
Sedation- used for insomina
-no dependence
Priopism-painful erection
Sucical ideation
All TCAs
SSRI
others
Risk hign <24yo
DEMENTIA
AVOID
TCA
ANTIach
ASTHMA
AVOID
MAOIS- interfer w/ sns bronchodialators
CV DISEASE
AVOID TCA ECT bupropion SSRIs
MAOI
AVOID
TCA
ANTIach
EPILESY
AVOID
TCA
burpropion
NARROW ANLGE GLUACOMA
AVOID
TCA
ANTIach
BLOOD PRESSURE
Dec BP TCA trazadone nefazadone MAOIs
INCrease BP
Venofaxine
Levomicopran
INSOMINIA
SEDATION PROPERITES nefazadone trazondone paroxetine mertazapine
ANXIETY
nefazadone
mertazapine
SSRI
Decreased energy melancholy
bupropion
despramine
venalfaxine
Tips for pat
Be patient Long onsert >6week must reach optimal dose 67% respond 33% dont REsponese >50% dec s/s, NO REPSONSE SWITCH
Remision- sx fee <7 Ham-d
Treatment resistant >1 failed treatment (inc chronic, 2-3x relapse, Inc risk of mortality
TCA d.c synddrome
lethargy, na, HA, GAD, sleep, akathisia, parkinson
cholerngeic rebound
Tape Needs
NO
fluextein
bupropion
Yes
TCA
SPCVEN
