Antidepressants and Mood Stabilizers 2

Question 1

Anticholinergic effects

Answer 1

-TCAs!!! (desipramine is least)

Question 2

drowsiness

Answer 2

-TCAs!!

Question 3

orthostatic hypotension

Answer 3

• TCAs!! (nortriptyline least)
• SARA’s- trazodone +++
• MAOIs

Question 4

QTc prolongation

Answer 4

• TCAs!!

- SARAs- trazodone

Question 5

wt gain

Answer 5

• TCAs!!

- SARAs- mirtazapine ++++

Question 6

sexual dysfxn

Answer 6

• SSRIs!!
• TCAs (except amoxapine, desipramine, nortriptyline)
• MAOIs (except selegiline)

Question 7

general antidepressant efficacy- 5 R’s

Answer 7

• response= 50% reduction in sx’s (not well, just better)- partial response is >25% reduction, <50%
• remission= sx free
• recovery- 2-6 months of remission
• relapse- return of sx’s AFTER remission but b/f recovery
• recurrence- return of sx’s after recovery

Question 8

general antidepressant efficacy- goal

Answer 8

• remission/recovery

- if a pt doesnt respond after 8 wks- switch to a diff moa

Question 9

all antidepressants are assoc w?

Answer 9

• withdrawal syndrome!!- slow titration downward is recommended
• sx’s- dizziness, HA, nervousness, nausea, insomnia, flu-like aches

Question 10

Mood stabilizers

Answer 10

(tx for bipolar pts)

• Antiseizure agents- carbamazepine, lamotrigine, divalproate/valproic acid
• Lithium

Question 11

Lithium- moa

Answer 11

• inhibits calcium-dep and depolarization-provoked release of NE and DA- inhibits R blockers and substances that stim/inhibit G-prot syn/actions
• interfere w Gs and Gi- keep them in inactive state

Question 12

Lithium- SE’s

Answer 12

Lithium- SE’s

-polyuria (polydipsia)- clinical picture of Nephrogenic Diabetes Insipidus!!

Question 13

Lithium- polyuria

Answer 13

monovalent ion

• handled by kidneys similar to Na/K
• Li+ competes w Na for kidney reabs
• chronic Li+ ingestion can lead to resistance to ADH, resulting in polyuria/polydipsia

Question 14

Lithium- drug interactions

Answer 14

w other agents impacting Na/K

• diuretics (thiazides)
• ACEIs (lisinopril)
• NSAIDs
• narrow therapeutic agent

Question 15

Lithium- indications

Answer 15

• acute and maintenance tx of mania/bipolar disorder

- augmentation in unipolar depressive pts w inadequate response to antidepressant tx

Question 16

Mood Stabilizers (Anti-seizures) agents

Answer 16

• carbamazepine- MAJOR CYP450 inducer!!!
• valproic acid/divalproex
• lamotrigine