Antidepressants Flashcards
What are the 3 big classes of side effects of TCAs?
Antihistaminic
Anticholinergic
Antiadrenergic
What antihistaminic side effects are there of TCAs?
Sedation
Weight gain
What anticholinergic SEs are there?
Dry mouth
Dry eyes
Constipation
What antiadrenergic SE are there?
Orthostatic hypotension
Sexual dysfunction
How do TCAs work?
Side chains that bind to serotonin receptors
What are examples of TCAs?
Amitrytiline
Clomipramine
Imipramine
Doxepin
Heart SE of TCAs?
QT prolongation
What are secondary TCAs?
Metabolites of TCAs
Primarily block noradrenaline
How do monoamine oxidase inhibtors work?
Bind irreversibly to monoamine oxidase
Prevent inactivation of amines
What amines are stopped from being deactivated by MAOIs?
Dopamine
Serotonin
Norepinephrine
What happens with these non-inactivated amines?
They don’t get broken down in the gut and get absorbed to increase levels
Side effects of MAOIs?
Orthostatic hypotension
Sexual dysfunction
Sleep disturbance
Sedation
HYPERTENSIVE CRISIS
SEROTONIN SYNDROME
What causes a hypertensive crisis with MAOIs?
When consumed with tyrosine rich foods
Why does tyrosine cause a hypertensive crisis with MAOIs?
Is also an amine that is sympathomimetic
What must be done when switching an SSRI to a MAOI because of serotonin syndrome?
Must wait 2 - 3 weeks depending on SSRI halflife
Example of a MAOI?
Phenelzine
Name 6 SSRIs?
Sertraline Fluoxetine Paroxetine Citalopram Escitalopram Fluvoxamine
Pros of sertraline?
Weak P450 interactions
Short half life
Less sedating
Cons sertraline?
GI adverse SE
Pros paroxetine?
Short half life
No build up if mania occurs
Cons paroxetine?
CYP2D6 inhibition
Sedation
Weight gain
Pros fluoxetine?
Long half life
Increases energy
Good to use to wean off SSRIs and prevent discontinuation syndrome
What is good about a longer half life in SSRIs?
Less chance of discontinuation syndrome
Cons fluoxetine?
Increased chance of metabolite build up
P450 interactions
MORE LIKELY TO CAUSE MANIA!
Pro citalopram?
Low P450 interaction
Longer half life than fluoxetine
Cons citalopram?
LONG QT
Sedation
GI effects
Pros fluvoxamine?
Analgesic properties
Cons fluvoxamine?
Short half life
Headache
Strong inhibitor of CYPs
4 SNRIs?
Venlafaxine
Duloxetine
Mirtazipine
Bupropion
How do SNRIs work?
Inhibit reuptake of serotonin and noradrenaline
Pros venlafaxine?
No P450 activity
Good renal clearance
- Better for geriatrics
Cons venlafaxine?
Increased BP
Bad discontinuation syndrome
QT prolongation
Pros duloxetine?
Good for physical symptoms of depression
Smaller BP increase than venlafaxine
Cons duloxetine?
CYP inhibitor
Study indicated high drop out rate
Pros mirtazipine?
Good augmentation with SSRI
Hypnotic
Less sexual SE
Cons mirtazipine?
Hella weight gain
Increased cholesterol and TAGs
Very sedating at low doses
Pros bupropion?
Good augmentation
No weight gain
Low mania chance
Good in ADHD
Cons bupropion?
LOWERS SEIZURE THRESHOLD
Does not treat anxiety
Pharma regimen for treatent resistant depression?
SSRI + SNRI
+ Lithium
+ antipsychotic
ECT
