Antidepressants Flashcards
What is the definition of MDD?
The mental state of excessive sadness characterized by persistently low mood or extensive loss of pleasure and interest
What is the neurotrophic hypothesis centered around for MDD?
BDNF
What is the monoamine hypothesis centered around for MDD?
5-HT, NE, and DA
Evidently this is the important one to remember
What is the hormonal hypothesis centered around for MDD?
HPA axis and glucocorticoids, hormones in general
What is the prevalence of minor depression versus major?
60 to 25%
What are three characteristics of TCA’s?
Three ring molecular core
Similair to phenothiazines
Most NE reuptake inhibitors-IDK what that means
What do tertiary amine TCA’s do?
Inhibit NE and 5-HT reuptake
What are the 4 tertiary amine TCA’s?
Imipramine
Amytriptyline
Trimipramine
Clomipramine
What does secondary amine TCAs do?
Selectively inhibit NE reuptake inhibitors
What are the two secondary amine TCAs?
Desipramine and nortryptyline-evidently not selective…
Does anticholinergic actions occur more in secondary or tertiary amines?
Tertiary amine have greater
What are TCA’s effects on alpha?
They have anti alpha selectivity for a1 mostly, causing hypotension
What are the side effects of TCAs?
Anti cholinergic- GI specifically Alpha 1 blocker- postural hypotentions Depression to hypomania Cardiac toxicity Weight gain Diaphoresis
What is the antuhypertensive that TCAs interfere with?
Guanethidine
What does TCAs and SSRI combined cause?
Serotonin sydrome
What is the serotonin syndrome triad?
Cognitive-delerium, coma
Autonomic-hypertension, tachycardia, diaphoresis
Somatic-myoclonus, hyperreflexia, tremor
What is the treatment mentioned for serotonin syndrome?
Cyproheptadine
What are two other uses for TCAs?
Enuresis and ADHA
What are the common SSRIs?
Fluoxetine Citalopram Escitalopram paroxetine Sertraline
What the main side effects of SSRIs and SNRIs?
Sexual function and suicide
What are the three SNRIs?
Venlafaxine, desvenlafaxine and duloxetine
What is the one SNRI used for pain related to diabetuc neuropathy and fibromylagia?
Duloxetine
What drug category is trazadone?
5-HT2 antagonist
What drug category is buproprion and mirtazapine?
Unicyclic
Tetracyclic
How does buproprion work
Blocks NE and DA reuptake
How does mirtazapine work?
Presnynaptic a2 autoreceptor antagonist, causing release of NE and 5-HT
What are the non selective MAOI’s?
Phenelzine and tranylcypromine
What are the selective MAOI’s?
Selegiline and rasagiline
What are the food/drug interactions with MAOI’s?
Impaired metabolism of CNS depressants
Increases indirect sympathomimetics-Causes HTN
Tyramine-Hypertensive crisis
What is the newly approved antidepressant?
Esketamine
What are the advantages and indications for esketamine?
Fast onset-just a couple hours or days
For MDD that havent responded to SSRIs
Is lithium onset slow or fast?
Slow
What are the two main mechanisms that lithium does?
Inhibits IP3 and DAG, and inhibits GSK-3
Does lithium have a high or low therapeutic index?
Low
What does lithium toxicity cause?
Tremor, hypothyroidism, diabetes insipidus
What are the DDI with lithium?
Diuretics increae reabsorption of NSAIDS, but not tylenol or aspirin
