Antidepressants and Mood Stabilizers Flashcards
Recognize the different classes of antidepressants and general ideas about mechanism of action.
SSRIs = block 5HT pre-synaptic reuptake pump SNRIs = block 5HT AND NE reuptake pumps TCAs = block reuptake of 5-HT and NE, (and, to lesser extent, DA), as well as H1, muscarinic cholinergic receptors and α-1 MAOIs = irreversibly inhibit MAO-A and MAO-B --> increase levels of 5-HT and NE others = Buproprion, Mirtazapine, Trazodone and nefazodone, Vilazodone, VNS, DBS, TMS
What are the 3 phases of treatment for mood disorders?
acute tx
continuation phase
maintenance phase
What are these drugs: fluoxetine paroxetine sertraline citalopram escitalopram fluvoxamine vilazodone
SSRIs
What are these drugs: venlafaxine desvenafaxine duloxetine milnacirin levoilnaciprin
SNRIs
What are these drugs: amitryptiline nortriptyline desipramine imipramine doxepin trimipramine protriptyline amoxapine
TCAs
What are these drugs: phenelzine selegeline tranylcypromine isocarbxazid
MAOIs
Why would you choose a TCA?
very effective
severe depression
can monitor blood levels
fewer SEs
Why would you avoid a TCA?
hypotension orthostasis dry mouth constipation weight gain sexual dysfunction DANGEROUS IN OD- give short supply
Name the drug class, based on its SEs: hypotension orthostasis dry mouth constipation weight gain sexual dysfunction DANGEROUS IN OD- give short supply
TCAs
Why would you choose an MAOI?
effective in non-responsive pts
atypical depression
Why would you avoid using an MAOI?
hypotension orthostasis dry mouth constipation urinary retention sexual dysfunction weight gain HYPERTENSIVE CRISIS- TYRAMINE RXN
Name the drug class, based on its SEs: hypotension orthostasis dry mouth constipation urinary retention sexual dysfunction weight gain HYPERTENSIVE CRISIS- TYRAMINE RXN
MAOIs
Why would you choose an SSRI?
safe, effective
also for anxiety, panic, OCD, PTSD, premenstrual dysphoric disorder
Why would you avoid SSRIs?
diarrhea nausea jitteriness/anxiety SEXUAL DYSFUNCTION drug interactions: P450 INHIBITION
Name the drug class, based on its SEs: diarrhea nausea jitteriness/anxiety SEXUAL DYSFUNCTION drug interactions: P450 INHIBITION
SSRIs
What is the best studied, best proven drug for bipolar disorder?
lithium
Describe the general timeline of response to antidepressants.
takes weeks to work (4-16 weeks)
Discuss issues around treatment of bipolar disorder.
bipolar = 3 phases: manic, depressive, and future episodes
NO drugs truly work in all 3 phases
Mania tx is effective but not so much bipolar depression
Describe basic medication strategies for treating bipolar mania and depression.
PT will likely be taking several (3) drugs at once
mania = everything EXCEPT lamotrigine and olanzapine + fluoxetine (Symbyax) depression = ONLY olanzapine + fluoxetine (Symbyax), quetiapine, and lurasidone
What drugs for bipolar disorder are NOT effective for the mania?
lamotrigine
olanzapine + fluoxetine (Symbyax)
What drugs for bipolar disorder DO treat the depression?
olanzapine + fluoxetine (Symbyax)
quetiapine
lurasidone
What are the following drugs useful for in the tx of bipolar disorder?
olanzapine + fluoxetine
quetiapine
lurasidone
bipolar depression
What drugs for bipolar disorder are effective for maintenance?
lithium
lamotrigine
aripiprazole
olanzapine
What are the following drugs useful for in the tx of bipolar disorder? lithium lamotrigine aripiprazole olanzapine
maintenance
What drugs for bipolar disorder are effective for relapse prevention?
lithium
olanzapine
What are the following drugs useful for in the tx of bipolar disorder?
lithium
olanzapine
relapse prevention
Do you prescribe antidepressants for bipolar depression?
NO
What is the mechanism of action of Buproprion (Wellbutrin)?
increases whole-body NE, weakly blocks reuptake of DA
What is the mechanism of action of Mirtazapine?
blocks 5-HT2A, 5-HT2C, 5-HT3, α-2-adrenergic receptors
This drug increases whole-body NE and weakly blocks reuptake of DA.
Buproprion (Wellbutrin)
This drug blocks 5-HT2A, 5-HT2C, 5-HT3, and α-2-adrenergic receptors.
Mirtazapine
This drug’s most potent action is blockade of post-synaptic 5-HT2, and it blocks reuptake of 5-HT and NE.
Trazodone and nefazodone
What is the mechanism of action for Trazodone and nefazodone?
blockade of post-synaptic 5-HT2, and it blocks reuptake of 5-HT and NE
How does Vilazodone work?
an SSRI + 5HT1A partial agonist
Name the drug that is an SSRI + 5HT1A partial agonist.
Vilazodone
What are the positive and negatives to using Buproprion (Wellbutrin)?
\+ = NO sexual dysfunction, NO weight gain, activating - = increased anxiety, jitteriness, ineffective for panic disorder, insomnia, HIGH SZ RISK, contraindicated in EATING DISORDERS
Name the drug:
+ = NO sexual dysfunction, NO weight gain, activating
- = increased anxiety, jitteriness, ineffective for panic disorder, insomnia, HIGH SZ RISK, contraindicated in EATING DISORDERS
Buproprion (Wellbutrin)
What are the positive and negatives to using Mirtazapine?
\+ = Helpful with insomnia, rapid anti-anxiety effect, LOW SEXUAL DYSFUNCTION - = Daytime somnolence, WEIGHT GAIN
Name the drug:
+ = Helpful with insomnia, rapid anti-anxiety effect, LOW SEXUAL DYSFUNCTION
- = Daytime somnolence, WEIGHT GAIN
Mirtazapine
