antidepressants and mood stabilizers Flashcards
5 classes of antidepressants
1) SSRI = block 5HT presynap reuptake
2) SNRI = block 5-HT and NE reuptake
3) TCAD = block reuptake of 5-HT, NE , DA, and block muscarinic, H1, cholinergic, alpha1 receptor
4) MAOI = irreversible inhib MAO-A and MAO-B, incr 5-HT and NE
5) other
mechanism of SSRI
pluses
block 5HT presynap reuptake
plus = safe, effective, used in ED, GAD, PTSD, anxiety, panic, OCD, PMDD
minuses of SSRI
drug interaction
acute = diarrhea, nausea, jittery/anxiety, insomnia
long term = sexual decr, cog blurring, weight gain
interaction with P450 inhib
sertraline
what class
SSRI
fluoxetine what class
ssri
citalopram what class
ssri
paroxetine what class
ssri
mechanism of SNRI
pluses
block 5-HT and NE reuptake
more effective, better tolerate than TCAD
safe
SNRI minuses
sexual side effects
sweating
incr diastolic pressure
withdrawal symptom = electric shock + flu
venlafaxine what class
SNRI
TCAD mechanism
pluses
block 5-HT, NE, DA reuptake
block muscarinic, alpha1, H1, cholinergic receptors
time tested
effective esp severe depression
can check blood level
TCAD
minuses
hypotension, orthostasis weight gain sexual side effect 10 day can lethal
MAOI mechanism
pluses
irrev inhib MAO-A and MAO-B incr 5-HT and NE
effective in nonresp patient esp atypical depression
time tested
MOAI minuses
hypotension orthostasis dry mouth, constip, urinary retention sexual side effect weight gain
TYRAMINE = HYPERTENSIVE CRISS
Others
mirtazapine mech
pluses
blocks 5-HT2A, 5-HT2C, 5-HT3, alpha2 adrenergic
insomnia, anxiety, low sex side effect
mirtazapine minuses
daytime somnolence, weight gain
Bupropion mechanism
pluses
incr whole body NE, weakly block reuptake of DA
no sex side effect,
weight neutral
equal to SSRI
bupropion
minuses
don’t use when
incr anxiety,
ineffective in panic
inosmnia
incr seizure risk
DON’T USE IN EATING DIOSRDER OR SEIZURE
first line antidepressant
if side effect too much use…
first line = SSRI
if too much side effect = bupropion but don’t use with anxiety
All antidepressants have ___ response rates
ALL COMPARABLE
general timeline of response to antidepressants
8-14 weeks before determine whether works
because need long term change like neurotrophic factors + altered gene expression
what is only antidepressant therapy with more rapid side effects
ECT
issues when treating bipolar
more complex than unipolar depression because TREATMENT OF DIFFERENT PHASES must be considered
ideal = anti-manic, antidepressive and prevent futrue episodes
which is easier to treat bipolar mania vs bipolar depression
ex of drugs to treat mania and depression
bipolar mania
only 2 drugs for bipolar depression = quetipaine, lamotrigine, olanzapine + fluoxetine, lithium
antimaniac = lithium, atypical antipsych, divalproex, carbamazepine
