Antidepressants

Question 1

ANTIDEPRESSANTS

Answer 1

• They are mainly used for depression and anxiety.
• It can take up to 4 to 8 weeks (at a high enough dose) for them to take effect.
• May have effects on the baby with pregnancy/breastfeeding.

Question 2

SSRIs

Answer 2

• selective serotonin reuptake inhibitors
• They have general side effects like stomach upset, headache, increased anxiety (early on), and can also cause some sexual side effects, but in general, these are pretty safe medications and are used the most.

Question 3

SNRIs

Answer 3

-serotonin, norepinephrine reuptake inhibitors
-Similar to SSRI’s
-another version to try if SSRI’s don’t appear to be working
side effects similar

Question 4

Other Antidepressants

Answer 4

-Less sexual SE’s

Question 5

TCAs

Answer 5

• tricyclic antidepressants

- Older and have more side effects and so aren’t used much.

Question 6

MAOIs-

Answer 6

• monoamine oxidase inhibitors
• Older and also more side effects and so aren’t used much.
• Atypical depression - overeating, oversleeping, rejection sensitivity, mood reactivity
• They have diet restrictions because certain foods can lead to hypertensive crisis. Avoid foods with tyramine - lots of aged foods
• They can also cause serotonin syndrome when mixed with other medications and this can be fatal.
• more side effects - sedation, VS oversleeping

Question 7

efficacy

Answer 7

equal across large group
individuals may differ
Choose based on: side effects, interactions, past experience

Question 8

Black Box Warning

Answer 8

Suicidality less than 24- SI or behavior
2 vs 4%
NNH 143
Most think benefit outweighs harm
less prescriptions to kids 
bottom line - monitor and discuss with pts

Question 9

Seretonin Syndrome

Answer 9

Mental Status change
VS change
Muscle hyperactivity
avoid combining serotonin agents, especially with MAOIs

Question 10

Paroxetine

Answer 10

Paxil
SSRI
can cause sedation/help with sleep
give at bedtime
anticholinergic properties - memory 
short half-life = w/d

Question 11

Fluoxetine

Answer 11

Prozac 
SSRI
longer half - life of 1 week: help with w/d 
Oldest and well known 
Also used in eating disorders

Question 12

Sertraline

Answer 12

Zoloft
SSRI
Less drug drug interaction
maybe best for women of childbearing age to due lower effects in pregnancy and breastfeeding

Question 13

Citalopram

Answer 13

Celexa
SSRI
Less drug drug interaction
>40 mg, possible heart effects

Question 14

Escitalopram

Answer 14

Lexapro
SSRI
Less drug-drug interaction
S-enantiomer of citalopram

Question 15

“Me Too” Drugs

Answer 15

medications that are very similar 
SSRI
enantiomers or metabolites 
Common in psychiatry
Criticized as for profit

Question 16

Fluvoxamine

Answer 16

Luvox
SSRI
more drug-drug interaction
connection to columbine 
used rarely 
some use with OCD

Question 17

Venlafaxine

Answer 17

Effexor
SNRI
can increase blood pressure

Question 18

Desvenlafaxine

Answer 18

Pristiq
SNRI
can increase blood pressure
“Me Too” active metabolite of venlafaxine

Question 19

Duloxetine

Answer 19

Cymbalta
SNRI
No increased BP
Pain Medications

Question 20

Levomilnacipran

Answer 20

Fetzima
SNRI
Can increase BP 
newer and less evidenced 
used less

Question 21

Mirtazapine

Answer 21

Remeron
"Other Antidepressants"
sedation/help with sleep 
qhs
weight gain

Question 22

Bupropion

Answer 22

Wellbutrin
"other antidepressants" 
smoking cessation
contraindicated seizure or eating d/o
can increase anxiety

Question 23

trazodone

Answer 23

"other antidepressants"
Used mainly for sleep (25 - 100 mg qhs) 
Higher doses antidepressant, but sedating 
priapism - medical emergency 
orthostatic hypotension - get up slowly

Question 24

Nefazodone

Answer 24

“other antidepressants”
rare hepatic failure
used rarely

Question 25

Vilazodone

Answer 25

Viibryd
“other antidepressants”
newer and not used much

Question 26

Vortioxetine

Answer 26

Brintellix
“other antidepressants”
newer and not used much

Question 27

Tricyclic antidepressants

Answer 27

TCAs
Older and not used much
More side effects - sedation, VS, heart, anticholinergic
Can be lethal in overdose
nortryptiline, desipramine, amitriptyline (Elavil)

Question 28

esketamine

Answer 28

Spravato
NMDA receptor antagonist
FDA approved 2019 
Treatment resistant depression 
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