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Psychopharmacology > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

How long does it take for symptoms to improve when an antidepressant is diagnosed? What should be done if symptoms do not improve?

A

Delay of 3-6 weeks after a therapeutic dose is reached before symptoms improve.

If no improvement is seen after prescription of an adequate dose for at least two months then the treatment should be switched to another agent or augmented with one

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2
Q

What are the classes of antidepressant?

A

Tricyclics (TCAs)

Monoamine Oxidase Inhibitors (MAOIs)

Selective Serotonin Reuptake Inhibitors (SSRIs)

Serotonin/Noradrenaline Reuptake Inhibitors (SNRIs)

Novel antidepressants

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3
Q

What is the mechanism behind tertiary TCAs?

A

Act on serotonin receptors

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4
Q

What are the side effects of tertiary TCAs?

A

Antihistaminic

Anticholinergic

Antiadrenergic

QT lengthening

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5
Q

What are some examples of tertiary TCAs?

A

Amitriptyline

Clomipramine

Imipramine

Doxepin

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6
Q

When should tertiary TCAs be avoided and why?

A

In high risk suicide patients as they can be taken in overdose

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7
Q

What is the mechanism behind secondary TCAs?

A

Block noradrenaline

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8
Q

What are the side effects of secondary TCAs?

A

Similar to tertiary TCAs but less severe

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9
Q

What are some examples of secondary TCAs?

A

Desipramine

Nortriptyline

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10
Q

What is the mechanism behind monoamine oxidase inhibtors?

A

Binds irreversibly to monoamine oxidase, preventing inactivation of amines (norepinephrine, dopamine, serotonin) and so increases synaptic levels

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11
Q

What are the side effects of monoamine oxidase inhibitors?

A

Antiadrenergic side effects

Antihistaminic side effects

Dry mouth

Sleep disturbance

Hypertensive crisis if eating tyramine rich foods (cheese, red wine, processed meats, beans)

Serotonin syndrome

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12
Q

What are some examples of monoamine oxidase inhibitors?

A

Phenelzine

Tranylcypromine

Selegiline

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13
Q

In what situation is a monoamine oxidase inhibitor most effective?

A

Treatment resistant depression

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14
Q

What mechanism is behind selective serotonin reuptake inhibitors?

A

Blocks presynaptic serotonin uptake

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15
Q

What are the side effects of selective serotonin reuptake inhibitors?

A

GI upset (most often nausea)

Sexual dysfunction

Anxiety

Restlessness

Nervousness

Insomnia

Fatigue/sedation

Dizziness

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16
Q

What are some examples of selective serotonin reuptake inhibitors?

A

Paroxetine

Sertraline

Fluoxetine

Citalopram

Escitalopram

Fluvoxamine

17
Q

What are the symptoms of SSRI discontinuation syndrome?

A

Agitation

Nausea

Disequilibrium

Dysphoria

Usually lasts 7-10 days

18
Q

What is the mechanism behind serotonin/norepinephrine reuptake inhibitors (SNRIs)?

A

Inhibits both serotonin and noradrenergic reuptake like TCAs

19
Q

What are some examples of SNRIs?

A

Venlafaxine

Duloxetine

20
Q

What are the possible uses of SNRIs?

A

Depression

Anxiety

Neuropathic pain

21
Q

What is the mechanism behind mirtazapine?

A

Different mechanism of action may provide good augmentation for SSRIs

Can be used as hypnotic at lower doses

22
Q

What are the side effects of mirtazapine?

A

Increases serum cholesterol

Sedative at low doses

Weight gain

23
Q

What are the side effects of buproprion?

A

Seizure risk at high doses

Anxiety

Agitation

Insomnia

Psychotic side effects at high doses

24
Q

What are the contraindications of buproprion?

A

Traumatic brain injury

Bulimia

Anorexia

25
Q

What are the symptoms of serotonin syndrome?

A

Abdominal pain

Diarrhoea

Sweats

Tachycardia

Hypertension

Myoclonus

Irritability

Delirium

26
Q

What are the potential complications of serotonin syndrome?

A

Hyperpyrexia

Cardiovascular shock

Death

27
Q

How is serotonin syndrome prevented?

A

Wait for two weeks when switching from an SSRI to an MAOI, with the exception of fluoxetine where you need to wait for five weeks due to the long half-life

28
Q

What is activation syndrome and when does it occur?

A

Activation syndrome occurs when serotonin increases in the brain and can cause nausea and increased levels of anxiety.

Usually goes away after a few days of prescription but can be prolonged.

29
Q

How is antidepressant prophylaxis given?

A

Following first episode- 6 months prophylaxis

Following second episode- 2 years prophylaxis

Following third episode- lifelong prophylaxis

30
Q

How is treatment resistant depression managed?

A

Generally- change SSRI to SNRI then add to SNRI

Combination of antidepressants

Adjunctive treatment with lithium

Adjunctive treatment with atypical antipsychotic (Quetipaine, olanzapine, aripiprazole)

Electroconvulsive therapy

Psychopharmacology (4 decks)

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