Antidepressants Flashcards
How long should one wait to evaluate a response to antidepressants?
6-8w
Give examples of SSRIs
Fluoxetine Citalopram Escitalopram Paroxetine Sertraline Fluvoxamine
Give examples of SNRIs
Venlaxafine
Desvenlafaxine
Duloxetine
Give examples of TCAs
Amitryptiline
Imipramine
Desipiramine
Give examples of MAOIs
Tranylcypromine
Moclobemide (RIMA)
Give examples of NDRIs
Bupropion
Give examples of SARIs
Trazadone
Give examples of NASSAs
Mirtazapine
Give examples of NRIs
Reboxetine
Atomoxetine
Name 8 drug classes classified as antidepressants
SSRIs SNRIs NDRIs NRIs TCAs/TDAs MAOIs RIMAs SARIs NaSSAs MAs
What does SSRI stand for?
Selective serotonin reuptake inhibitor
What does SNRI stand for?
Serotonin-norepinephrine reuptake inhibitor
What does TCA stand for?
Tricyclic antidepressant
What does MAOI stand for?
Monoamine oxidase inhibitors
What does NDRI stand for?
Norepinephrine-dopamine reuptake inhibitor
What does SARI stand for?
Serotonin antagonist and reuptake inhibitor
What does NaSSA stand for?
Noradrenergic and specific serotonergic antidepressants
What does NRI stand for?
Norepinephrine reuptake inhibitor
What kind of drug is reboxetine?
NRI
What kind of drug is trazadone?
SARI
What kind of drug is bupropion?
NDRI
What kind of drug is mirtazapine?
NaSSA
What kind of drug is atomoxetine?
NRI
What kind of drug is fluoxetine?
SSRI
What kind of drug is venlafaxine?
SNRI
What kind of drug is citalopram?
SSRI
What kind of drug is paroxetine?
SSRI
What kind of drug is tranylcypromine?
MAOI
What kind of drug is imipramine?
TCA
What kind of drug is sertraline?
SSRI
What kind of drug is duloxetine?
SNRI
What kind of drug is amitryptiline?
TCA
What kind of drug is deipramine?
TCA
What kind of drug is moclobemide?
MAOI
Give examples of antidepressant therapy
Cognitive behavioural therapy Interpersonal psychotherapy Psychodynamic psychotherapy Electroconvulsive therapy (ECT) Transcranial magnetic stimulation (TMS) Deep brain stimulation (DBS)
What kind of drug is alprazolam?
Benzodiazepine
Give options of drugs for ovulation suppression
GnRH analogue
Danazol
Transdermal estradiol patches
Selected OCP
Which drug class does maprotiline belong to?
Tricyclic antidepressants (TTADs?)
Danazol in the luteal phase is ineffective for PMDD
True or false?
True
What does RIMAs stand for?
Reversible inhibitors of monoamine oxidase
What does MAs stand for?
Melatonin agonists
Give the dose for fluoxetine
20-60mg po mane
Give the dose for paroxetine
20-50mg po mane
Give the dose for citaopram
20-40mg po mane
Give the dose for escitaopram
10-20mg po mane
Give the dose for sertraline
50-200mg po mane
Give the dose for fluvoxamine
50-150mg po bd
Name common side effects of SSRIs
Sexual dysfunction N+V Diarrhoea Headache Insomnia
1st line treatment for MDD?
SSRis
2nd line treatment for MDD?
SNRIs
NDRIs
TADs
For MDD augmentation, resistance and prominent pain symptoms
Give the dose for venlafaxine
75-300mg po mane
Give the dose for desvenlafaxine
50-400mg po mane
Give the dose for duloxetine
60-120mg po mane
Name common side effects of SNRIs
GIT discomfort Sexual dysfunction Sedation Hypotension Headache Dry mouth
Explain the role of NRIs in depression
Mostly ineffective as antidepressant
For augmentation in MDD
Give the dose for reboxetine
4-5mg po bd
Name the common side effects of NRIs
Urinary hesitancy Constipation Headache Nasal congestion Perspiration Dry mouth Dizziness Decreased libido Insomnia
Explain the role of NRIs in MDD
Mostly ineffective as antidepressant
For augmentation in MDD
Give the dose for bupropion
150-300mg po mane
Name the common side effects of NDRIs
Headache
Insomnia
Nausea
Which antidepressant carries the risk of lethal arrythmia with overdose?
TADs
Explain the role of NDRIs in MDD
Augmentation
Prominent hypersomnia and fatigue
Sexual dysfunction
Give the dose for clomipramine
10-250mg po nocte
Give the dose for imipramine
10-200mg po nocte
Give the dose for trimipramine
30-300mg po nocte
Give the dose for lofepramine
140-210mg po nocte
Give the dose for maprotiline
75-200mg po nocte
Name the most common side effects of TADs
Anticholinergic
Sedation
Orthostatic hypotension
Cardiac arrythmias
Name anticholinergic side effects
Constipation
Urinary retention
Dry mouth
Blurred vision
Give the dose for tranylcipromine
5-100mg po bd
Give the dose for moclobemide
75-300mg po bd
Which antidepressant class can cause tyramine-induced hypertensive crisis?
MAOIs
RIMAs
Give examples of tyramine-containing foods
Aged cheese Fish Biltong Marmite Sauerkraut Beer Chiati wine Liquer
Explain the role of NaSSAs
1st/2nd line
Augmentation
Prominent insomnia
Give the dose for mirtazapine
15-45mg po nocte
Name common side effects of NaSSAs
Sedation
Weight gain
Increased appetite
Dry mouth
Explain the role of NaSSAs in MDD
1st/2nd line
Augmentation
Prominent insomnia
Name common side effects of NaSSAs
Sedation
Weight gain
Increased appetite
Dry mouth
Explain the role of SARis
Mostly ineffective in MDD
Prominent insomnia
Give the dose for trazadone
75-300mg po bd
Name the common side effects of SARIs
Sedation Orthostatic hypotension Dizziness Headache Nausea
What is the role of MAs in MDD?
Prominent insomnia
Give examples of MAs
Agomelatine
Give the dose for agomelatine
25-50mg po nocte
Name common side effects of MAs
Dizziness
Nausea
Give the dose for vorioxetine
5-20mg po daily
Name the most common side effects of vortioxetine
Constipation Nausea Vomiting Serotonin syndrome Abnormal bleeding Hyponatremia
What is the most common drug combination that causes serotonin syndrome
SSRI + MAOI OR lithium
Name the symptoms of serotonin syndrome as they appear
- DIarrhoea
- Restlessness
- Extreme agitation, hyperreflexia, autonomic instability
- Myoclonus, seizures, hyperthermia, uncontrollable shivering, rigidity
- Delirium, coma, status epilepticus, CVS collapse
- Death
Give pharmacological treatment options for serotonin syndrome
Nitroglycerin Cyproheptadine Chlorpromazine Dantrolene BZDs Anticonvulsants
Which drugs most commonly cause discontinuation syndrome?
SSRIs
Short half life eg paroxetine
Give the symptoms of discontinuation syndrome
Dizziness Weakness Nausea Rebound depression Anxiety Insomnia Poor concentration Headache Migraine-like Parasthesias URT symptoms
When do discontinuation syndrome symptoms appear and resolve?
6 weeks after discontinuation
Resolve after 3 weeks
Which drug is best if patient was on an SSRI before presenting with discontinuation syndrome and why?
Fluoxetine
Long half life